An empirical dietary inflammatory pattern increases the incidence of the metabolic syndrome in a multi-ethnic Asian population

The rising incidence of the metabolic syndrome (MetS) is a major public health issue, especially in Asian populations. The pro-inflammatory diet might contribute to the development of the MetS. Previous studies have not investigated the association between the Empirical Dietary Inflammatory Pattern (EDIP) and the incidence of MetS prospectively in a multi-ethnic Asian population. This study aimed to; (1) develop and validate the EDIP score adapted to an Asian population (EDIP-A) and (2) investigate its prospective association with MetS incidence using two multi-ethnic Asian cohorts in Singapore. Data from the Multi-Ethnic Cohort Phase 1 baseline (n = 2720) was used to derive the EDIP-A score. Forty food groups were entered into the reduced rank regression (RRR), followed by stepwise linear regression to identify food groups that explained the amount of variation in the two inflammatory biomarkers, high-sensitive C-Reactive Protein (hsCRP) and Glycoprotein Acetylation (GlycA). Validation of the score was done in an independent cohort, Singapore Health 2012 (n = 1269). The association between EDIP-A score and MetS incidence was examined in a longitudinal cohort, the Multi-Ethnic Cohort (n = 2888, median follow-up period: 6.5 years), using multivariable logistic regression. The EDIP-A score was significantly associated with biomarkers hsCRP and IL6 (p < 0.05), demonstrating its validity. A higher EDIP-A score was associated with higher odds of MetS [odds ratio (OR) 1.13 95% CI (1.02, 1.26)] (p < 0.05). A higher EDIP-A score, reflecting a more pro-inflammatory diet, was associated with higher incidence of MetS in a multi-ethnic Asian population.