Dietary inflammatory index and mortality in hemodialysis patients by path analysis approach (NUGE-HD study)

•Proinflammatory diet is directly (unmediated effect) associated with higher hemodialysis mortality.•Higher C-reactive protein is directly (unmediated effect) associated with higher hemodialysis mortality.•Higher body mass index is directly (unmediated effect) associated with fewer deaths in hemodialysis.•Fresh/minimally processed foods were positively associated with anti-inflammatory diet. The aim of this study was to evaluate the interrelationships between dietary, nutritional, and inflammatory factors in predicting all-cause mortality among individuals in hemodialysis (HD) treatment. Participating in this study were 137 patients undergoing HD (58.4% men, 61.7 ± 15.4 y of age) from the NUtrition and GEnetics on HemoDialysis outcomes (NUGE-HD study) cohort. Sociodemographic, anthropometric, and clinical data were collected. Dietary inflammatory index scores were calculated from a quantitative food frequency questionnaire. Plasma C-reactive protein was used as an inflammatory marker. Data were analyzed by path analysis. During the 2-y follow-up, 27 patients (19.7%) died. Compared with survivors, non-survivors were older (P = 0.01) and had lower body mass index (P = 0.04). In relation to direct (unmediated) associations, dietary inflammatory index (P = 0.049) and C-reactive protein (P = 0.016) were positively associated, whereas body mass index was negatively associated with mortality (P = 0.012). There were no indirect (mediated) associations of the variables evaluated with mortality. More proinflammatory diet and systemic inflammation have a direct association with mortality among patients undergoing HD therapy. Additionally, more proinflammatory diet is associated with unhealthy dietary pattern.