Abstract:AIM: To evaluate the association between pro-inflammatory dietary patterns, as quantified by the dietary inflammatory index (DII), and the prevalence of glaucoma. METHODS: This population-based study used data from the National Health and Nutrition Examination Survey (2005-2008). DII scores were calculated based on nutrient data derived from dietary questionnaires. The association between DII scores and glaucoma risk was assessed using sample-weighted, covariate-adjusted multivariable logistic regression models, with further stratified analyses performed across subgroups. RESULTS: A total of 5659 eligible participants aged 40-85y were included, of whom 383 (6.7%) had glaucoma and 5276 (93.3%) did not. After adjustment for covariates, participants in the highest DII tertile had a 1.35-fold increased risk of glaucoma [odds ratio (OR)=1.35, 95% confidence interval (CI): 1.03-1.79], with a significant linear trend (P for trend=0.034). Restricted cubic spline analysis further verified the association between DII scores and glaucoma risk (P=0.043). In subgroup analyses, a significant positive association between higher DII scores and elevated glaucoma risk was observed in males (OR for tertile 3 vs 1=1.48, 95%CI: 1.02-2.15; P for trend =0.049), participants with diabetes (OR=1.56, 95%CI: 1.04-2.34; P for trend =0.028), and participants with obesity (OR=1.66, 95%CI: 1.07-2.58; P for trend =0.023). CONCLUSION: A pro-inflammatory diet, reflected by higher DII scores, is positively associated with an increased risk of glaucoma among U.S. adults. These findings suggest that anti-inflammatory dietary interventions may serve as a potential preventive strategy against glaucoma.