Abstract

Background and Objectives: This study explored the association between the dietary inflammatory index (DII) and lung function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and the potential mediating role of blood inflammatory markers. Methods and Study Design: In this cross-sectional study of 507 patients with AECOPD, dietary intake was assessed through 24-hour dietary recalls, and the DII was determined. Generalized linear models, logistic regression and mediation analysis were used to evaluate associations between DII, inflammatory markers [white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and systemic inflammatory response index (SIRI)], and lung function [forced expiratory volume in one second (FEV1), forced vital capacity (FVC)]. Results: DII was 2.81and showed a significant negative linear correlation with FVC (p <0.05) and with FEV1 (p <0.05).  After adjusting for confounding factors, each unit increase in DII was associated with a decrease of 0.053 L in FEV1 and 0.078 L in FVC. Additionally, FEV1 showed negative associations with SII, SIRI, NLR, PLR, and WBC (all p <0.05). Mediation analysis revealed that WBC exerted a statistically significant mediating effect between DII and FEV1 (ACME = -7.54 × 10⁻³, p <0.05). Conclusions: It was indicated that a pro-inflammatory diet is associated with reduced lung function in AECOPD patients, with lung function showing a significant negative correlation with inflammatory markers. WBC serves as a key mediator between the DII and FEV1.

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