Cognitive impairment, micro and macrovascular complications contribute to the high morbidity and mortality of type 1 diabetes (T1D) in an aging population. The dietary inflammatory index (DII), a validated measure of the inflammatory potential of dietary nutrients, has not been evaluated for its relationship to complications in T1D. To this end, validated semiquantitative food frequency questionnaires were administered at baseline to 591 individuals of the Joslin 50-year Medalist Study (“Medalists”), a well-characterized cohort having ≥50 years of T1D. The DII score was derived for each Medalist as a weighted summary score from 35 nutrients that have been associated with inflammatory markers in literature. A higher score indicated the pro-inflammatory potential of the diet. Logistic and linear regression models were applied to test cross-sectional relationships between the DII and complications. A higher DII was significantly (p<0.05) associated with 1.6 and 1.4 times increased odds of nephropathy (eGFR≤60 ml/min/1.7m2) and neuropathy (MNSI score >2) respectively, independent of glycemic control, diabetes duration, or other confounders. The DII was not associated with baseline self-report history of cardiovascular disease, nor with proliferative diabetic retinopathy (ETDRS >53). In a subset (n=69) who were given a cognitive battery, a higher DII was significantly associated (p=0.02) with worse working memory (Wechsler memory scale) but not with motor skills (Grooved Pegboard), executive function (Delis Kaplan) or immediate or delayed recall (Rey Auditory Verbal Learning Tests). To conclude, in aging adults with chronic T1D, a pro-inflammatory diet is associated with nephropathy, neuropathy and worse working memory, signaling a need for further studies examining diet and inflammation to eventually inform better strategies to lower morbidity in populations with long duration T1D.
H. Shah: None. E. Wolfson: None. M. Yu: None. F. Hu: None. G.L. King: Research Support; Self; Janssen Pharmaceuticals, Inc.
National Institute of Diabetes and Digestive and Kidney Diseases (1DP3DK112192-01, 1DP3DK094333-01); Beatson Pledge Fund