Mediating roles of systemic immune-inflammation index and body mass index in the association between dietary inflammatory index and cardiovascular disease in diabetes

This study aimed to analyze the dietary inflammatory index (DII) and its impact on cardiovascular disease (CVD) in individuals with diabetes and to explore the role of the systemic immune-inflammation index (SII) and body mass index (BMI) in the relationship between DII and CVD. Data were obtained from the National Health and Nutrition Examination Survey 2009 to 2023. A generalized linear model was used to examine the influence of DII on CVD among individuals with diabetes. The mediation effect model was employed to examine the relationship between DII, SII, BMI, and CVD among individuals with diabetes. Among 5068 participants, 1243 (24.53%) had diabetes mellitus (DM) with CVD. DII was a risk factor for CVD among individuals with diabetes (odds ratio = 1.140, 95% confidence interval [CI]: 1.091–1.192, P < .001). BMI partially mediated the relationship between DII and CVD among adults with DM, with an effect coefficient of 0.005 (95% CI: 0.001–0.010). SII partially mediated the relationship between DII and CVD among adults with DM, with an effect coefficient of 0.008 (95% CI: 0.001–0.016). Among adults with DM, we should pay attention to monitoring the level of DII and reducing BMI, which may help reduce the risk of comorbid CVD. Furthermore, the assessment and identification of CVD risk among diabetic patients with a high DII using the SII is crucial.