Association of the energy-adjusted children's dietary inflammatory index with hearing loss in school-aged children: A cross-sectional study of NHANES 2005–2020

Objective Hearing loss (HL) has been linked to a pro-inflammatory diet. This study evaluated the association between HL and the Energy-Adjusted Children's Dietary Inflammatory Index (EC-DII), a comprehensive inflammatory assessment of dietary nutrients in children. Methods This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) for children aged 6 to 14 years who completed both audiometric testing and 24-h dietary assessments between 2005 and 2020. HL was defined as audiometric thresholds ≥16 dB on the pure-tone average of 0.5, 1, 2, and 4 kHz for speech frequency (SFHL) and 3, 4, and 6 kHz for high frequency (HFHL). EC-DII scores (Energy-adjusted per 1000 kcal to account for differences in total energy intake) were calculated for each participant and classified into quartile I-IV. The association was evaluated using multivariable logistic regression models, with statistical significance reported as p -values, odds ratios (ORs), and 95% confidence intervals (CIs). Results In adjusted regression analysis model, EC-DII scores were significantly associated with an increased risk of HFHL (OR = 1.16, CI = 1.06–1.27, p = 0.001) and SFHL (OR = 1.16, CI = 1.04–1.30, p = 0.009). EC-DII quartile IV, the highest level of dietary inflammation, was associated with an increased risk of HFHL (OR = 1.33; CI 1.09–1.6, p = 0.004) and SFHL (OR = 1.31, CI 1.06–1.63, p = 0.017). Conclusion The study demonstrated that higher EC-DII scores, as well as the highest dietary inflammatory level quartile IV, were significantly associated with HL. Due to the cross-sectional nature of the study, causal inferences and temporal relationships could not be established. Therefore, the potential contribution of a pro-inflammatory diet, as quantified by the EC-DII, to the development of HL in children requires further investigation through prospective cohort studies and well-designed clinical trials.