Previous studies have shown that higher DII scores are associated with increased levels of systemic inflammatory biomarkers such as interleukin (IL)-1, IL-4, IL-6, IL-10, C-reactive protein (CRP), and tumour necrosis factor-alpha (TNF-a) (16, 17), and that higher DII is associated with an increased risk of neoplasms, cardiovascular disease, metabolic disease, and others, which reveal an important role for anti-inflammatory diets in the treatment and prevention of disease (18–20). Here, TNF is linked to metabolic disease.