Document Type

Journal Article

Publication Title

Public Health Nutrition


Cambridge University Press


School of Medical and Health Sciences / Institute for Nutrition Research




North-West University

South African National Research Foundation (SANRF)

Population Health Research Institute

South African Medical Research Council (SAMRC)

North West Province Health Department

South African Netherlands Partnerships in Development

Novo Nordisk Fonden Challenge Programme: Harnessing the Power of Big Data to Address the Societal Challenge of Aging [NNF17OC0027812] (HTC)


Ferreira, M., Cronjé, H. T., van Zyl, T., Bondonno, N. P., & Pieters, M. (2022). The association between an energy-adjusted dietary inflammatory index and inflammation in rural and urban Black South Africans. Public Health Nutrition, 25(12), 3432-3444.



To quantify the inflammatory potential of the diet of rural and urban Black South Africans using an adapted energy-adjusted dietary inflammatory index (AE-DII) and to investigate its relationship with inflammatory and cardio-metabolic disease risk markers. Dietary inflammatory potential has not been investigated in African populations.


Cross-sectional investigation.


Rural and urban sites in the North West province of South Africa.


1,885 randomly selected, apparently healthy Black South Africans older than 30 years.


AE-DII scores ranged from -3.71 to +5.08 with a mean of +0.37. AE-DII scores were significantly higher in men (0.47±1.19) than in women (0.32±1.29), and in rural (0.55±1.29) than urban participants (0.21±1.19). Apart from its dietary constituents, AE-DII scores primarily associated with age, rural-urban status and education. Contrary to the literature, alcohol consumption was positively associated with AE-DII scores. Of the four tested inflammatory and 13 cardio-metabolic biomarkers, the AE-DII was only significantly negatively associated with albumin and high-density lipoprotein cholesterol, and positively with waist circumference and fasting glucose, upon full adjustment.


Rural men consumed the most pro-inflammatory diet, and urban women the least pro-inflammatory diet. The diet of the participants was not overtly pro- or anti-inflammatory and was not associated with measured inflammatory markers. The inflammatory potential of alcohol at different levels of intake requires further research. Understanding dietary inflammatory potential in the context of food insecurity, unhealthy lifestyle practices and lack of dietary variety remains limited.



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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.