Introduction

Worldwide, life expectancy is increasing and the number of older adults who identify as 65 years of age or older continues to increase day by day. With the increase in the older adult population all over the world, aging has become a global phenomenon rather than an individual problem. The increase in chronic diseases, disability and frailty with aging is a priority of public health [1]. Acute inflammation is a beneficial physiological response to stress situations [2] and is necessary to protect against harmful environmental agents and bacterial and viral infections [3]. It contributes to the elimination of threats and the repair of resulting tissue damage. In contrast, a persistent disturbance in tissue homeostasis causes chronic inflammation, a process linked to various human pathologies [2].

The generation of inflammatory mediators is referred to as the "inflammatory response," and it is regulated by activating negative feedback mechanisms, such as the release of cytokines that are anti-inflammatory, blocking proinflammatory signaling cascades, and stimulating regulatory cells. On the other hand, inappropriate, excessive or untimely production of inflammatory mediators damages the organism and diseases occur [4]. Excessive or chronic inflammatory reactions can typically damage the organism and are involvedin the pathogenesis of various persistent diseases such as atherosclerosis, cancer, obesity, metabolic syndrome (MetS), asthma, neurodegeneration, depression, schizophrenia, bipolar disorder [2, 3, 5].

Methods

This study was conducted by searching the databases “PubMed, ScienceDirect, Web of Science and Google Scholar” using the following keywords alone or in combinations: “dietary inflammatory index,” “inflammation,” "anti-inflammatory,” “older adult,” “elderly,” “depression,” “dementia,” “Alzheimer's disease,” “cardiometabolic diseases,” “musculoskeletal diseases,” “cancer,” and “chronic disease.” The subreferences of the selected articles were also researched and examined. This analysis comprised studies published over the last decade that investigated the association between DII and chronic diseases (depression, dementia, Alzheimer's disease, cardiometabolic diseases, musculoskeletal diseases, cancer) in older adults. Thus, the search was narrowed down to between 2015 and 2024. The inclusion criteria for the trials considered factors such as literature review, trial design, research sample, intervention time, data collection, results, and limitations. Special attention was focused on recent studies. The current work has been grounded in research, meta-analyses, and reviews. Narrative synthesis was then undertaken to describe key findings as relevant to the aims of this review.

The Relationship Between Inflammation and Age

Chronic inflammation represents an important phenomenon in aging [1]. An key indicator of the aging process is inflammation, which is defined as a high blood level of inflammatory markers [6]. The decline in immunity parallels the observed increase in systemic levels of proinflammatory molecules in older adults [2]. Elevations in plasma or serum levels of inflammatory mediators, including acute phase proteins and cytokines, are associated with aging [7]. Although high levels of proinflammatory cytokines shape the proinflammatory state associated with aging, the source of chronic low-grade inflammation associated with aging is not yet fully understood [8].

A common feature of aging is cellular senescence, which contributes to the morbidity and comorbidity of numerous age-related illnesses [9]. Cellular senescence is characterised by two important features: the permanent stop of cell growth and the generation of a proinflammatory secretome known as the senescence-associated secretory phenotype (SASP) [3]. Interleukin-6 (IL-6) and other proinflammatory cytokines, as well as a complex mixture of growth factors, proteases, chemokines, and matrix metalloproteinases, make up SASP.SASP-secreting cells respond by opening a self-sustaining intracellular proinflammatory signalling cycle centred around the Nuclear Factor Kappa β (NF-κβ), transforming growth factor-beta (TGF-β), interleukin-1α (IL-1α), IL-6 pathway [3]. DNA damage also sets off SASP and cellular senescence [10]. Inflammation naturally increases with age. Proinflammatory molecules such as IL-6, IL-1β and TNF-α have higher systemic titers in older adults than in younger adults [2]. This causes an increase in the risk of many diseases that limit a person's healthy life span, including dementia, type 2 diabetes (T2DM), insulin resistance, cardiovascular diseases (CVD) and types of cancer [11]. Chronic inflammation with aging is a complex phenomenon. Thus, in older individuals, variations in the expression of proinflammatory genes have been linked to genetic polymorphisms [2]. Senescent cells often avoid apoptosis because they are damaged, non-dividing, and have changed metabolism [9]. Age-related diseases and disabilities are supported by a biological backdrop that is characterized by the persistence of inflammatory stimuli across time [6].

Dietary factors are a key modifiable target for reducing chronic disease risk. Through a variety of pathways, including energy balance, oxidative stress, and intestinal microbiota modification, diet influences the risk of chronic disease. These methods of action are based on the possible proinflammatory or anti-inflammatory characteristics of food patterns and individual food items [5]. Particularly for older people, the dietary plan is crucial for preserving health and lowering rates of morbidity and mortality [12].

Dietary Inflammatory Index

The Dietary Inflammatory Index (DII) is a new tool developed to further investigate the mechanical inflammatory contribution of various dietary components [5] and specifically aims to measure the inflammatory potential of the diet. A diet that is proinflammatory has a higher DII score, whereas an anti-inflammatory diet has a lower DII score. Different cultures and eating patterns employ the same DII scores, which are standardized based on worldwide dietary intakes [13]. DII has been widely used to investigate the relationship between disease and dietary inflammatory potential. This is due to the fact that it is based on dietary nutrient intake as opposed to type of food consumed [14]. There is a direct relationship between certain dietary components and inflammation. Focusing on the overall diet quality rather than analysing individual foods is more appropriate to explain the inflammatory mechanism [15]. The DII consists of 45 nutrient parameters, including nutrients with anti-inflammatory or proinflammatory properties and compounds such as flavanoids. As opposed to specific dietary components, the nutrient matrix, or the intricate interactions between nutrients and compounds inside foods and dietary patterns, DII refers to the study of dietary patterns [5]. Red and processed meat, high-fat dairy, and refined grains are pro-inflammatory and associated with increased levels of C-reactive protein (CRP), IL-6, and fibrinogen. However, whole grains, and green vegetables, anf fruit are associated with low levels of inflammatory markers [13].

A diet higher in anti-inflammatory foods may help lower the risk of disease [16]. Dietary factors can alter the expression of inflammatory genes and the concentration of inflammatory markers in the human body. Both effects are associated with chronic diseases [14]. Anti-inflammatory diets and diets with low inflammation potential are associated with lower risks of non-modifiable diseases such as obesity, T2DM, and CVD [13]. Mechanisms potentially underlying inflammation include genomic instability, cell senescence, primary dysregulation of immune cells, mitochondria dysfunction, microbiota composition changes, and chronic infections [1]. There are several putative paths that could explain the correlation with dietary inflammatory potential and early mortality, even though the exact mechanisms are unknown. Elevated inflammatory potential may increase the amount of inflammatory components such as IL-4, IL-6, IL-10, IL-1β and accelerate the rate of telomere shortening. Proinflammatory diets tend to include ingestion of saturated fats, which are notably linked to a higher risk of cancer and CVD mortality. They may also raise the concentrations of Very Low-Density Lipoprotein (VLDL), Low-Density Lipoprotein (LDL), and Tumor Necrosis Factor-alpha (TNF-α), all of which are linked to a higher risk of mortality [14].

Diseases Associated with DII in Older Adults

Studies on the effects of both acute and chronic inflammation on illness and health emphasize how crucial nutritional status is. Specific foods are known to have strong effects on inflammatory pathways in the body. For this reason, avoiding proinflammatory foods when choosing foods is at the centre of an anti-inflammatory nutrition plan [17].

Neurodegenerative Diseases

Depression

According to the World Health Organization, depression accounts for 4.3% of all diseases globally, making it one of the leading causes of disability worldwide [18]. Depressive symptoms are also common and persistent in older adults. This condition is associated with decreases in physical performance and mortality [19]. The incidence of geriatric depression is higher in those with medical illnesses and those in long-term care [7]. The pathophysiology of depression involves inflammation [18]. Proinflammatory diets may increase risk of depressive symptoms [20]. Cytokines produced in the brain by microglia and other central nervous system cells are important positive modulators of various central nervous system functions, such as maintaining neuroplasticity. Nevertheless, protracted or excessive inflammatory cytokine activity impairs many neuronal functions, such as neurotransmitter signaling and the production, reuptake and release of neurotransmitters. This affects functions related to mood and cognitive processes [21, 22].

In one study, an elevated likelihood of depressive symptoms was linked to higher DII scores, which indicate a diet that is more proinflammatory [23]. An association between dietary inflammation and depression symptoms was discovered in a different investigation.Proinflammatory food consumption has been linked to an increased risk of depression and depressive symptoms [24]. Sánchez-Villegas et al. [25] reported in their study that elevated DII values were linked to depression, and that there was a stronger relationship among participants over 55 years of age and those with cardiometabolic comorbidities. In a cohort study of older persons, based on the DII score, a proinflammatory diet was linked to a higher incidence of depressed symptoms [26]. Bruno Bizzozero-Peroni et al. [27] found a link between the incidence of depression in older persons and a diet high in inflammation. Ruiqiang Li et al. [20] found in their study that the prevalence of depression in individuals over the age of 55 was 23.4%. Older patients with depression have a higher potential for dietary inflammation. Another study reported a strong association between diversified dietary intake, especially anti-inflammatory diets, and depressive symptoms in older adults [28]. It is stated that understanding the biomarkers of stress and inflammation during the aging process, therapeutic and preventive strategies for mood and cognitive issues in later life may be developed [29].

Some studies examining the relationship between DII and depression are summarized in Table 1.

Table 1 Some studies examining the relationship between DII and depression
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Dementia and Alzheimer's Disease

The immune system's erratic behavior combined with inflammatory food habits may make cognitive decline more likely. But the exact processes by which inflammatory eating patterns may affect the onset of cognitive decline in older adults remain unclear [30]. Systemic inflammation is an important driver of cognitive decline in older adults [31]. It has been reported that a diet with proinflammatory properties is associated with poorer cognitive functions later in life and a higher risk of cognitive impairment or dementia [32]. Semantic, working, and episodic memory deficiencies were linked to higher DII scores [33]. It is noted that many of the proteins found in an inflammatory diet are also affiliated with the risk of dementia, and are connected with plasma biomarkers of neurodegeneration and the pathophysiology of Alzheimer's disease (AD) [30]. Higher DII scores may be associated with increased risk of dementia, indicating that individual-specific and targeted dietary interventions could benefit the development of strategies aimed at primary prevention of dementia [34]. Patients with AD are susceptible to many complications including increased inflammatory markers and oxidative damage, mortality, microvascular disease, dyslipidaemia and insulin resistance [35]. In a large cohort study, it was observed that the risk of all-cause dementia increased with increasing DII levels [36]. In another prospective cohort study, an association was found between high DII scores and the incidence of all-cause dementia and AD. It has been observed that individuals with a proinflammatory dietary habit and a high AD genetic risk score have a higher risk of AD [37]. Inflammatory dietary burden was associated with links to cognitive decline in older individuals over 60 years of age [38]. The Mediterranean diet, a dietary pattern rich in anti-inflammatories, has been associated with better cognition and lower incidence of dementia [39]. A dietary pattern rich in fruits, leafy green vegetables, fish, nuts, and olive oil is associated with a slowdown in cognitive decline and a reduced risk of dementia [40].

The depletion of estrogen post-menopause predisposes women to cognitive decline due to increased risk of chronic inflammation. In a study conducted on postmenopausal women, individuals adhering to a proinflammatory diet were found to have a higher likelihood of cognitive impairment compared to those adhering to an anti-inflammatory diet [41]. It has been reported that individuals with vascular dementia tend to consume deep-fried foods and full-fat dairy products more frequently and engage in less physical exercise. These patients also exhibit a higher prevalence of dyslipidemia, with increased intake of saturated fats, trans fats, and cholesterol being implicated in elevating the risk of dementia. However, higher consumption of fish and DHA has been associated with a lower risk of vascular dementia and cognitive decline [42].

Some studies examining the relationship between DII and Dementia and Alzheimer's disease are summarized in Table 2.

Table 2 Some studies examining the relationship between DII and Dementia and Alzheimer's
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In conclusion, proinflammatory diets may be linked to an increased risk of dementia and depression, while inflammatory diets may raise the risk of age-related cognitive decline and dementia. More in vivo, in vitro, animal and human clinical and epidemiological studies are needed to examine the effect of anti-inflammatory nutrition on cognition to gain a deeper comprehension the relationship between neurodegenerative diseases and DII, to emphasize its relationship with nutrition and to make generalizations.

Cardiometabolic Diseases

Populations at high risk of cardiometabolic disease constitute a significant proportion of the world [43]. Cardiometabolic disorders are a group of interrelated conditions and risk factors that include a range of health problems such as diabetes, obesity, stroke, CVD, hypertension, dyslipidemia, MetS [44]. Especially the older adult population is at the center of attention in terms of cardiometabolic diseases [44]. A high inflammatory diet is linked with MetS, hypertension, hyperglycaemia, abdominal obesity and hypertriglyceridemia. An increase in the DII is associated with a higher incidence of abdominal obesity and hyperglycemia in overweight individuals. Increased body mass index (BMI), weight growth, and the likelihood of becoming obese have all been linked to higher DII scores [45], which are related to chronic low-grade inflammation both locally in the systemically and gut [46]. Proinflammatory diet has been directly associated with high levels of proinflammatory markers such as IL-1β, IL-6, TNF-α and CRP [47]. In a study conducted on men, a significant increase in the DII scores with increasing age has been demonstrated. DII has been shown to have positive correlations with age and obesity indices, suggesting that diet may play a role in the emergence of obesity in older adults through inflammatory modulation mechanisms [48]. It has been discovered that people who follow a diet pattern with a higher DII score accumulate more fat overall, in their visceral adipose tissue, and in their liver [49]. In a cohort study examining individuals aged 20–90 years, among those with a normal BMI range, a proinflammatory diet measured by high DII scores was linked to a higher risk of CVD mortality in individuals with central obesity [50]. In metabolically unhealthy overweight/obese people, a proinflammatory diet was found to raise the risk of cardiovascular and all-cause mortality in a study utilizing NHANES data [15]. Another study found that a proinflammatory diet increased the risk of all-cause mortality in adults with abdominal obesity or overweight/obesity [51]. It is assumed that the relationship between obesity and inflammation is bidirectional. In a study involving an eight-year follow-up, the risk of developing overweight or obesity was found to be lower in individuals with anti-inflammatory diets than in individuals with proinflammatory diets [52]. Rather from being the cause of T2DM and obesity, chronic inflammation is a result of both [53]. Additionally, there is a positive correlation between DII and the prevalence of central obesity in postmenopausal women and hyperglycemia in males [54]. The pathogenesis of T2DM and CVD is linked to chronic systemic inflammation, which is characterized by inflammatory cytokine levels that are consistently elevated in the blood. In a study involving adults, the risk of MetS increased 1.28-fold in individuals following a proinflammatory diet [55].

Higher amounts of cytokine release in the blood stream of fat tissue in obese individuals with MetS and higher CRP production in the liver explain the relationship between MetS and CRP [56]. According to another cohort study, higher DII scores were associated with an increased risk of MetS. Significantly higher intake of flavan-3ols, flavonols, tea, isoflavones, polyunsaturated fatty acids, onions, fiber, folate, protein, as well as vitamins A, C, E, B1, B2 and B6, which are associated with a more inflammatory diet lower MetS has been associated with the risk [56]. Components of MetS are associated with subclinical inflammation and DII [57]. In a meta-analysis, although proinflammatory and anti-inflammatory diets were not associated with the risk of MetS, DII was found to be associated with the risk of CVD and all types of mortality [58]. Individuals adhering to a proinflammatory diet have a 38% higher risk of developing CVD [59].

In a prospective cohort study conducted in France, it was discovered that people with high DII scores had an increased risk of developing MetS following a 12.4-year follow-up period [60]. Numerous research have looked into the connection between DII and MetS, but findings are inconsistent [54, 57, 58, 60]. In a longitudinal study, six months following bariatric surgery, a proinflammatory diet at first was linked to lower decreases in body weight and body fat as well as inferior nutritional quality (reduced consumption of vegetables, fruits and legumes) [45]. Another meta-analysis shows that a high DII scores are linked to higher BMI and obesity [61]. In the NHANES study, participants with chronic heart disease (CHD) were found to have significantly higher DII scores compared to those without CHD. Additionally, it was observed that women are more sensitive to DII [62].

Some studies examining the relationship between DII and cardiometabolic disease are summarized in Table 3.

Table 3 Some studies examining the relationship between DII and cardiometabolic disease
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Unhealthy dietary habits lead to chronic systemic inflammation, which is a key characteristic of metabolic diseases. Evidence suggests that reducing dietary inflammation may potentially decrease the risk of cardiometabolic diseases and associated mortality. However, evidence regarding the relationship between DII and conditions such as obesity, diabetes and MetS is conflicting and inconsistent. Owing to the small sample sizes in many studies, more case–control and prospective studies are needed to understand the association between DII and cardiometabolic diseases and to make generalizations about its association with nutritional status.

Musculoskeletal Health

The most common bone diseases among adults and older adults are osteoporosis and osteomalasia [67]. It's feasible that dietary inflammation and nutrients directly affect the mineralization of bone [16]. The impact of an inflammatory diet on fractures is little understood, despite the fact that nutrition can be a source of inflammation [68]. Research indicates that increased levels of inflammation are linked to bone loss and fracture risk, and that these levels may be lowered with dietary interventions [68, 69]. High DII score is also associated with decreased bone mineral density [70]. In a study, it was observed that women with high DII scores had a significantly higher risk of bone fractures [68]. Individuals with high intake of proinflammatory nutrients and low intake of anti-inflammatory nutrients have a higher risk of sarcopenia [71]. In a meta-analysis, it was reported that high DI increased the risk of sarcopenia [72]. In older adult men, a more proinflammatory diet is connected to the lumbar spine and lower hip bone mineral density, as well as a higher incidence of fractures and falls. Conversely, in women, a more proinflammatory diet is associated with higher lower extremity muscle quality and a lower risk of fractures [12]. Fang et al. [73] reported that higher DII scores were associated with lower bone mineral density in the lumbar spine and total hip, as well as increased risk of osteoporosis and fractures. Conversely, the Mediterranean diet, which is anti-inflammatory in nature, has been shown to have positive effects on hip fracture risk and lumbar spine bone mineral density in older adults [74].

A negative correlation between DII and bone mineral density was obtained when DII > 0.35 in patients with chronic kidney disease. The bone mineral density of the femur and femoral neck decreases with increasing DII score [75]. Postmenopausal women are in a high risk group for the development of osteoporosis because they experience rapid bone loss with hormonal changes [67]. Postmenopausal women with higher DII scores have been found to be associated with a more proinflammatory dietary pattern, which in turn is correlated with low bone mineral density [15]. In a study, it was observed that an increasing DII score, indicating a proinflammatory diet, is a risk factor for low bone mineral density in the lumbar spine [76]. Women with lower DII scores, which suggest a less inflammatory dietary pattern, were linked to decreased bone mineral density loss in another study involving postmenopausal women [69]. In another study conducted with postmenopausal women revealed that an increase in DII score is a risk factor for osteoporosis [77].

A significant association has been found between adherence to the Mediterranean diet and a lower risk of hip fracture [78]. In another study, higher DII scores were found to be associated with lower bone density, increased risk of falls, and higher incidence of fractures in older adult men [12]. In a case–control study in older adults, a proinflammatory diet was positively associated with hip fracture risk [79]. Veronese et al. [80] found that participants with a more proinflammatory diet and higher DII score had a significantly higher prevalence of radiographically symptomatic knee osteoarthritis. In another study, a more proinflammatory diet was associated with a higher incidence of fractures in women, while the findings were not significant in men [68]. There was no correlation found by the Brazilian Osteoporosis Study between DII scores and low-impact fractures [81]. In another study, no significant relationship was found between DII and bone health in postmenopausal women [67]. Zhao et al. [82] found that higher DII scores were associated with an increased risk of osteoporosis in women, while no association was found in men. A study conducted with 794 men, with an average age of 81.1 years, found that a proinflammatory diet increased the concentrations of inflammatory markers IL-6, IL-7, and TNF-a, as well as the risk of falls [12]. A meta-analysis revealed that poorer skeletal muscular strength, mass, and sarcopenia risk were strongly correlated with the increased dietary inflammatory potential correlated with high DII [83].

Results from individual, observational and longitudinal cohort studies have shown that a proinflammatory diet has negative effects on fracture risk [12, 68, 69], bone mineral density [15, 69, 84], osteoporosis [67] and sarcopenia [71, 72]. High DII scores have also been associated with frailty [85].

However, there are discrepancies in the literature regarding the relationship between DII and bone health. Further studies are needed to better understand the relationship between DII and musculoskeletal health.

Some studies examining the relationship between DII and musculoskeletal health are summarized in Table 4.

Table 4 Some studies examining the relationship between DII and musculoskeletal health
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Cancer

Inflammation is considered a crucial factor in carcinogenesis. It is thought that a major factor in the carcinogenesis of inflammation-related disorders may be stem cell-induced oxidative and nitrosative DNA damage. DNA damage can lead to mutations and may play a role in initiating and/or supporting inflammation-mediated carcinogenesis [87]. Inflammation-induced reactive oxygen and nitrogen species harm not just DNA but also other macromolecules like proteins and lipids, leading to their malfunction. Roughly 25% of cancer-causing factors are caused by infection, and mutagenic DNA lesions are a hallmark of malignancies connected to inflammation [88]. Chronic inflammation is known to be a risk factor for cancers in various regions [87]. Diet is a significant source of bioactive compounds that have the potential to interact with chronic inflammation. This can result in the growth of cells, mutagenesis, suppression of apoptosis, and the release of mediators that may encourage the malignant transformation of cells and the development of cancer [89]. There is a linear dose–response relationship between DII and overall cancer risk [90]. Higher DII scores have been linked to a higher incidence of breast cancer [91]. It has been shown that among obese participants, a greater DII is linked to an increased risk of gynecological cancers, particularly ovarian and endometrial cancer [89]. According to the results of a meta-analysis, a more proinflammatory diet is associated with increased risk of prostate cancer, kidney cancer, and bladder cancer. However, there is no association between DII and urothelial carcinoma [92]. The consumption of diets with higher proinflammatory potential has been linked to an increased risk of colorectal cancer in obese people, according to new research [93]. It has been emphasized that as DII scores increase, the risk of prostate cancer also increases and promoting diets rich in anti-inflammatory nutritional components may help prevent prostate cancer [94]. In case–control studies conducted by Shivappa et al. proinflammatory diet, indicated by higher DII scores, was associated with an increased risk of bladder [95], esophageal squamous cell [96], mouth and pharynx [97], laryngeal [98], ovarian cancers [84] and non-Hodgkin lymphoma [99]. In another study, men exhibiting higher DII scores and premenopausal women showed increased incidence risks of prostate and breast cancer, respectively. Furthermore, a favorable correlation has been noted between women's breast cancer risk and their BMI and DII score [100]. A case–control study has shown that a proinflammatory diet is associated with an increased risk of esophageal squamous cell carcinoma [101].

Some studies examining the relationship between DII and cancer are summarized in Table 5.

Table 5 Some studies examining the relationship between DII and cancer
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Studies conducted in various populations from different countries have shown consistent relationships between DII scores and a wide range of cancer types. Further case–control, clinical, and high-quality prospective studies are needed to better understand the relationship between DII and different types of cancer.

Conclusion

Inflammation is an important factor for pathophysiologies associated with aging such as depression, cognitive performance and decline, carcinogenesis, and bone mineralization. Studies indicate that higher DII scores, which reflect a more proinflammatory diet, are associated with an increased risk of certain cancers, neurodegenerative diseases, cardiometabolic diseases, musculoskeletal diseases and related mortality, and the relationship of dietary inflammation in the pathophysiology of these diseases. Figure 1 summarizes the findings related to certain diseases and the DII in older adults. Figure 1 summarizes the findings related to certain diseases and the DII in older adults. Particularly in the older adult population, emphasizing the benefits of a more anti-inflammatory dietary plan is highlighted to reduce disease risks and mortality. Proinflammatory diets have been linked to an increased risk of cancers, neurodegenerative, cardiometabolic, musculoskeletal, and other diseases in older adults. To better understand the relationship between DII and neurodegenerative diseases, to emphasize its relationship with nutrition, and to make generalizations, more in vivo, in vitro, animal, human clinical, and epidemiological studies are needed to examine the effects of anti-inflammatory nutrition on diseases common in older adults.

Fig. 1
figure 1

Summary of findings regarding certain diseases and DII in older adults

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Suggestions and Future Perspective

Although studies involving adults are more prevalent, research involving older adults and DII is more limited. It is known that chronic inflammation increases with aging. Diet is one of the factors affecting inflammation. In the light of these investigations, the topics of anti-inflammatory nutrition and DII for the treatment of inflammation-related diseases in older adults are strong and open to development topics of discussion. Despite the significant interest in the potential positive effects of anti-inflammatory nutrition on diseases, contributing to clearer evidence of its protective effects on health necessitates further randomized controlled trials, in vivo, in vitro, cell, animal, human and case–control studies for better risk assessment. It is beneficial to explain the importance of the Mediterranean diet to individuals in order to protect and improve their health across all life stages, ensuring adequate and balanced nutrition, and providing nutrition education and guidance to ensure its sustainability. To assess the reliability and effectiveness of the excessively consumed anti-inflammatory diets (DII used to examine the effectiveness of this diet) and to clarify and strengthen current evidence due to conflicting data regarding the prevention of inflammation-related diseases, longer-term studies are beneficial.

Limitations

This review is based on the analysis of studies found in the literature and therefore the limitations of the study are limited to the scope of the sources reviewed. Most of the studies examined are observational studies, and such studies inherently have limitations in determining causal relationships. Although the findings presented in this review provide a general framework, they are insufficient to determine the role of individual lifestyle factors and genetic variations in the relationship between inflammation and chronic diseases. The lack of studies to evaluate the effectiveness of an anti-inflammatory nutrition plan, especially in the older adult population, and the lack of more data on the feasibility and sustainability of these nutritional strategies are also important limitations.

Key References

4. • Furman D, Campisi J,  Verdin E,  Carrera-Bastos P,  Targ S,  Franceschi C,  et al. Chronic inflammation in the etiology of disease across the life span. Nature Medicine. 2019. https://doi.org/10.1038/s41591-019-0675-0.

This article provides an in-depth look at the structure of cronic iflammation and its effects on health.

55. •• Li R, Zhan W, Huang X, Zhang Z, Zhou M, Bao W, et al. Association of dietary inflammatory index and metabolic syndrome in the elderly over 55 years in Northern China. British Journal of Nutrition. 2022. https://doi.org/10.1017/S0007114521004207.

This article summarizes dietary inflammatory index in the elderly over 55 years.