Decoding the E DII Score: A Comprehensive Guide
Chronic low-grade inflammation is a contributing factor to numerous diseases, including type 2 diabetes, cardiovascular disease, and certain cancers. While many lifestyle factors influence inflammation, diet is a significant and modifiable contributor. The E DII, or Energy-Adjusted Dietary Inflammatory Index, was developed by researchers to quantitatively measure the inflammatory potential of a person's diet. By analyzing the intake of specific nutrients and food components, this score provides a valuable snapshot of how dietary patterns might influence systemic inflammation.
How the E DII Score is Calculated
The E DII score is a powerful metric that synthesizes complex dietary data into a single, interpretable number. Its calculation is a multi-step process that accounts for numerous dietary components and normalizes the results against a global standard to ensure comparability across populations.
- Dietary Assessment: Data on an individual's food and nutrient intake is collected, typically through a food frequency questionnaire (FFQ) or multiple 24-hour dietary recalls. This provides a detailed record of consumed food parameters.
- Standardization: The intake of each dietary component is standardized using a global comparative database. This involves calculating a Z-score by comparing the individual's intake to the global mean intake for that component.
- Proportional Scaling: To produce a symmetrical distribution, each Z-score is converted to a percentile, doubled, and then has one subtracted from it. This centers the scores around zero, with values ranging from -1 to +1.
- Application of Inflammatory Effect Score: Each dietary component is assigned a literature-derived inflammatory effect score, based on its established pro- or anti-inflammatory properties. The scaled percentile is then multiplied by this effect score.
- Energy Adjustment: Unlike the standard DII, the final E DII score is adjusted for total energy intake, often on a per-1000 kcal basis. This minimizes confounding effects from different eating patterns and improves predictive ability. The individual E DII is the sum of all calculated dietary component values.
Interpreting the E DII Score
Interpreting the E DII is straightforward: the score exists on a continuum, with its position indicating the diet's overall inflammatory profile.
- Negative Score (e.g., -5.0): A more negative score indicates a predominantly anti-inflammatory diet. This is associated with higher intakes of anti-inflammatory food components like fruits, vegetables, nuts, and healthy fats.
- Score Near Zero: A score close to zero suggests a diet with a neutral inflammatory potential, balanced between pro- and anti-inflammatory components.
- Positive Score (e.g., +4.0): A higher, more positive score signifies a more pro-inflammatory diet. This is correlated with increased consumption of pro-inflammatory foods such as refined grains, processed meats, and high-fat items.
E DII vs. DII Score: Why Adjust for Energy?
| Feature | E DII Score | DII Score |
|---|---|---|
| Energy Adjustment | Yes, normalized per 1000 kcal | No, based on total intake |
| Confounding Risk | Lower due to energy normalization | Higher; total energy intake can distort results |
| Predictive Ability | Improved predictive ability for health outcomes like diabetes | Less precise; associations may not be statistically significant without energy adjustment |
| Research Use | Preferred for clinical and epidemiological studies to minimize bias | Used in research, but often considered less robust than E DII |
| Scoring Components | Uses fewer components, as total energy is in the denominator | Can utilize up to 45 different food and nutrient parameters |
Health Implications of the E DII Score
Research has increasingly focused on the E DII score's utility as a predictive tool for various chronic diseases. Studies have found associations between a higher, more pro-inflammatory E DII score and:
- Higher risk of incident diabetes.
- Increased body mass index (BMI) and abdominal obesity.
- Higher incidence of cardiovascular mortality.
- Elevated blood pressure, total cholesterol, and triglycerides.
- Increased risk of cancer development, with larger pro-inflammatory shifts in E DII scores over time correlated with higher odds of a cancer diagnosis.
- Higher risk of mental health issues, such as stress and anxiety, among specific populations.
How to Improve Your E DII Score
Improving your E DII score involves shifting dietary patterns toward more anti-inflammatory choices. These changes can have a positive impact on overall health markers.
Anti-inflammatory (Lower E DII Score)
- Fruits and vegetables
- Healthy fats (e.g., omega-3s from fish, olive oil)
- Whole grains
- Legumes and nuts
- Certain spices and herbs (e.g., turmeric, garlic)
- Lean protein sources (fish)
Pro-inflammatory (Higher E DII Score)
- Processed and refined grains
- Processed and red meat
- High-fat dairy
- Sugar and high-energy beverages
- Trans fats and saturated fats
By prioritizing foods with anti-inflammatory properties, individuals can actively work toward lowering their E DII score and potentially reduce their risk of related chronic conditions.
Conclusion
The E DII score offers a robust, research-backed method for quantifying the inflammatory potential of a person's diet. As a modified and improved version of the DII, the E DII's energy adjustment makes it a more reliable tool in epidemiological studies for assessing the diet-inflammation relationship. Interpreting the E DII score as a marker for a pro- or anti-inflammatory diet provides valuable insights into how dietary patterns can impact systemic inflammation and the risk of chronic diseases. For both clinicians and individuals, understanding and utilizing the E DII framework can be a powerful step toward promoting better cardiometabolic and overall long-term health outcomes. It provides a clear, actionable pathway for dietary interventions focused on reducing inflammation and improving health.
Further reading: Energy-Adjusted Dietary Inflammatory Index Is Associated With 5-Year All-Cause and Cardiovascular Mortality Among CKD Patients
Key takeaways
- Energy-Adjusted Assessment: The E DII score is an improved metric over the DII, calculating dietary inflammatory potential while adjusting for total energy intake to enhance accuracy and comparability.
- Score Interpretation: A positive E DII score indicates a pro-inflammatory diet linked to health risks, while a negative score signifies an anti-inflammatory diet associated with better health outcomes.
- Health Correlations: Higher E DII scores are correlated with an increased risk of chronic conditions, including cardiovascular disease, diabetes, obesity, and certain cancers.
- Nutrient-Based Calculation: The score is derived by assessing an individual's intake of specific macro- and micronutrients, as well as food components, and comparing them against a global standard.
- Dietary Modification: Improving the E DII score involves consuming more anti-inflammatory foods like fruits, vegetables, and healthy fats, while reducing pro-inflammatory ones such as processed meats and refined carbohydrates.
- Research Tool: In nutrition and epidemiological research, the E DII is a robust tool for investigating the complex relationships between diet, chronic inflammation, and long-term health.
FAQs
What does E DII stand for? E DII stands for Energy-Adjusted Dietary Inflammatory Index, a quantitative tool used to assess the inflammatory potential of an individual's diet.
How is a high E DII score different from a low score? A high, positive E DII score indicates a predominantly pro-inflammatory diet associated with increased risk of chronic diseases, whereas a low, negative score signifies an anti-inflammatory diet linked to better health.
Is the E DII the same as the DII? No, the E DII is an energy-adjusted version of the DII. By normalizing for total energy intake, the E DII provides a more precise and comparable measure of a diet's inflammatory potential than the standard DII.
What kinds of foods raise the E DII score? Foods that increase the E DII score include processed meats, refined carbohydrates, sugary drinks, and foods high in saturated and trans fats.
What foods can help lower the E DII score? To lower the E DII score, a diet rich in fruits, vegetables, whole grains, nuts, and healthy fats like omega-3 fatty acids is beneficial.
Is the E DII score used in clinical settings? While primarily a research tool, the E DII's insights are clinically relevant. It helps dietitians and healthcare professionals identify dietary patterns that may contribute to chronic inflammation and guide patients toward healthier, anti-inflammatory food choices.
Can an E DII score change over time? Yes, an E DII score can and does change based on dietary habits. A significant shift toward a more pro-inflammatory diet over time has been shown to increase the risk of certain health issues, such as cancer.
