TABLE 1.

Main characteristics of the studies that have attempted to calculate DII scores¹

First author, year (ref)	Study design	Study name/country	Objective	Results	Issue with the index calculation
Kizil, 2016 (134)	Cross-sectional	Turkey	A group from Turkey attempted to evaluate the association between the DII and serum CRP and protein energy wasting in hemodialysis patients.	DII showed significant correlation with reliable malnutrition and inflammation indicators, including subjective global assessment (r = 0.28, P < 0.01), malnutrition inflammation score (r = 0.28, P < 0.01), and serum CRP (r = 0.35, P < 0.001) in hemodialysis patients.	The DII score is created by simply summing up all food parameter–specific inflammatory effect scores, without any regard to the need to use the scoring algorithm.
Bawaked, 2017 (135)	Cross-sectional	Spain	To examine the DII's association with diet quality indicators in a representative sample of Spanish youth	Scoring for the KIDMED and the total dietary antioxidant capacity significantly decreased (P < 0.001 and P = 0.030, respectively) across quintiles of the DII, whereas the opposite was true for energy density (P < 0.001).	When calculated from all the 45 food parameters, DII scores can range from −8.87 to +7.98. Usually, for DII scores derived from 25–30 food parameters, the range is from −5.5 to +5.5. This group calculated DII from just 23 food parameters, and their DII scores ranged from −6.7 to +7.8, which is inconsistent with the findings we obtained in >160 publications in the last 4 y, which indicate that the effective range rarely exceeds 11.
Georgousopoulou, 2016 (136)	Cohort	ATTICA/Greece	To evaluate the association between anti-inflammatory diet and 10-y CVD incidence	An anti-inflammatory diet, as expressed by higher DII scores, was borderline associated with 10-y CVD incidence (OR for the third tertile vs. the first tertile: 0.98; 95% CI: 0.96, 1.01).	In this study, authors calculated a modified version of the DII and called it the D-AII. The difference between DII and D-AII is that in calculating D-AII scores, the z scores are not converted to centered percentiles and instead are multiplied directly by inflammatory effect scores. The scores ranged from 10 to 77, and therefore cannot be compared with DII scores.
Agudo, 2017 (137)	Cohort	EPIC/Spain	To examine the association between inflammatory potential of the diet and mortality in the Spanish cohort of EPIC	There was a significant association between ISD and mortality: subjects classified in the fifth quintile of the ISD (more proinflammatory diets) had an HR of 1.42 (95% CI: 1.25, 1.60) compared with those in the first quintile; the corresponding figures were 1.89 (1.48, 2.40). for CVD mortality and 1.44 (1.22, 1.69) for death by cancer.	The difference here is that instead of standardizing the intake values to means and SD from the global database, authors have standardized the intake values to means and SDs of the study population, thus limiting interpretation and comparability with other studies.
Farhangi, 2018 (138)	Cross-sectional	Iran	To examine the relation between dietary inflammatory potential and CVD risk factors in a cross-sectional analysis	They reported that men in the third and fourth quartiles of DII scores (i.e., more proinflammatory) had higher total cholesterol, TGs, albumin, creatinine, blood urea nitrogen, and CRP.	The description of how they calculated the DII scores is correct. However, the range of DII scores presented, stated to be from −19.33 to 10.62, is outside of the theoretical bounds of −8.87 to +7.98. Furthermore, the lower bound of the first quartile was −29.83. Clearly, there was a significant miscalculation.

¹CRP, C-reactive protein; CVD, cardiovascular disease; D-AII; Dietary Anti-Inflammation Index; DII, Dietary Inflammatory Index; EPIC, European Investigation into Cancer and Nutrition; ISD, Inflammatory Score of Diet; KIDMID, Mediterranean Diet Quality Index for children and adolescents; ref, reference.