{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:04:25Z","timestamp":1780639465803,"version":"3.54.1"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Children's Dietary Inflammatory Index (C-DII) is associated with elevated body mass index (BMI), a major risk factor for pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS). However, the interrelationships between pro-inflammatory diets, BMI, and OSAHS severity in children remain unclear. This study aimed to examine the association between C-DII and OSAHS severity and assess whether BMI statistically explained the association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study involved 297 children diagnosed with OSAHS. Dietary intake was assessed using a 3-day 24-h dietary recall (including two weekdays and one weekend) to calculate the C-DII scores. All participants underwent polysomnography to determine the obstructive apnea-hypopnea index (OAHI) as an indicator of OSAHS severity. Multiple linear regression analyses evaluated the association between C-DII tertiles (T1 as reference compared to T2 and T3) and OAHI, adjusting for key sociodemographic and clinical covariates. A mediation analysis using the PROCESS macro quantified the proportion of the association statistically attributable to BMI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After covariate adjustment, the highest C-DII tertile (T3, pro-inflammatory diet) had a significantly higher OAHI vs. the lowest tertile (T1) (\u03b2 = 2.04, 95% CI: 0.07\u20134.01,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.042). This difference is equivalent to an increase of approximately two obstructive events per hour. The association attenuated and lost significance after adding BMI to the model (\u03b2 = 1.58, 95% CI: \u22120.37\u20133.54,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.112). BMI remained strongly associated with OAHI (\u03b2 = 0.53,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001). Mediation analysis indicated that BMI statistically accounted for 20.18% of the total observed association between C-DII on OAHI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A pro-inflammatory diet (higher C-DII score) is associated with more severe pediatric OSAHS. This association was largely statistically explained by BMI. Causality cannot be inferred from this cross-sectional study. These findings support integrating dietary and weight strategies in pediatric OSAHS care. Nonetheless, longitudinal studies are needed to clarify diet-specific effects beyond weight control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1772032","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:38:12Z","timestamp":1780637892000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Body mass index mediates the association between children's dietary inflammatory index and obstructive sleep apnea-hypopnea syndrome in children: a cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Yi","family":"Wen","sequence":"first","affiliation":[{"name":"School of Nursing, Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinglan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Eye and Otorhinolaryngology, Women and Children's Hospital 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