Table 2.
Associations between E-DII scores from diet and incident anxiety outcomes in the UK Biobank.
| Quartile 1 | Quartile 2 | Quartile 3 | Quartile 4 | Ptrend 1 | HRcontinuous
(95% CI) 2 |
Pinteraction-by-sex 3 | |
|---|---|---|---|---|---|---|---|
| Total anxiety disorders 4 | 0.57 | ||||||
| No. of cases/person-years | 722/222,038 | 677/221,840 | 647/221,779 | 739/220,852 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.99 (0.89–1.10) | 1.00 (0.90–1.11) | 1.21 (1.09–1.35) | <0.001 | 1.08 (1.04–1.12) | |
| Model 2, HR (95% CI) 6 | Ref. | 1.00 (0.90–1.11) | 0.99 (0.89–1.10) | 1.12 (1.00–1.25) | 0.04 | 1.04 (1.00–1.08) | |
| Males | |||||||
| No. of cases/person-years | 145/68,717 | 202/90,872 | 218/109,875 | 320/130,288 | |||
| Model 1, HR (95% CI) 5 | Ref. | 1.05 (0.85–1.31) | 0.94 (0.76–1.16) | 1.17 (0.95–1.43) | 0.23 | 1.04 (0.97–1.12) | |
| Model 2, HR (95% CI) 6 | Ref. | 1.05 (0.85–1.31) | 0.94 (0.76–1.17) | 1.08 (0.88–1.32) | 0.95 | 1.00 (0.94–1.07) | |
| Females | |||||||
| No. of cases/person-years | 577/153,321 | 475/130,968 | 429/111,904 | 419/90,564 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.96 (0.85–1.09) | 1.02 (0.90–1.16) | 1.24 (1.09–1.41) | <0.001 | 1.09 (1.04–1.14) | |
| Model 2, HR (95% CI) 6 | Ref. | 0.97 (0.86–1.10) | 1.01 (0.89–1.15) | 1.15 (1.00–1.31) | 0.02 | 1.06 (1.01–1.11) | |
| Phobic anxiety disorders 4 | 0.84 | ||||||
| No. of cases/person-years | 80/224,777 | 84/224,242 | 63/223,988 | 84/223,457 | |||
| Model 1, HR (95% CI) 5 | Ref. | 1.13 (0.83–1.53) | 0.91 (0.65–1.27) | 1.32 (0.96–1.82) | 0.03 | 1.14 (1.01–1.28) | |
| Model 2, HR (95% CI) 6 | Ref. | 1.13 (0.83–1.53) | 0.88 (0.63–1.24) | 1.19 (0.86–1.65) | 0.17 | 1.09 (0.97–1.22) | |
| Males | |||||||
| No. of cases/person-years | 17/69,214 | 20/91,577 | 20/110,589 | 37/131,432 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.90 (0.47–1.72) | 0.76 (0.40–1.46) | 1.21 (0.67–2.18) | 0.18 | 1.15 (0.93–1.43) | |
| Model 2, HR (95% CI) 6 | Ref. | 0.90 (0.47–1.71) | 0.75 (0.39–1.44) | 1.12 (0.61–2.05) | 0.31 | 1.12 (0.90–1.39) | |
| Females | |||||||
| No. of cases/person-years | 63/155,563 | 64/132,664 | 43/113,399 | 47/92,024 | |||
| Model 1, HR (95% CI) 5 | Ref. | 1.20 (0.85–1.70) | 0.96 (0.65–1.41) | 1.32 (0.90–1.95) | 0.10 | 1.12 (0.98–1.29) | |
| Model 2, HR (95% CI) 6 | Ref. | 1.21 (0.85–1.71) | 0.93 (0.63–1.38) | 1.19 (0.80–1.76) | 0.30 | 1.08 (0.94–1.24) | |
| Other anxiety disorders 4 | 0.39 | ||||||
| No. of cases/person-years | 656/222,306 | 605/222,174 | 597/221,994 | 668/221,192 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.97 (0.87–1.09) | 1.01 (0.90–1.13) | 1.20 (1.07–1.34) | <0.001 | 1.07 (1.03–1.12) | |
| Model 2, HR (95% CI) 6 | Ref. | 0.98 (0.87–1.09) | 1.00 (0.89–1.12) | 1.11 (0.99–1.24) | 0.09 | 1.04 (0.995–1.08) | |
| Males | |||||||
| No. of cases/person-years | 130/68,775 | 185/90,943 | 203/109,948 | 286/130,453 | |||
| Model 1, HR (95% CI) 5 | Ref. | 1.08 (0.86–1.35) | 0.98 (0.78–1.22) | 1.16 (0.94–1.43) | 0.43 | 1.03 (0.96–1.11) | |
| Model 2, HR (95% CI) 6 | Ref. | 1.08 (0.86–1.35) | 0.98 (0.78–1.22) | 1.07 (0.86–1.33) | 0.78 | 0.99 (0.92–1.06) | |
| Females | |||||||
| No. of cases/person-years | 526/153,532 | 420/131,231 | 394/112,047 | 382/90,739 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.93 (0.82–1.06) | 1.03 (0.90–1.17) | 1.23 (1.08–1.41) | <0.001 | 1.09 (1.04–1.15) | |
| Model 2, HR (95% CI) 6 | Ref. | 0.94 (0.82–1.07) | 1.01 (0.89–1.15) | 1.14 (0.99–1.30) | 0.03 | 1.06 (1.01–1.11) | |
| Panic disorder7 | 0.99 | ||||||
| No. of cases/person-years | 38/224,913 | 35/224,472 | 44/224,095 | 54/223,694 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.97 (0.61–1.53) | 1.27 (0.82–1.97) | 1.66 (1.09–2.54) | 0.002 | 1.28 (1.10–1.50) | |
| Model 2, HR (95% CI) 6 | Ref. | 0.98 (0.62–1.55) | 1.26 (0.81–1.97) | 1.48 (0.95–2.31) | 0.02 | 1.22 (1.04–1.43) | |
| Males | |||||||
| No. of cases/person-years | 10/69,243 | 12/91,605 | 18/110,630 | 27/131,547 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.92 (0.40–2.13) | 1.18 (0.55–2.56) | 1.57 (0.76–3.24) | 0.07 | 1.26 (0.98–1.61) | |
| Model 2, HR (95% CI) 6 | Ref. | 0.92 (0.40–2.14) | 1.19 (0.54–2.61) | 1.40 (0.66–2.97) | 0.19 | 1.19 (0.92–1.53) | |
| Females | |||||||
| No. of cases/person-years | 28/155,669 | 23/132,867 | 26/113,465 | 27/92,147 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.97 (0.56–1.69) | 1.30 (0.76–2.23) | 1.70 (1.00–2.89) | 0.01 | 1.29 (1.06–1.57) | |
| Model 2, HR (95% CI) 6 | Ref. | 0.98 (0.56–1.70) | 1.28 (0.74–2.20) | 1.53 (0.88–2.67) | 0.04 | 1.23 (1.01–1.51) | |
| Mixed anxiety and depressive disorder 7 | 0.81 | ||||||
| No. of cases/person-years | 65/224,809 | 67/224,381 | 73/223,950 | 96/223,478 | |||
| Model 1, HR (95% CI) 5 | Ref. | 1.08 (0.77–1.53) | 1.23 (0.88–1.73) | 1.71 (1.24–2.36) | 0.001 | 1.22 (1.08–1.37) | |
| Model 2, HR (95% CI) 6 | Ref. | 1.08 (0.76–1.52) | 1.20 (0.85–1.68) | 1.52 (1.09–2.13) | 0.02 | 1.15 (1.02–1.30) | |
| Males | |||||||
| No. of cases/person-years | 17/69,210 | 20/91,595 | 28/110,570 | 43/131,456 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.89 (0.46–1.69) | 1.02 (0.56–1.86) | 1.29 (0.74–2.27) | 0.23 | 1.13 (0.93–1.36) | |
| Model 2, HR (95% CI) 6 | Ref. | 0.87 (0.45–1.66) | 0.97 (0.53–1.78) | 1.08 (0.60–1.94) | 0.74 | 1.03 (0.85–1.26) | |
| Females | |||||||
| No. of cases/person-years | 48/155,598 | 47/132,786 | 45/113,380 | 53/92,023 | |||
| Model 1, HR (95% CI) 5 | Ref. | 1.16 (0.78–1.74) | 1.32 (0.88–1.98) | 1.95 (1.31–2.88) | 0.001 | 1.26 (1.09–1.45) | |
| Model 2, HR (95% CI) 6 | Ref. | 1.17 (0.78–1.76) | 1.31 (0.87–1.98) | 1.81 (1.20–2.73) | 0.01 | 1.22 (1.05–1.41) | |
| Unspecified anxiety disorder 7 | 0.31 | ||||||
| No. of cases/person-years | 486/223,364 | 429/223,209 | 439/222,867 | 470/222,286 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.95 (0.83–1.08) | 1.04 (0.91–1.18) | 1.21 (1.06–1.38) | 0.002 | 1.08 (1.03–1.13) | |
| Model 2, HR (95% CI) 6 | Ref. | 0.94 (0.83–1.07) | 1.01 (0.88–1.15) | 1.08 (0.94–1.24) | 0.26 | 1.03 (0.98–1.08) | |
| Males | |||||||
| No. of cases/person-years | 93/68,983 | 129/91,262 | 142/110,253 | 191/130,938 | |||
| Model 1, HR (95% CI) 5 | Ref. | 1.06 (0.81–1.38) | 0.97 (0.75–1.26) | 1.12 (0.87–1.43) | 0.76 | 1.01 (0.93–1.10) | |
| Model 2, HR (95% CI) 6 | Ref. | 1.05 (0.80–1.37) | 0.97 (0.74–1.26) | 1.02 (0.79–1.32) | 0.46 | 0.97 (0.89–1.06) | |
| Females | |||||||
| No. of cases/person-years | 393/154,380 | 300/131,947 | 297/112,614 | 279/91,348 | |||
| Model 1, HR (95% CI) 5 | Ref. | 0.91 (0.78–1.06) | 1.07 (0.92–1.24) | 1.27 (1.09–1.48) | <0.001 | 1.11 (1.05–1.17) | |
| Model 2, HR (95% CI) 6 | Ref. | 0.90 (0.77–1.05) | 1.03 (0.88–1.20) | 1.12 (0.95–1.32) | 0.07 | 1.05 (0.995–1.12) |
Abbreviations: E-DII, energy-adjusted dietary inflammatory index; HR, hazard ratio; ICD, International Classification of Diseases; OCD, obsessive-compulsive disorder; 1 Ptrend was calculated using the continuous E-DII score in the corresponding model. 2 The continuous HR and associated 95% CI was calculated for each one standard deviation increase in the E-DII score. 3 Pinteraction-by-sex was calculated with the cross-product of sex and E-DII quartiles in the multivariable-adjusted Cox model (Model 2). 4 Total anxiety disorders include phobic anxiety disorders (ICD-10: F40, including agoraphobia, social phobias, specific phobias, other phobic anxiety disorders, unspecified phobic anxiety disorder), other anxiety disorders (ICD-10: F41, including panic disorder, generalized anxiety disorder, mixed anxiety and depressive disorder, other mixed anxiety disorders, other specified anxiety disorders, unspecified anxiety disorder), and OCD (ICD-10: F42, including predominantly obsessional thoughts or ruminations, predominantly compulsive acts, mixed obsessional thoughts and acts, other obsessive-compulsive disorders, unspecified obsessive-compulsive disorder). As the number of OCD cases was only 16, we did not list and analyze. The total number of cases was not the same as the sum of three diseases (F40–F42) because one may have multiple anxiety disorders. 5 Model 1 adjusted for age (<58, ≥58), sex (male, female), and average total energy intake (kcal/day). 6 Model 2 adjusted for age (<58, ≥58), sex (male, female), average total energy (kcal/day), ethnicity (Asian or Asian British, Black or Black British, Chinese, mixed, other ethnic groups, White, unknown), education qualification (college or university degree/vocational qualification, national examination at age 17–18, national examination at age 16, unknown), Townsend deprivation index (least deprived, intermediate, most deprived, unknown), cigarette smoking status (never, past smokers ≥ 15 cigarettes/d, past smokers < 15 cigarettes/d, past smokers with amount unknown, current smokers ≥ 15 cigarettes/d, current smokers < 15 cigarettes/d, current smokers with amount unknown, unknown status), alcohol drinking status (never, past drinkers, current drinkers ≤ 7.1 g/d, current drinkers with 7.2–18.6 g/d, current drinkers > 18.6 g/d, unknown status), physical activity (low, medium, high, unknown), depression status (yes, no), sleep quality (healthy, intermediate, poor, unknown), body mass index status (underweight, normal, overweight, obese), vitamin/mineral supplement use (no, yes), number of related comorbidities (0, 1–2, ≥3). 7 Panic disorder (ICD-10: F41.0), mixed anxiety and depressive disorder (ICD-10: F41.2), and unspecified anxiety disorder (ICD-10: F41.9) are three subtypes of other anxiety disorders. We did not analyze the remaining subtypes of other anxiety disorders due to the small number of cases (35 cases for generalized anxiety disorder, 3 cases for other mixed anxiety disorders, 4 cases for other specified anxiety disorders).