Date of Award
Summer 2025
Document Type
Open Access Dissertation
Department
Epidemiology and Biostatistics
First Advisor
Matthew Lohman
Abstract
Research has increasingly evaluated the role of dietary patterns in age-related health outcomes, yet few studies have comprehensively investigated the association between the inflammatory potential of diet, measured by Dietary Inflammatory Index (DII) and Energy-Adjusted DII (E-DII), and fall risk among U.S. older adults, compared E-DII fall-predictive value with the Healthy Eating Index (HEI-2015), or explored the mediating role of frailty. This dissertation aimed to 1) investigate the longitudinal association between E-DII and risk of falls and related injuries among older U.S. adults, 2) compare the fall-predictive performance of E-DII and HEI, and 3) examine frailty as a mediator of the E-DII-fall association.
Data were obtained from the Health and Retirement Study (HRS), a nationally representative survey of U.S. older adults. E-DII and HEI scores were calculated using the 2013 Health Care and Nutrition Study (n = 8,035), an HRS subset. Analyses were conducted on a baseline sample of older adults aged ≥ 65 (baseline year = 2012, n = 4,272), with fall outcomes tracked from 2016 to 2020. Generalized Estimating Equations (GEE) were used to estimate associations, predictive performance was compared using the Receiver Operating Characteristic (ROC) curves (AUC, sensitivity, specificity), and causal mediation models assessed the proportion mediated.
Overall, we observed that older adults in the highest E-DII quartile had significantly greater odds of falling compared to those in the lowest. While both indices showed high specificity for identifying non-fallers, E-DII demonstrated higher sensitivity in identifying fallers, and frailty significantly mediated approximately one-fifth of the E-DII-falls association. These findings support prior studies linking pro-inflammatory dietary patterns to adverse health outcomes and are the first to demonstrate this association with falls among U.S. older adults.
Collectively, this dissertation highlights the importance of integrating nutritional interventions and routine frailty screening into fall prevention strategies. Emphasizing high-quality, anti-inflammatory diets, especially among frail individuals, may reduce fall risk, slow the progression of frailty, and promote healthier aging. Further research using inflammatory biomarkers and musculoskeletal measures is recommended.
Rights
© 2025, Afsaneh Fallahi
Recommended Citation
Fallahi, A.(2025). Association Between the Energy-Adjusted Dietary Inflammatory Index (E-DII) and Risk of Falls and Related Injuries in Older Adults in the United States. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/8509