To examine the associations between the inflammatory potentials of diet and lifestyle, as measured by the Dietary Inflammation Score (DIS) and Lifestyle Inflammation Score (LIS), with the risk of type 2 diabetes mellitus (T2DM), hypertension and chronic kidney disease (CKD).

This retrospective cohort study used data collected between 2000 and 2012 from the Multi-Ethnic Study of Atherosclerosis cohort, which was conducted across six US communities.

The study sample included 4736 participants for the analysis of T2DM, 2149 participants for hypertension and 4631 participants for CKD.

The primary outcomes were the incidence of T2DM, hypertension and CKD during follow-up.

During a median follow-up of 9.0 years, 537 participants developed T2DM, 1019 developed hypertension and 1067 developed CKD. DIS was not associated with T2DM in the overall population; however, women in the third quartile of DIS had a 52% higher risk of developing T2DM (HR 1.52; 95% CI 1.07 to 2.15). Also, individuals in the third quartile of DIS had a 22% higher risk of hypertension (1.22; 95% CI 1.02 to 1.47) in the overall population; however, no significant linear trend was observed across the quartiles (P-trend=0.397). Individuals in the fourth quartile of LIS had over twice the risk of developing T2DM (2.15; 95% CI 1.57 to 2.95), although no significant linear trend was observed across quartiles (P-trend

This study highlights the role of diet and lifestyle-related inflammation in the development of hypertension and T2DM risk, providing novel evidence from a large, multiethnic US cohort. The findings underscore the potential of dietary and lifestyle strategies that target inflammation to reduce cardiometabolic disease risk.