Data Sheet 1_Associations between an inflammatory diet index and nonunion: a prospective study of 172,839 UK biobank participants.csv

PurposesThis study utilizes prospective cohort data from the UK Biobank to investigate the association between the energy-adjusted dietary inflammation index (E-DII) and the development of fracture nonunion.
MethodsIn this study, COX regression was used to analyze the correlation between E-DII and nonunion. Among 172,839 participants free of prior nonunion at baseline, 2,341 (1.4%) developed nonunion during a median follow-up of 14.2 years. E-DII scores, calculated from five separate 24-h dietary recall assessments, were used to quantify dietary inflammatory potential, with higher values indicating pro-inflammatory patterns.
ResultsMultivariable-adjusted analyses revealed that participants with anti-inflammatory dietary patterns (E-DII < −1) exhibited a significantly elevated risk of impaired fracture healing compared to those with pro-inflammatory diets (E-DII > 1), yielding an adjusted hazard ratio (HR) of 1.89 (95% CI: 1.45–3.11). A nonlinear U-shaped dose–response relationship was identified, with the nadir of nonunion risk observed at E-DII values between 0.3 and 1.2. Conversely, values outside this range were associated with progressively higher risks. Transcriptomic profiling identified differential expression of 35 inflammation-related genes—including CD3E and CX3CR1—significantly downregulated in nonunion cases compared to controls. These genes are functionally enriched in pathways governing immune response regulation and leukocyte activation.
ConclusionThese findings propose that a moderately pro-inflammatory dietary pattern may confer protection against impaired bone healing, whereas both strongly anti-inflammatory and excessively pro-inflammatory diets were associated with compromised healing outcomes. Based on these results, tailored dietary strategies designed to optimize inflammatory homeostasis during fracture recovery are recommended to enhance clinical outcomes.

研究目的：本研究利用英国生物样本库（UK Biobank）的前瞻性队列数据，探讨能量调整饮食炎症指数（energy-adjusted dietary inflammation index, E-DII）与骨折不愈合（fracture nonunion）的发生关联。

研究方法：本研究采用Cox回归（COX regression）分析E-DII与骨折不愈合的相关性。基线时无骨折不愈合病史的172839名参与者中，共计2341名（占比1.4%）在中位随访14.2年期间发生骨折不愈合。研究通过5次独立的24小时膳食回顾（24-h dietary recall）计算得到E-DII评分，以此量化膳食炎症潜能，评分越高代表饮食的促炎特征越显著。

结果：多变量校正分析显示，与促炎饮食模式组（E-DII>1）相比，抗炎饮食模式组（E-DII<-1）的参与者骨折愈合受损风险显著升高，校正后风险比（hazard ratio, HR）为1.89，95%置信区间（confidence interval, CI）为1.45~3.11。本研究还识别出非线性U型剂量反应关系，骨折不愈合风险的最低点出现在E-DII值介于0.3至1.2的区间内；超出该区间的E-DII值则与风险逐步升高相关。转录组学分析显示，与对照组相比，骨折不愈合病例体内有35个炎症相关基因存在差异表达，其中包括CD3E与CX3CR1，这些基因在骨折不愈合组中显著下调。经功能富集分析，上述基因显著富集于免疫应答调控及白细胞活化相关通路。

结论：本研究结果表明，中度促炎饮食模式可能对骨愈合受损具有保护作用，而强抗炎饮食与过度促炎饮食均与不良愈合结局相关。基于上述发现，建议采用旨在优化骨折康复期间炎症稳态的个性化膳食策略，以改善临床预后。