Hesong Wang, Feng Jin, Liang Tian, Guizhi Kang, Yingjie Yang, Ziyu Zhao, Nuo Zhang, Xue Liu, Yongning Huang
Higher CDAI was associated with lower radiologic CRS burden and modestly lower symptom burden among adults with CRS. Exploratory mediation analyses suggested that insulin resistance may partly account for the association between CDAI and radiologic disease burden, with TyG providing supportive evidence as a pragmatic non-insulin surrogate. These cross-sectional findings highlight a potential diet-metabolism relationship in CRS and support further prospective and interventional studies to clarify temporality, causality, and biological significance.
BACKGROUND: Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory sinonasal disease with variable radiologic and symptom burden. Dietary antioxidant capacity and insulin resistance may be related to CRS burden, but their interrelationship remains unclear. This study investigated the association of energy-adjusted composite dietary antioxidant index (CDAI) with CRS burden and explored the potential mediating roles of insulin resistance-related indicators.
METHODS: In this single-center cross-sectional study, we analyzed baseline data from 340 adult patients with clinically diagnosed CRS who were recruited at Huludao Central Hospital. Dietary intake was assessed using 24-h dietary recalls, and the CDAI was calculated by summing standardized values of six energy-adjusted antioxidant nutrients. CDAI was analyzed as tertiles of the CDAI score and as standardized CDAI per 1-SD increment. HOMA-IR was specified as the primary mediator, and the triglyceride-glucose (TyG) index was considered a pragmatic non-insulin mediator. The primary outcome was Lund-Mackay CT score, and the secondary outcome was SNOT-22 score. Multivariable regression, binary sensitivity analyses, exploratory mediation analyses, and subgroup analyses were performed.
RESULTS: Higher CDAI tertiles were associated with lower fasting insulin, HOMA-IR, TyG index, and Lund-Mackay CT score. In fully adjusted models, each 1-SD increment in CDAI was associated with lower Lund-Mackay CT score (β, -0.799; 95% CI, -1.069 to -0.528; p < 0.001) and lower SNOT-22 score (β, -0.979; 95% CI, -1.866 to -0.093; p = 0.031). In exploratory mediation analyses, HOMA-IR accounted for part of the association between CDAI and Lund-Mackay CT score, with an indirect effect of -0.203 and a mediated proportion of 25.4%. TyG showed a smaller indirect component, with an indirect effect of -0.115 and a proportion mediated of 14.4%. Sensitivity and subgroup analyses showed directionally consistent findings.
CONCLUSION: Higher CDAI was associated with lower radiologic CRS burden and modestly lower symptom burden among adults with CRS. Exploratory mediation analyses suggested that insulin resistance may partly account for the association between CDAI and radiologic disease burden, with TyG providing supportive evidence as a pragmatic non-insulin surrogate. These cross-sectional findings highlight a potential diet-metabolism relationship in CRS and support further prospective and interventional studies to clarify temporality, causality, and biological significance.