TNF and major depressive disorder: Foods high in sugar, saturated fat, and processed foods tend to have higher DII scores, while foods rich in antioxidants, fiber, and healthy fats tend to have lower scores.25 Foods with higher DII levels are associated with increased levels of TNF-α, IL-6, and IL-1ß in the body.25 They can significantly affect the sleep quality and leads to malaise, depression, and anxiety.69 Pro-inflammatory diet causes expression of inflammatory mediators by binding to the TLR4 receptor through two pathways, nuclear factor-κB (NF-κB) and the c-Jun N-terminal kinase (JNK) pathway.