December 2020 Hot Topic: Pro-Inflammatory Diets and CVD Risk

Chef cooking; zoomed in on vegetables


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Research studies have demonstrated the health benefits of anti-inflammatory dietary patterns, including reduced risk of cardiovascular disease (CVD) and other chronic illnesses.1-3 So how do habitual pro-inflammatory diets impact chronic disease risk? A large US-based cohort study contributes new data to the diet, inflammation, and disease connection with an investigation into the link between pro-inflammatory diets and the risk of developing heart diseases.4

Study Specifics and Statistics

In November 2020, the Journal of the American College of Cardiology published the results of a large prospective study (n=210,145) that used an empirically developed, food-based dietary index to evaluate levels of inflammation induced by a person’s diet.4 The evidence indicated that a dietary pattern with higher inflammatory potential was associated with an increased incidence of total CVD, coronary heart disease (CHD), and stroke in US women and men.4 According to the investigators, the study is among the first to link a food-based dietary inflammatory index with CVD incidence.4

The study followed three cohorts, including:4

  • 74,578 women from the Nurses’ Health Study (1984-2016)
  • 91,656 women from the Nurses’ Health Study II (1991-2015)
  • 43,911 men from the Health Professionals Follow-Up Study (1986-2016)

Every four years during the noted timeframes, the participants’ diets were assessed by food frequency questionnaires. The inflammatory potential of their diets was evaluated using a food-based empirical dietary inflammatory pattern (EDIP) score. This evaluation method had been previously designed based on circulating plasma levels of three systemic inflammatory biomarkers (interleukin-6, TNF-alpha-R2, and C-reactive protein) and those pre-defined food groups most predictive of those biomarkers.4 During the study, EDIP scores were calculated through a process that included the average intake and weighted sum of these predefined food groups. A higher EDIP score indicated a pro-inflammatory diet while a lower score indicated an anti-inflammatory diet.4

Results of the study indicated that:4

  • A higher dietary inflammatory potential, reflected by a higher EDIP score, was significantly associated with an increased risk of CVD across all three cohorts and between sexes.
  • Compared to those consuming anti-inflammatory diets, participants consuming pro-inflammatory diets had a 38% greater relative risk of developing CVD. Similar association trends were observed between EDIP scores and risk of CHD and stroke.
  • Also compared with anti-inflammatory diets, participants consuming pro-inflammatory diets reported higher body mass index (BMI) and lower physical activity, were less likely to take a multivitamin, reported less intake of fruits, vegetables, and whole grains, and were more likely to have a family history of CHD.

In a subset of the study participants (n=33,719), a higher EDIP score was associated with increased circulating inflammatory biomarkers, lower levels of adiponectin, increased plasma triglyceride levels, and a notable reduction in high-density lipoprotein cholesterol.4 Also of note, when reporting results, researchers adjusted for confounders and risk factors, including, but not limited to, age, lifestyle factors, use of anti-inflammatory medications, and CVD risk factors such as higher BMI.4

Going “Green” for Heart Health

Habitual dietary patterns have demonstrated the potential to either harm or protect heart function, and personalized therapeutic treatments such as IFM’s Cardiometabolic Food Plan prioritize the inclusion of anti-inflammatory foods while limiting pro-inflammatory foods in an effort to optimize heart health. A varied intake of colorful fruits, vegetables, and spices, for example, ensures consumption of a range of anti-inflammatory phytochemicals, which contribute to optimal cardiovascular performance.5,6

A new randomized controlled trial (n=294) found that compared to groups following either healthy dietary guidance or a standard Mediterranean diet, the treatment group following a “green” Mediterranean diet for six months (lower in red/processed meat intake, higher in plants and polyphenols, and supplemented with 28g/day of walnuts, three to four cups/day of green tea, and 100g/day of Wolffia globosa, a Mankai duckweed strain, as a green, plant-based protein shake) recorded:7

  • Greater reduction of waist circumference and high-sensitivity C-reactive protein.
  • Greater decrease in low-density lipoprotein cholesterol, diastolic blood pressure, and homeostatic model assessment for insulin resistance.
  • Better improvement in the 10-year Framingham Risk Score.

Research studies continue in order to fully understand the relationships between nutritional habits and the risk of CVD and other chronic disease development, to detail involved inflammatory mechanisms, and to replicate and validate findings across populations.

Related Articles

Nutritional Controversies in Heart Disease: A Functional Medicine Cardiologist’s Perspective

The Right Food Plan for Cardiometabolic Patients

Lifestyle Interventions to Modify Cardiovascular Disease Risk

CVD and Social Determinants of Health


  1. Schulze MB, Martínez-González MA, Fung TT, Lichtenstein AH, Forouhi NG. Food based dietary patterns and chronic disease prevention. BMJ. 2018;361:k2396. doi:10.1136/bmj.k2396
  2. Pérez-Martinez P, Mikhailidis DP, Athyros VG, et al. Lifestyle recommendations for the prevention and management of metabolic syndrome: an international panel recommendation. Nutr Rev. 2017;75(5):307-326. doi:10.1093/nutrit/nux014
  3. Valls-Pedret C, Sala-Vila A, Serra-Mir M, et al. Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Intern Med. 2015;175(7):1094-1103. doi:10.1001/jamainternmed.2015.1668
  4. Li J, Lee DH, Hu J, et al. Dietary inflammatory potential and risk of cardiovascular disease among men and women in the U.S. J Am Coll Cardiol. 2020;76(19):2181-2193. doi:10.1016/j.jacc.2020.09.535
  5. Rees A, Dodd GF, Spencer JPE. The effects of flavonoids on cardiovascular health: a review of human intervention trials and implications for cerebrovascular function. Nutrients. 2018;10(12):1852. doi:10.3390/nu10121852
  6. Ottaviani JI, Britten A, Lucarelli D, et al. Biomarker-estimated flavan-3-ol intake is associated with lower blood pressure in cross-sectional analysis in EPIC Norfolk. Sci Rep. 2020;10(1):17964. doi:10.1038/s41598-020-74863-7
  7. Tsaban G, Yaskolka Meir A, Rinott E, et al. The effect of green Mediterranean diet on cardiometabolic risk; a randomised controlled trial. Heart. Published online November 23, 2020. doi:10.1136/heartjnl-2020-317802