← Back to all studies
anti-inflammatory foods

Body mass index mediates the association between children's dietary inflammatory index and obstructive sleep apnea-hypopnea syndrome in children: a cross-sectional study

5 June 2026

Wen Y, Chen J, Yang X, Xie S, Zhou J, Zhang X.

Summary

What the study found

This study discovered that children who consume a pro-inflammatory diet are more likely to experience severe obstructive sleep apnea. The research suggests that while diet quality directly impacts sleep, a significant portion of this relationship is driven by an increased body mass index.

Key findings

  • Children eating the most pro-inflammatory foods experienced about two additional breathing interruptions per hour compared to those with the healthiest diets.
  • A higher body mass index (BMI) accounted for approximately 20% of the link between a pro-inflammatory diet and sleep apnea severity.
  • The Children's Dietary Inflammatory Index (C-DII) serves as a reliable predictor for the severity of respiratory issues during sleep.
  • While diet is a major factor, weight management remains the most significant statistical driver of sleep apnea outcomes in this population.

Practical takeaways

Focusing on an anti-inflammatory diet—rich in fiber, antioxidants, and healthy fats—may help reduce the severity of sleep disorders in children. Because diet-driven weight gain is a primary contributor to sleep apnea, maintaining a healthy weight through nutrition is essential for long-term respiratory health and sleep quality.

Limitations

The study used a cross-sectional design, meaning it can only show associations rather than proving that a pro-inflammatory diet directly causes sleep apnea. Furthermore, the use of self-reported dietary recalls may lead to inaccuracies in actual nutrient intake.

Abstract

<h4>Background</h4>The Children's Dietary Inflammatory Index (C-DII) is associated with elevated body mass index (BMI), a major risk factor for pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS). However, the interrelationships between pro-inflammatory diets, BMI, and OSAHS severity in children remain unclear. This study aimed to examine the association between C-DII and OSAHS severity and assess whether BMI statistically explained the association.<h4>Methods</h4>This cross-sectional study involved 297 children diagnosed with OSAHS. Dietary intake was assessed using a 3-day 24-h dietary recall (including two weekdays and one weekend) to calculate the C-DII scores. All participants underwent polysomnography to determine the obstructive apnea-hypopnea index (OAHI) as an indicator of OSAHS severity. Multiple linear regression analyses evaluated the association between C-DII tertiles (T1 as reference compared to T2 and T3) and OAHI, adjusting for key sociodemographic and clinical covariates. A mediation analysis using the PROCESS macro quantified the proportion of the association statistically attributable to BMI.<h4>Results</h4>After covariate adjustment, the highest C-DII tertile (T3, pro-inflammatory diet) had a significantly higher OAHI vs. the lowest tertile (T1) (β = 2.04, 95% CI: 0.07-4.01, <i>p</i> = 0.042). This difference is equivalent to an increase of approximately two obstructive events per hour. The association attenuated and lost significance after adding BMI to the model (β = 1.58, 95% CI: -0.37-3.54, <i>p</i> = 0.112). BMI remained strongly associated with OAHI (β = 0.53, <i>p</i> = 0.001). Mediation analysis indicated that BMI statistically accounted for 20.18% of the total observed association between C-DII on OAHI.<h4>Conclusions</h4>A pro-inflammatory diet (higher C-DII score) is associated with more severe pediatric OSAHS. This association was largely statistically explained by BMI. Causality cannot be inferred from this cross-sectional study. These findings support integrating dietary and weight strategies in pediatric OSAHS care. Nonetheless, longitudinal studies are needed to clarify diet-specific effects beyond weight control.
Source study →