Research Article: Synergistic impact of chrono-nutritional and pro-inflammatory dietary patterns on chronic pain recovery: a prospective cohort study with population-based corroboration
Abstract:
Current research often overlooks synergistic interactions within dietary patterns, specifically between dietary composition and chrono-nutrition. Using Lumbar Disc Herniation (LDH) as a model of chronic inflammatory pain, this study examined whether meal-timing misalignment, quantified as Eating Jetlag (EJL; the absolute difference in eating midpoint between workdays and freedays), and a pro-inflammatory diet, quantified by the Dietary Inflammatory Index (DII), were associated with poorer recovery.
This two-stage study first employed a prospective longitudinal cohort of 324 LDH patients undergoing conservative treatment with 6-month follow-up. Baseline data on DII, EJL, and serum interleukin-6 (IL-6) were collected. Growth Mixture Modeling (GMM) identified functional recovery trajectories using ODI scores. Latent Profile Analysis (LPA), correlation/network analysis, and exploratory Structural Equation Modeling (SEM) were then used to characterize baseline diet-rhythm-inflammation features and their associations with symptoms. Second, weighted NHANES data from 2009–2010, 2015–2016, and 2017–2018 were analyzed as population-level corroboration.
GMM identified three recovery trajectories, with 23.8% of patients classified in the chronic persistent group. Compared with the Rapid Recovery group, the Chronic Persistent group had higher DII (0.85?±?1.45 vs. 0.31?±?1.41, p =?0.030), higher IL-6 (5.99?±?1.06 vs. 5.56?±?1.17, p =?0.021), worse sleep score (11.55?±?3.35 vs. 7.22?±?3.92, p <?0.001), and higher pain VAS (6.34?±?1.96 vs. 1.00?±?0.95, p <?0.001). Restricted cubic spline analysis showed a significant overall association between DII and poor recovery ( p =?0.018), whereas the nonlinear component was not significant ( p =?0.333). In multivariable analysis, sleep score, pain VAS, and baseline ODI remained independently associated with poor recovery. Exploratory SEM showed that DII was strongly associated with IL-6, EJL was associated with sleep disturbance, and pain VAS was strongly associated with baseline ODI; however, global model fit was suboptimal. In weighted NHANES analyses, higher DII remained associated with prevalent low back pain.
Chrono-nutritional misalignment and pro-inflammatory diets were associated with less favorable LDH recovery. These findings support further investigation of diet-rhythm-inflammation features in LDH prognosis and suggest that immuno-metabolic and behavioral factors may be clinically relevant adjunctive targets.
Introduction:
Current research often overlooks synergistic interactions within dietary patterns, specifically between dietary composition and chrono-nutrition. Using Lumbar Disc Herniation (LDH) as a model of chronic inflammatory pain, this study examined whether meal-timing misalignment, quantified as Eating Jetlag (EJL; the absolute difference in eating midpoint between workdays and freedays), and a pro-inflammatory diet, quantified by the Dietary Inflammatory Index (DII), were associated with poorer recovery.
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