A Watermelon Focused Dietary Inflammatory Index Counseling System to Reduce Systemic Inflammation

Study Objectives: Chronic inflammation underpins the development of numerous chronic diseases that contribute significantly to disability and mortality in the United States (US). Of particular interest, as it relates to inflammation, is diet which is a strong moderator of systemic inflammation. Diets high in fruit and vegetable intake, fish, and whole grains (e.g., Mediterranean and vegetarian diets) have been associated with lower levels of inflammation. On the other hand, diets rich in red meat, high-fat dairy products, and refined grains (Western diet) are typically associated with higher levels of inflammation. Up until 2014, no dietary index has been designed specifically to determine the inflammatory potential of individual's diet. However, researchers in the Cancer Prevention and Control Program, University of South Carolina developed the Dietary Inflammatory IndexTM (DII). The DII quantifies the level of dietary inflammatory potential on a scale from maximally anti- to pro-inflammatory. Watermelon is one of the fruits whose components have been shown to have anti-inflammatory effects. The overall objective of this proposal is to determine if a refined and modified watermelon-focused DII counselling system can reduce levels of chronic inflammation. The DII is a validated measure that has been shown to predict a range of outcomes including inflammation, cancer, CVD, and mortality, among others.

Specifically, the aims of this proposal are to:

1. Refine and modify the DII-based intervention by developing and incorporating numerous watermelon recipes which will score low (anti-inflammatory) on the DII scale.
2. Design and implement a two-arm intervention trial based on the refined watermelon-focused DII-based program for reducing levels of chronic inflammation. Each arm will have 15 participants (plus an additional 15 partners recruited by the intervention-arm participants). The intervention arm will receive the modified DII intervention whereas the control arm will receive general health education.

Justification: Include summary of prior work and expertise related to the topic and references cited: Until 2014 there had been no scientifically valid way to relate what individuals ate to the capacity of foods consumed to modulate inflammation. In response to the absence of an instrument that could summarize diets' ability to influence inflammatory processes, investigators developed the DII which is based on literature (nearly 2,000 peer-reviewed journal articles) on diet and inflammation through 2010.20 The DII categorizes individuals' diets according to their inflammatory potential. Additionally, it was found to predict changes in hs-CRP in the Seasonal Variation in Blood Cholesterol (SEASONS) Study. Subsequently, investigators have used the DII in about 100 datasets from around the world to test the effect of diet-associated inflammation on: 1) Inflammation markers such as CRP, IL-6, and TNF-alpha-R2; 2) CVD, 3) cancers of the breast, colon, prostate, ovary, endometrium, liver and pancreas; 3) all-cause, CVD and cancer-specific mortality; 4) respiratory conditions such as asthma; and 6) cognitive disorders. To date investigators have published more than 80 peer-reviewed DII publications.

Study Design Overview: Investigators have extensive experience with diet interventions spanning over two decades and involving a variety of endpoints including cancer, body weight, and those related to CVD, inflammation, and immune response. Intervention venues have ranged from the community (including worksites) and churches, research institute-based,to clinical practice sites. This study will include two study arms (i.e., intervention and control). Participants will be recruited from the community. Our goal is to recruit 15 participants per arm, in addition to enrolling partners (e.g., spouse, child, sibling) of intervention participants (n total = 45, n intervention = 30, n control = 15). Participants will undergo a baseline clinic, followed by twelve weeks of intervention classes, and then another clinic. The main intervention classes will take place at a state-of the-art demonstration kitchen located in the Cancer Prevention and Control Program at the University of South Carolina's Arnold School of Public Health.