目的：目前关于饮食炎症指数（DII）反映的饮食炎症潜力与心脑血管代谢性疾病（CMD）的关联仍缺乏确凿证据。本研究旨在探究DII与植物性膳食模式遵循度以及新发CMD（包括中风、2型糖尿病（T2DM）和心肌梗死（MI））风险之间的关联。方法：本次研究纳入中国健康与营养调查的成年人（N = 14,652）（1997-2015）。膳食摄入数据采用连续3天24小时膳食回顾和食物称重法进行采集。DII采用成熟且经验证的方法进行计算。CMD采用经验证的自报问卷进行识别。统计分析采用Cox比例风险回归模型。结果：在平均10年的随访中，共发现404例新发中风，1051例新发T2DM和280例新发MI。较低的PDI、hPDI、ERD、WISH和PHDI得分以及较高的uPDI得分与较高的DII得分相关（所有P趋势＜0.0001）。以较高DII得分反映的炎性饮食与中风（Q5 vs. Q1：HR = 1.90；95% CI：1.26-2.88；P趋势= 0.0006）、T2DM（Q5 vs. Q1：HR = 2.08；95% CI：1.61-2.69；P趋势＜0.0001）和MI（Q5 vs. Q1：HR = 1.70；95% CI：1.04-2.76；P趋势= 0.0114）的风险升高在整个队列中均得到肯定的关联。性别和BMI显著影响DII与T2DM风险的关联，性别显著影响DII与MI风险的关联。结论：对健康可持续的植物性膳食模式的遵循度较低，对不健康的植物性膳食模式的遵循度较高，与较高的DII得分相关。利用DII，我们在中国成年人（基线时无CMD和癌症）中报告了炎性饮食与中风、T2DM和MI新发风险增加之间的长期关联。这些发现为DII与心脑血管代谢性健康的关联提供了证据，并为当前文献的发展提供了有关DII是否应纳入膳食指南并作为改善饮食质量和预防CMD在中国人群中的一种有效工具的慎重评估。

Aims: convincing evidence is still limited for the validation of associations between the inflammatory potential of diets, based on the dietary inflammatory index (DII), and cardiometabolic outcomes. We aimed to investigate the associations between the DII with adherence to plant-based dietary patterns and the risk of new-onset cardiometabolic diseases (CMDs), including stroke, type 2 diabetes mellitus (T2DM) and myocardial infarction (MI). Methods: adults (N = 14 652) from the China Health and Nutrition Survey (1997-2015) were included in the current analysis. Dietary intake data were collected using a combination of 3 day consecutive 24 h dietary recalls and the food weighing method. The DII was calculated with established and validated methods. CMDs were identified using validated self-reported questionnaires. The Cox proportional hazard regression model was used for statistical analysis. Results: during a mean follow-up of 10 years, a total of 404 new-onset stroke, 1051 new-onset T2DM and 280 new-onset MI cases were identified. Lower PDI, hPDI, ERD, WISH and PHDI scores and higher uPDI scores were associated with higher DII scores (all P-trend < 0. 0001). A pro-inflammatory diet, as reflected by relatively higher DII scores, was positively associated with an increased risk of stroke (Q5 vs. Q1: HR = 1.90; 95% CI: 1.26-2.88; P-trend = 0.0006), T2DM (Q5 vs. Q1: HR = 2.08; 95% CI: 1.61-2.69; P-trend < 0.0001) and MI (Q5 vs. Q1: HR = 1.70; 95% CI: 1.04-2.76; P-trend = 0.0114) in the entire cohort. Sex and BMI significantly modified the association between the DII and the risk of T2DM, and sex significantly modified the association between the DII and the risk of MI. Conclusions: lower adherence to healthy and sustainable plant-based dietary patterns and higher adherence to unhealthy plant-based dietary patterns were associated with higher DII scores. With the use of the DII, we reported long-term positive associations between a pro-inflammatory diet and an increased risk of new-onset stroke, T2DM and MI in Chinese adults who were free from CMDs and cancer at the baseline. These findings provided evidence for the validation of associations between the DII and cardiometabolic health, and contributed to the current literature suggesting careful evaluations of whether the DII should be incorporated into dietary guidelines and utilized as an effective tool for improving the diet quality and CMD prevention in the Chinese population.