{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T08:42:02Z","timestamp":1772786522938,"version":"3.50.1"},"reference-count":85,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T00:00:00Z","timestamp":1680220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Inflammation and cytokine storm have been reported to be the main cause of acute symptoms of coronavirus disease (COVID-19). Diet-induced inflammation may affect the condition of patients with COVID-19. Therefore, this study aimed to investigate the relationship between disease severity, inflammatory and immune system biomarkers, and the dietary inflammatory index (DII) in patients with COVID-19.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross-sectional study was conducted on 500 adult patients with COVID-19. Patients were divided into mild, moderate, and severe conditions based on clinical and laboratory evidence. A validated food frequency questionnaire (FFQ) was used to determine DII and energy-adjusted DII (E-DII) scores. The serum C-reactive protein (CRP) level and blood cell count were measured for all patients. Multiple linear regression was used to explore the association between DII and E-DII and CRP, blood cell counts, and hospitalization in patients with COVID-19.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Coronavirus disease (COVID-19) patients with higher DII had higher consumption of fat and carbohydrate and lower intakes of protein, anti-inflammatory nutrients, garlic, caffeine, tea, onion, and fiber (<jats:italic>P<\/jats:italic> &amp;lt; 0.05). There was a positive association between DII and CRP (\u03b2 = 1.024, <jats:italic>P<\/jats:italic> &amp;lt; 0.001), hospitalization (\u03b2 = 1.062, <jats:italic>P<\/jats:italic> &amp;lt; 0.001), WBC count (\u03b2 = 0.486, <jats:italic>P<\/jats:italic> &amp;lt; 0.009), neutrophil count (\u03b2 = 0.565, <jats:italic>P<\/jats:italic> &amp;lt; 0.001), and neutrophil-to-lymphocyte ratio (\u03b2 = 0.538, <jats:italic>P<\/jats:italic> &amp;lt; 0.001) and a negative association between DII and the lymphocyte count (\u03b2 = \u22120.569, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). There was a positive association between E-DII and hospitalization (\u03b2 = 1.645, <jats:italic>P<\/jats:italic> &amp;lt; 0.001), WBC count (\u03b2 = 0.417, <jats:italic>P<\/jats:italic> &amp;lt; 0.02), and neutrophil-to-lymphocyte ratio (\u03b2 = 0.35, <jats:italic>P<\/jats:italic> &amp;lt; 0.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is a positive correlation between DII and inflammation, immune hyperactivation, and length of hospital stay in patients with COVID-19. Further longitudinal studies are necessary.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2023.1075061","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T12:49:19Z","timestamp":1680266959000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["The association between inflammatory and immune system biomarkers and the dietary inflammatory index in patients with COVID-19"],"prefix":"10.3389","volume":"10","author":[{"given":"Somayyeh","family":"Barania 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