Association of Dietary Inflammatory Index and Dietary Oxidative Balance Score with Mortality Among Individuals with Cardiovascular-Kidney-Metabolic Syndrome.

INTRODUCTION: Cardiovascular-kidney-metabolic (CKM) syndrome represents a complex interplay of cardiovascular, kidney, and metabolic disorders. Dietary factors, particularly those with pro-inflammatory and pro-oxidant properties, may influence disease progression and mortality, yet their role in the CKM syndrome population remains underexplored. AIM: To evaluate potential associations of the dietary inflammatory index (DII), the dietary oxidative balance score (DOBS), and mortality in individuals with CKM syndrome. METHODS: A total of 17,317 individuals with CKM syndrome were enrolled and stratified into three groups: stage 0, stages 1-3, and stage 4. DII and DOBS were derived from 26 and 16 preselected dietary components, respectively. Kaplan-Meier analysis, Cox proportional-hazards models, and forest plots were used to examine the associations between dietary scores and mortality across CKM stages. RESULTS: No significant associations were found in stage 0. In stages 1-3 and 4, pro-inflammatory/pro-oxidant diets were associated with increased mortality, with HRs for all-cause, cardiovascular, and non-cardiovascular mortality of 1.46 (1.10-1.94), 1.42 (0.70-2.87), and 1.47 (1.09-1.98) in stages 1-3, and 2.07 (1.33-3.20), 2.20 (1.06-4.59), and 2.01 (1.25-3.24) in stage 4, respectively. CONCLUSIONS: Pro-inflammatory and pro-oxidant dietary patterns, as measured by DII and DOBS, are associated with an increased risk of all-cause and non-cardiovascular mortality in both CKM stages 1-3 and stage 4, and with cardiovascular mortality specifically in stage 4. No significant association with cardiovascular mortality was observed in stages 1-3.