Associations of Dietary Zinc–Vitamin B6 Ratio with All-Cause Mortality and Cardiovascular Disease Mortality Based on National Health and Nutrition Examination Survey 1999–2016

Abstract

Previous studies have suggested a possible association among dietary zinc and vitamin B6 intake and CVD mortality and all-cause mortality. However, evidence on the association of dietary zinc and vitamin B6 intake and their interactions with CVD mortality and all-cause mortality remains unclear. This prospective study utilized data from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016. After a median follow-up of 10.4 years, 4757 deaths were recorded among 36,081 participants. Higher dietary zinc intake levels (≥9.87 mg/day) were associated with lower CVD mortality (hazard ratio (HR) = 0.85, 95% confidence interval (CI): 0.83–0.87). Vitamin B6 intake levels (≥1.73 mg/day) were associated with lower CVD mortality (HR = 0.91, 95% CI: 0.86–0.96) and all-cause mortality (HR = 0.91, 95% CI: 0.90–0.93). Higher dietary zinc intake and higher vitamin B6 intake were associated with a lower risk of CVD mortality, with an interaction between dietary zinc intake levels and vitamin B intake levels (LZLV group (HR, CI): 1.21,1.12–1.29; LZHV group (HR, CI): 1.42, 1.34–1.50; LZHV group (HR, CI): 1.28, 1.14–1.45; HZHV group (HR, CI): ref). There was also a J-type association (p for nonlinear < 0.001) between the dietary zinc–vitamin B6 ratio and CVD mortality, with a high dietary zinc–vitamin B6 ratio increasing the risk of CVD mortality (HR = 1.27, 95% CI: 1.19–1.35), whereas a moderate dietary zinc–vitamin B6 ratio appeared to be beneficial for CVD mortality. These results suggest that increasing the appropriate proportion of dietary zinc and vitamin B6 intake is associated with a lower risk of CVD mortality. Furthermore, precise and representative studies are needed to verify our findings.

Interactive association of the dietary oxidative balance score and cardiovascular disease with mortality in older adults: evidence from NHANES

“…However, there were no notable links found between DOBS and CVD (HR 0.71, 95% CI 0.49-1.04) or cancer mortality (HR 0.69, 95% CI 0.47-1.01). 15 The cross-sectional analysis conducted by X. Wang has revealed the significant and accelerated impact of a pro-oxidative dietary (lower DOBS) on the aging process. 11 These studies provide empirical evidence supporting the beneficial impact of DOBS on outcomes in older adults.…”

“…10 The DOBS scoring system is a dependable method for quantifying the potential antioxidant capacity of daily dietary intake, and has recently been utilized to evaluate its impact on health conditions including biological aging, 11 CVD, 12 cancer 13 and mortality. 14,15 There also exists a codependency between oxidative stress and CVD. Prior researches have provided evidence that the pathogenesis of CVD is facilitated by oxidative stress-induced damage to endothelial and smooth muscle cells, 16,17 and a higher intake of dietary antioxidants has been linked to a decreased risk of CVD.…”