Details of the development (20 (link)) and construct validation (21 (link)) of the DII have been previously described. Briefly, an extensive literature search was performed to obtain peer-reviewed journal articles that examined the association between six well known inflammatory biomarkers (IL-1β, IL-4, IL-6, IL-10, TNFα, and CRP) and 45 specific foods and nutrients (components of the DII). Literature-derived inflammatory effect scores for each of the DII components were standardized to a representative global diet database, constructed based on 11 datasets from diverse populations in different parts of the world. Overall DII scores for each individual participant represent the sum of each of the DII components in relation to the comparison global diet database (20 (link)). The DII score characterizes an individual’s diet on a continuum from maximally anti-inflammatory to maximally pro-inflammatory, with a higher DII score indicating a more pro-inflammatory diet and a lower (more negative) DII score indicating a more anti-inflammatory diet. In the WHI FFQ, 32 of the 45 original DII components were available for inclusion in the overall DII score (see (20 (link)) for list of 45 DII components). Components such as ginger, turmeric, garlic, oregano, hot pepper, rosemary, eugenol, saffron, flavan-3-ol, flavones, flavonols, flavonones, anthocyanidins that are included in the original DII calculation (20 (link)) were not included in the current study because they were not available from the WHI FFQ. The absence of these components is likely to have a minimal impact on overall DII scores because most of the missing food items are consumed in small quantities in this population.