A posteriori dietary patterns are related to C-reactive protein levels: results from a systematic review and meta-analysis
Objective: Given the small effects of single nutrients, evaluating the relationships between cardiovascular disease risk factors and dietary patterns may be particularly useful. An increasing number of studies in recent years are investigating the association of dietary patterns with C-reactive protein (CRP) levels. This systematic review and meta-analysis examined the association between a posteriori derived dietary patterns and CRP levels in adults.
Methods: PubMed and Scopus were searched for articles published up to March 2015 that examined the association of total diet and CRP levels among adults. Two independent reviewers performed the study selection, quality rating, and data extraction process. Effect sizes of eligible studies were pooled by using random-effects models. Heterogeneity was tested using I2 statistic.
Results: Overall, 16 cross-sectional and 4 case-control studies that used a posteriori approach were considered for the meta-analysis and were eligible for inclusion. The comparison of the highest and lowest categories of healthy/prudent patterns revealed a significant decrease in CRP (mean difference (MD): -0.23; 95% CI: -0.40 to -0.056; p = 0.006) when other lifestyle factors were controlled for, although there was heterogeneity in the studies. Pooled results indicated higher levels of CRP (MD: 0.16; 95% CI: 0.15 to 0.23; p < 0.001) in the highest category of unhealthy/Western pattern compared with those in the lowest category, though there was significant heterogeneity.
Conclusion: The results of the present meta-analysis provide evidence that a healthy/prudent pattern decreases CRP level, while adherence to unhealthy/Western pattern leads to a higher level of CRP in adults.
2. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107(3):363-9.
3. Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. Jama. 2001;286(3):327-34.
4. Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R. Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation. 2005;111(11):1448-54.
5. Guo L, Liu S, Zhang S, Chen Q, Zhang M, Quan P, et al. C-reactive protein and risk of breast cancer: A systematic review and meta-analysis. Scientific reports. 2015;5:10508.
6. Barinas-Mitchell E, Cushman M, Meilahn EN, Tracy RP, Kuller LH. Serum levels of C-reactive protein are associated with obesity, weight gain, and hormone replacement therapy in healthy postmenopausal women. American journal of epidemiology. 2001;153(11):1094-101.
7. Tracy RP, Psaty BM, Macy E, Bovill EG, Cushman M, Cornell ES, et al. Lifetime smoking exposure affects the association of C-reactive protein with cardiovascular disease risk factors and subclinical disease in healthy elderly subjects. Arteriosclerosis, Thrombosis, and Vascular Biology. 1997;17(10):2167-76.
8. Laimer M, Ebenbichler C, Kaser S, Sandhofer A, Weiss H, Nehoda H, et al. Markers of chronic inflammation and obesity: a prospective study on the reversibility of this association in middle-aged women undergoing weight loss by surgical intervention. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity. 2002;26(5):659-62.
9. Tchernof A, Nolan A, Sites CK, Ades PA, Poehlman ET. Weight loss reduces C-reactive protein levels in obese postmenopausal women. Circulation. 2002;105(5):564-9.
10. Fung TT, McCullough ML, Newby P, Manson JE, Meigs JB, Rifai N, et al. Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2005;82(1):163-73.
11. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. Jama. 2004;292(12):1440-6.
12. Lopez-Garcia E, Schulze MB, Meigs JB, Manson JE, Rifai N, Stampfer MJ, et al. Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction. The Journal of nutrition. 2005;135(3):562-6.
13. Ervin RB. Healthy Eating Index scores among adults, 60 years of age and over, by sociodemographic and health characteristics: United States, 1999-2002. Advance data. 2008(395):1-16.
14. Qi L, Van Dam RM, Liu S, Franz M, Mantzoros C, Hu FB. Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Diabetes Care. 2006;29(2):207-11.
15. De Bacquer D, Clays E, Delanghe J, De Backer G. Epidemiological evidence for an association between habitual tea consumption and markers of chronic inflammation. Atherosclerosis. 2006;189(2):428-35.
16. Mozaffarian D, Pischon T, Hankinson SE, Rifai N, Joshipura K, Willett WC, et al. Dietary intake of trans fatty acids and systemic inflammation in women. Am J Clin Nutr. 2004;79(4):606-12.
17. Pischon T, Hankinson SE, Hotamisligil GS, Rifai N, Willett WC, Rimm EB. Habitual dietary intake of n-3 and n-6 fatty acids in relation to inflammatory markers among US men and women. Circulation. 2003;108(2):155-60.
18. Brown AA, Hu FB. Dietary modulation of endothelial function: implications for cardiovascular disease. The American journal of clinical nutrition. 2001;73(4):673-86.
19. Slattery ML. Analysis of dietary patterns in epidemiological research. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. 2010;35(2):207-10.
20. Jacobs DR, Steffen LM. Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. The American journal of clinical nutrition. 2003;78(3):508S-13S.
21. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Dietary patterns and markers of systemic inflammation among Iranian women. J Nutr. 2007;137(4):992-8.
22. Nanri A, Yoshida D, Yamaji T, Mizoue T, Takayanagi R, Kono S. Dietary patterns and C-reactive protein in Japanese men and women. Am J Clin Nutr. 2008;87(5):1488-96.
23. Fung TT, Rimm EB, Spiegelman D, Rifai N, Tofler GH, Willett WC, et al. Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. The American journal of clinical nutrition. 2001;73(1):61-7.
24. Eilat-Adar S, Mete M, Nobmann ED, Xu J, Fabsitz RR, Ebbesson SO, et al. Dietary patterns are linked to cardiovascular risk factors but not to inflammatory markers in Alaska Eskimos. The Journal of nutrition. 2009;139(12):2322-8.
25. Picot J, Hartwell D, Harris P, Mendes D, Clegg A, Takeda A. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. 2012.
26. Barbaresko J, Koch M, Schulze MB, Nothlings U. Dietary pattern analysis and biomarkers of low-grade inflammation: a systematic literature review. Nutrition reviews. 2013;71(8):511-27.
27. Egger M, Smith GD, Altman D. Systematic reviews in health care: meta-analysis in context: John Wiley & Sons; 2008.
28. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60.
29. Schulze MB, Hoffmann K, Manson JE, Willett WC, Meigs JB, Weikert C, et al. Dietary pattern, inflammation, and incidence of type 2 diabetes in women. Am J Clin Nutr. 2005;82(3):675-84.
30. Centritto F, Iacoviello L, di Giuseppe R, De Curtis A, Costanzo S, Zito F, et al. Dietary patterns, cardiovascular risk factors and C-reactive protein in a healthy Italian population. Nutr Metab Cardiovasc Dis. 2009;19(10):697-706.
31. Heidemann C, Hoffmann K, Spranger J, Klipstein-Grobusch K, Mohlig M, Pfeiffer AF, et al. A dietary pattern protective against type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)--Potsdam Study cohort. Diabetologia. 2005;48(6):1126-34.
32. Hoffmann K, Zyriax BC, Boeing H, Windler E. A dietary pattern derived to explain biomarker variation is strongly associated with the risk of coronary artery disease. Am J Clin Nutr. 2004;80(3):633-40.
33. Mikkilä V, Räsänen L, Raitakari OT, Marniemi J, Pietinen P, Rönnemaa T, et al. Major dietary patterns and cardiovascular risk factors from childhood to adulthood. The Cardiovascular Risk in Young Finns Study. Br J Nutr. 2007;98(1):218-25.
34. Eilat-Adar S, Mete M, Nobmann ED, Xu J, Fabsitz RR, Ebbesson SOE, et al. Dietary patterns are linked to cardiovascular risk factors but not to inflammatory markers in Alaska Eskimos. J Nutr. 2009;139(12):2322-8.
35. Nettleton JA, Polak JF, Tracy R, Burke GL, Jacobs Jr DR. Dietary patterns and incident cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis 1-3. Am J Clin Nutr. 2009;90(3):647-54.
36. Nettleton JA, Matijevic N, Follis JL, Folsom AR, Boerwinkle E. Associations between dietary patterns and flow cytometry-measured biomarkers of inflammation and cellular activation in the Atherosclerosis Risk in Communities (ARIC) Carotid Artery MRI Study. Atherosclerosis. 2010;212(1):260-7.
37. Nettleton JA, Steffen LM, Schulze MB, Jenny NS, Barr RG, Bertoni AG, et al. Associations between markers of subclinical atherosclerosis and dietary patterns derived by principal components analysis and reduced rank regression in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2007;85(6):1615-25.
38. Nettleton JA, Steffen LM, Mayer-Davis EJ, Jenny NS, Jiang R, Herrington DM, et al. Dietary patterns are associated with biochemical markers of inflammation and endothelial activation in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2006;83(6):1369-79.
39. Lopez-Garcia E, Schulze MB, Fung TT, Meigs JB, Rifai N, Manson JE, et al. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2004;80(4):1029-35.
40. Pierce BL, Austin MA, Crane PK, Retzlaff BM, Fish B, Hutter CM, et al. Measuring dietary acculturation in Japanese Americans with the use of confirmatory factor analysis of food-frequency data. Am J Clin Nutr. 2007;86(2):496-503.
41. Lamichhane AP, Liese AD, Urbina EM, Crandell JL, Jaacks LM, Dabelea D, et al. Associations of dietary intake patterns identified using reduced rank regression with markers of arterial stiffness among youth with type 1 diabetes. Eur J Clin Nutr. 2014;68(12):1327-33.
42. Fung TT, Willett WC, Stampfer MJ, Manson JE, Hu FB. Dietary patterns and the risk of coronary heart disease in women. Arch Intern Med. 2001;161(15):1857-62.
43. Oliveira A, Rodriguez-Artalejo F, Gaio R, Santos AC, Ramos E, Lopes C. Major habitual dietary patterns are associated with acute myocardial infarction and cardiovascular risk markers in a southern European population. J Am Diet Assoc. 2011;111(2):241-50.
44. Labonte ME, Dewailly E, Lucas M, Chateau-Degat ML, Couture P, Lamarche B. Traditional dietary pattern is associated with elevated cholesterol among the Inuit of Nunavik. J Acad Nutr Diet. 2014;114(8):1208-15.e3.
45. Nanri H, Nakamura K, Hara M, Higaki Y, Imaizumi T, Taguchi N, et al. Association between dietary pattern and serum C-reactive protein in Japanese men and women. J Epidemiol. 2011;21(2):122-31.
46. Lee Y, Kang D, Lee SA. Effect of dietary patterns on serum C-reactive protein level. Nutr Metab Cardiovasc Dis. 2014;24(9):1004-11.
47. Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol. 2006;48(4):677-85.
48. Anderson AL, Harris TB, Tylavsky FA, Perry SE, Houston DK, Lee JS, et al. Dietary patterns, insulin sensitivity and inflammation in older adults. Eur J Clin Nutr. 2012;66(1):18-24.
49. Lowe G, Woodward M, Rumley A, Morrison C, Tunstall-Pedoe H, Stephen K. Total tooth loss and prevalent cardiovascular disease in men and women: possible roles of citrus fruit consumption, vitamin C, and inflammatory and thrombotic variables. Journal of clinical epidemiology. 2003;56(7):694-700.
50. Wannamethee SG, Lowe GD, Rumley A, Bruckdorfer KR, Whincup PH. Associations of vitamin C status, fruit and vegetable intakes, and markers of inflammation and hemostasis. Am J Clin Nutr. 2006;83(3):567-74.
51. Ma Y, Griffith JA, Chasan-Taber L, Olendzki BC, Jackson E, Stanek EJ, et al. Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr. 2006;83(4):760-6.
52. Zampelas A, Panagiotakos DB, Pitsavos C, Das UN, Chrysohoou C, Skoumas Y, et al. Fish consumption among healthy adults is associated with decreased levels of inflammatory markers related to cardiovascular disease: the ATTICA study. J Am Coll Cardiol. 2005;46(1):120-4.
53. Santos S, Oliveira A, Lopes C. Systematic review of saturated fatty acids on inflammation and circulating levels of adipokines. Nutr Res. 2013;33(9):687-95.
54. Jacques PF, Tucker KL. Are dietary patterns useful for understanding the role of diet in chronic disease? The American journal of clinical nutrition. 2001;73(1):1-2.
|Issue||Vol 3, No 2 (Spring 2017)|
|C- reactive protein dietary pattern Healthy pattern Western Pattern Un-Healthy patterns|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|