Associations of Serum Carotenoids With Risk of Cardiovascular Mortality Among Individuals With Type 2 Diabetes: Results From NHANES

Qiu, Zixin; Chen, Xue; Geng, Tingting; Wan, Zhenzhen; Lu, Qi; Li, Lin; Zhu, Kaiheng; Zhang, Xuena; Liu, Yujie; Lin, Xiaoyu; Chen, Liangkai; Shan, Zhilei; Liu, Liegang; Pan, An; Liu, Gang

doi:10.2337/dc21-2371

Cited by 86 publications

(78 citation statements)

References 32 publications

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“…Clinical trial has shown that high does β-carotene supplementation may increase lung cancer incidence in male smokers ( 46 ). Higher concentrations of serum β-carotene were significantly associated with an increased risk of cardiovascular mortality among patients with diabetes ( 47 ). For lycopene, there is no epidemiological evidence that lycopene in different concentrations exhibits the conversion between anti-oxidation and pro-oxidation properties, or harmful effects at high concentrations ( 48 ).…”

Section: Discussionmentioning

confidence: 99%

Association of serum lycopene concentrations with all-cause and cardiovascular mortality among individuals with chronic kidney disease: A cohort study

et al. 2022

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BackgroundLycopene is one of the hydrocarbon carotenoids which is largely studied for its strong antioxidant and anti-inflammatory properties, as well as improvement of endothelial function and anti-arteriosclerosis effects. The use of lycopene has been shown to reduce mortality in the general population. However, few studies have examined the association between serum lycopene level and all-cause and cardiovascular mortality among participants with chronic kidney disease (CKD).MethodThis study included 7,683 adults with CKD from the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994) and NHANES 2001–2006. Mortality status and cause of death were ascertained by linkage to National Death Index records through 31 December 2018. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% CIs for mortality from all-cause and cardiovascular disease (CVD).ResultDuring a median follow-up time of 309 months, there were 5,226 total deaths. The median (interquartile range) serum lycopene concentration was 20.0 (12.0, 32.0) μg/dl. After fully adjusted, restricted cubic spline analyses reported that higher serum lycopene concentrations were significantly associated with decreased risk of all-cause and CVD mortality in participants with CKD (P < 0.001, P = 0.001). When extreme quartiles of serum lycopene concentrations were compared, the multivariable-adjusted HR (95% CI) was 0.778 (0.714–0.848) for all-cause mortality (P < 0.001), and 0.791 (0.692–0.905) for CVD mortality (P < 0.001). Specifically, higher serum lycopene decreased the risk of all-cause and CVD mortality at both CKD stage 1–2 and stage 3–5. Further subgroup analyses and sensitivity analyses supported the current results.ConclusionHigher serum lycopene was independently associated with a decreased risk of all-cause and CVD mortality in patients with CKD. These findings suggested that maintain serum lycopene concentrations could lower mortality risk in CKD patients.

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Section: Discussionmentioning

confidence: 99%

Association of serum lycopene concentrations with all-cause and cardiovascular mortality among individuals with chronic kidney disease: A cohort study

et al. 2022

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“…Model 3 was additionally modified for diabetes-related factors, including diabetes duration, use of glucose-lowering medications (none, insulin, oral hypoglycemic agent, or others), history of CVD or hypertension, HbA1c level, TC level, HDL-C level, and eGFR. The multiple imputation method was utilized to impute the missing values for some covariates [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…In total, 2833 adults with diabetes aged ≥ 20 were enrolled in the NHANES III (1988–1994). The ascertainment of diabetes included a self-report of physician diagnosis, fasting plasma glucose level ≥ 7.0 mmol/L (126 mg/dL), 75-g oral glucose tolerance test result ≥ 11.1 mmol/L (200 mg/dL), or glycated hemoglobin A1c (HbA1c) level ≥ 6.5% (48 mmol/mol) [ 19 – 21 ]. Participants without data on serum thyroid hormone levels (n = 615), TSH and total thyroxine (TT 4 ) levels outside the reference range (n = 266), those with a history of thyroid disease at baseline (n = 110), those lost to follow-up (n = 4), and those who self-reported as being pregnant (n = 8) were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

“…Baseline data on demographics and lifestyle factors such as age, sex, race/ethnicity, education, family income, drinking status, smoking status, body mass index (BMI), Healthy Eating Index (HEI), and physical activity were acquired using established protocols [ 21 , 22 ]. BMI was defined as the ratio of body weight to height squared, expressed in kg/m 2 , and was categorized as < 25, 25–30, or ≥ 30.…”

Section: Ascertainment Of Outcomesmentioning

confidence: 99%

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TSH levels within the normal range and risk of cardiovascular and all-cause mortality among individuals with diabetes

Zhu

Lao

Chen

et al. 2022

Cardiovasc Diabetol

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Background Evidence regarding thyroid-stimulating hormone (TSH) levels within the normal range and mortality in adults with diabetes is scarce. This study aimed to identify the association between TSH levels and cardiovascular disease (CVD) and all-cause mortality among euthyroid patients with diabetes. Methods This prospective cohort study included 1830 adults with diabetes from the Third National Health and Nutrition Examination Survey III. Mortality outcomes were ascertained by linkage to National Death Index records through December 31, 2019. Participants were categorized by tertiles of TSH levels (low-normal, 0.39–1.30 mIU/L; medium-normal, 1.30–2.09 mIU/L; high-normal, 2.09–4.60 mIU/L). Multivariable Cox proportional hazards models were used to explore the association between TSH levels within the normal range and overall and CVD mortality. Furthermore, restricted cubic spline analyses were used to determine the nonlinear relationship between TSH levels and mortality. Results During a median follow-up of 17.1 years, 1324 all-cause deaths occurred, including 525 deaths from CVD. After multivariate adjustment, a U-shaped relationship was observed between TSH levels in euthyroid status and all-cause or CVD mortality among patients with diabetes (both P < 0.05 for nonlinearity). Compared with participants with medium-normal TSH levels, those with high-normal TSH levels had a significantly higher risk of all-cause (hazard ratio, 1.31; 95% confidence interval, 1.07–1.61) and CVD (1.52; 1.08–2.12) mortality. Similarly, low-normal TSH levels also increased all-cause (1.39; 1.12–1.73) and CVD (1.69; 1.17–2.44) mortality risk. In stratum-specific analyses, we found that high-normal TSH levels were associated with higher mortality risk in younger (< 60 years) patients with diabetes but not in older (≥ 60 years) participants. Conclusion Low- and high-normal serum TSH levels were associated with increased all-cause and CVD mortality in euthyroid adults with diabetes. Further studies are needed to confirm the present observation in a wider population.

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“…Previous evidence has suggested that several nutritional biomarkers were significantly related to health outcomes. Higher serum β-carotene levels were related to lower overall and CVD mortality [ 7 , 8 ]. Serum sodium showed a U-shaped relationship with mortality [ 9 ], while both hypernatremia [ 10 ] and hyponatremia [ 11 ] were risk factors for death.…”

Section: Introductionmentioning

confidence: 99%

Serum Nutritional Biomarkers and All-Cause and Cause-Specific Mortality in U.S. Adults with Metabolic Syndrome: The Results from National Health and Nutrition Examination Survey 2001–2006

et al. 2023

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Background: There is limited research on the associations between serum nutritional biomarkers and mortality risk in patients with metabolic syndrome (MetS). Existing studies merely investigated the single-biomarker effect. Thus, this study aimed to investigate the combined effect of nutritional biomarker mixtures and mortality risk using the Bayesian kernel machine regression (BKMR) model in patients with MetS. Methods: We included the MetS patients, defined according to the 2018 Guideline on the Management of Blood Cholesterol from the National Health and Nutrition Examination Survey (NHANES) 2001–2006. A total of 20 serum nutritional biomarkers were measured and evaluated in this study. The Cox proportional hazard model and restricted cubic spline models were used to evaluate the individual linear and non-linear association of 20 nutritional biomarkers with mortality risk. Bayesian kernel machine regression (BKMR) was used to assess the associations between mixture of nutritional biomarkers and mortality risk. Results: A total of 1455 MetS patients had a median age of 50 years (range: 20–85). During a median of 17.1-year follow-up, 453 (24.72%) died: 146 (7.20%) caused by CVD and 87 (5.26%) by cancer. Non-linear and linear analyses indicated that, in total, eight individual biomarkers (α-carotene, β-carotene, bicarbonate, lutein/zeaxanthin, lycopene, potassium, protein, and vitamin A) were significantly associated with all-cause mortality (all p-values < 0.05). Results from BKMR showed an association between the low levels of the mixture of nutritional biomarkers and high risk of all-cause mortality with the estimated effects ranging from 0.04 to 0.14 (referent: medians). α-Carotene (PIP = 0.971) and potassium (PIP = 0.796) were the primary contributors to the combined effect of the biomarker mixture. The nutritional mixture levels were found to be negatively associated with the risk of cardiovascular disease (CVD) mortality and positively associated with the risk of cancer mortality. After it was stratified by nutrients, the mixture of vitamins showed a negative association with all-cause and CVD mortality, whereas the mixture of mineral-related biomarkers was positively associated with all-cause and cancer mortality. Conclusion: Our findings support the evidence that nutritional status was associated with long-term health outcomes in MetS patients. It is necessary for MetS patients to be concerned with certain nutritional status (i.e., vitamins and mineral elements).

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Associations of Serum Carotenoids With Risk of Cardiovascular Mortality Among Individuals With Type 2 Diabetes: Results From NHANES

Cited by 86 publications

References 32 publications

Association of serum lycopene concentrations with all-cause and cardiovascular mortality among individuals with chronic kidney disease: A cohort study

Association of serum lycopene concentrations with all-cause and cardiovascular mortality among individuals with chronic kidney disease: A cohort study

TSH levels within the normal range and risk of cardiovascular and all-cause mortality among individuals with diabetes

Serum Nutritional Biomarkers and All-Cause and Cause-Specific Mortality in U.S. Adults with Metabolic Syndrome: The Results from National Health and Nutrition Examination Survey 2001–2006

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