Association of composite dietary antioxidant index with prevalence of stroke: insights from NHANES 1999-2018

Abstract

BackgroundThere is a growing acknowledgment of the potential influence of antioxidative effects resulting from dietary decisions on the occurrence of stroke. The objective of this study was to elucidate the correlation between the composite dietary antioxidant index (CDAI) and the incidence of stroke in the general population of the United States.MethodsWe gathered cross-sectional data encompassing 40,320 participants from the National Health and Nutrition Examination Survey (NHANES) spanning the years 1999 to 2018. Employing weighted multivariate logistic regression, we assessed the correlation between CDAI and stroke, while also investigating potential nonlinear relationships through restricted cubic spline (RCS) regression. Further, the intake of CDAI components were then incorporated into a predictive nomogram model, subsequently evaluated for its discriminatory prowess in stroke risk assessment using the receiver operating characteristic (ROC) curve.ResultsPost-adjustment for confounding variables, we found that higher CDAI score were associated with a decreased risk of stroke, the odds ratio (OR) [95% CI] of CDAI associating with prevalence was 0.96 [0.94-0.98] (P< 0.001). Moreover, the adjusted OR [95% CI] for stroke across ascending CDAI quartiles stood at 0.90 [0.74-1.09], 0.74 [0.60-0.91], and 0.61 [0.50-0.76] compared to the reference quartile, respectively. The RCS analysis indicated a nonlinear yet negative correlation between CDAI and stroke. The nomogram model, constructed based the intake of antioxidants, exhibited a significant predictive capacity for stroke risk, boasting an area under the curve (AUC) of 77.4% (76.3%–78.5%).ConclusionOur investigation ascertained a nonlinear negative relationship between CDAI and stroke within the broader American population. However, given the inherent limitations of the cross-sectional design, further comprehensive research is imperative to establish the causative nature of this association.

Interactive effects of Composite Dietary Antioxidant Index with Body Mass Index for the risk of stroke among U.S. adults: insight from NHANES 2001–2018

“…Notably, in those with a BMI under 25, the link between CDAI and stroke does not hold statistical significance. This observation aligns with findings from Teng et al and Mao et al, though their research did not delve into BMI’s role in the CDAI-stroke relationship ( 12 , 13 ). Considering the differences in variable adjustments mentioned earlier, it becomes essential to undertake more extensive adjustments of variables to further examine the interaction between CDAI and BMI in stroke risk among American adults.…”

“…These findings collectively affirm the link between higher dietary antioxidant intake and reduced stroke risk. Teng et al ( 13 ) also found that higher CDAI scores were associated with a lower stroke risk after adjusting for confounders, with an OR of 0.96 (95% CI 0.94–0.98, p < 0.001), and that nomogram models based on antioxidant intake exhibited substantial predictive power for stroke risk, showing an area under the curve (AUC) of 77.4% (76.3–78.5%). Together, these results support the hypothesis that increased dietary antioxidant intake is associated with a diminished risk of stroke, as evidenced by the CDAI.…”

“…Chen et al ( 11 ) reported a non-linear association with a turning point at CDAI = 3.078; before this point, each unit increase in CDAI reduced stroke risk by 6.0% (OR 0.940, 95% CI 0.904–0.976), but beyond it, the association was not significant (OR 1.024, 95% CI 0.977–1.074). Teng et al ( 13 ) noted a gradual decline in stroke risk with increasing CDAI until a specific inflection point of 3.66, beyond which the protective effect seemed to stabilize, indicating a potential saturation effect at higher CDAI levels. This is inconsistent with our research findings, although we have also found a non-linear relationship between the two, there are differences in determining the inflection point, which may be due to differences in adjusting variables.…”

“…Teng et al’s inflection point is more aligned with our study’s results, so this may be due to their omission in the explanation of confounding factors adjustment. Moreover, the analyses by Teng et al and Mao et al, though adjusted for confounding factors, likely overlooked additional confounders such as economic status, activity level, renal function, hyperlipidemia, and sleep-related factors ( 12 , 13 ), all known to impact stroke risk. Economic conditions and physical activity levels have been linked to stroke incidence and mortality ( 30–33 ).…”