Dietary inflammatory and antioxidant index and its relationship with inflammatory status and treatment outcomes in children with acute lymphocytic leukemia

Abstract

Abstract Background: Acute lymphoblastic leukemia (ALL) is increasingly prevalent, and finding strategies to mitigate its burden is critical. This study aimed to assess the relationship between the dietary inflammatory index (DII) and dietary total antioxidant capacity (DTAC) with inflammatory status and treatment outcomes in children aged 5–13 years recently diagnosed with ALL Methods: This cross-sectional study was conducted over 12 months and involved 54 children with ALL, selected from Mardani Azar Children's Hospital in Tabriz. After obtaining informed consent from parents, dietary data were collected using a validated 168-item semi-quantitative food frequency questionnaire. Laboratory analyses included CRP, albumin, neutrophils, lymphocytes, and monocytes. DII was calculated using the Shivappa method, and DTAC was assessed via the Ferric Reducing Antioxidant Power (FRAP) method. Statistical analyses included correlation and multivariable linear regression, with a significance level set at 0.05. Results: No significant association was found between DII and inflammatory markers or hospitalization duration in either crude or adjusted models. However, a significant inverse relationship was observed between FRAP and several inflammatory markers: MLR (ß: -0.19, p=0.001), PLR (ß: -0.26, p=0.03), and GPS (ß: -0.08, p=0.02). Additionally, FRAP showed a marginal inverse association with CRP in the crude model (ß: -0.13, p=0.05) and a direct association with the PNI (ß: 0.09, p<0.001). No other significant associations were identified. Conclusions: While no association was observed between DII and inflammatory markers or treatment outcomes, FRAP was inversely associated with several inflammatory indices such as PLR, MLR, and GPS, highlighting its potential role in mitigating inflammation in children with ALL. Further research is needed to confirm these findings and explore their clinical implications. Keywords: Dietary inflammatory index, Dietary total antioxidant capacity; Acute Lymphoblastic Leukemia; Inflammation Outcomes; Cross-Sectional.