Dietary Antioxidant Indices in Relation to All-Cause and Cause-Specific Mortality Among Adults With Diabetes: A Prospective Cohort Study

Abstract

BackgroundThe potential beneficial effect of individual antioxidants on mortality has been reported. However, the association of overall intakes of dietary antioxidants with all-cause and cause-specific mortality among adults with diabetes remained unclear.MethodsA total of 4,699 US adults with diabetes were enrolled in 2003–2014 in the National Health and Nutrition Examination Survey (NHANES) and followed for mortality until 31 December 2015. The Dietary Antioxidant Quality Score (DAQS) and the Dietary Antioxidant Index (DAI), which indicate the total antioxidant properties, were calculated based on the intakes of vitamins A, C, E, zinc, selenium, and magnesium. The Cox proportional hazards regression models were used to investigate the associations of the DAQS or the DAI with all-cause and cause-specific mortality.ResultsA total of 913 deaths occurred during 27,735 person-years of follow-up, including 215 deaths due to cardiovascular disease (CVD) and 173 deaths due to cancer. The higher intakes of antioxidant vitamins A, E, magnesium, and selenium were associated with lower all-cause mortality. The adjusted hazard ratios (HRs) (95% CIs) comparing the highest DAQS (5–6) to the lowest DAQS (0–2) were 0.70 (0.53–0.92) for all-cause mortality, 0.56 (0.35–0.90) for CVD mortality, and 0.59 (0.33–1.04) for cancer mortality. Consistent inverse associations were found between the DAI and mortality.ConclusionHigher intake of overall dietary antioxidants was associated with lower risk of death from all-cause and CVD in adults with diabetes. Future dietary intervention studies are needed to determine whether increasing overall antioxidant micronutrients intake could prevent premature death among adults with diabetes.

Composite Dietary Antioxidant Index and Plasma Levels of Soluble Klotho: Insights from NHANES

“…Besides, dietary antioxidants were also reported to be associated with mortality, although not consistently. Wang et al observed that higher intakes of antioxidants were associated with reduced mortality risk from all causes and cardiovascular disease in diabetic adults [ 40 ]. According to other studies, higher intakes of magnesium, zinc, selenium, and vitamins A, C, and E were inversely related to reduced mortality risk [ 41 – 43 ].…”

Association between the composite dietary antioxidant index and chronic kidney disease: evidence from NHANES 2011–2018

“…Previous studies demonstrated that high CDAI Food & Function Paper levels reduce the levels of inflammatory factors and lower the risk of various diseases, such as lung cancer, non-alcoholic fatty liver disease, and DM. 3,8,[31][32][33] However, existing evidence of the association between higher dietary antioxidant intake and CKD is limited. This study aimed to address this research gap and provide evidence that adequate antioxidant intake may reduce the incidence of CKD.…”

“…These results are consistent with those of previous studies. 6,8 Although the specific reasons for this finding are unclear, it may be because these individuals have higher levels of oxidative stress, and exogenous antioxidant intake appears to be more protective in those with higher innate or acquired ROS-levels. 34 Our results suggest that people at high risk of CKD may benefit more from overall dietary antioxidant intake.…”

Joint effects between cadmium exposure and dietary antioxidant quality score on osteoporosis and bone mineral density

“…The DAQS is composed of six essential dietary antioxidant micronutrients, namely vitamins A, C, E, Se, Zn and Mg (19) . Each of the six nutrient/mineral intakes was compared with the respective recommended daily intake for US adults.…”

“…Total intakes of each nutrient/mineral were calculated by summing from total daily intake from diet and supplemental intake. DAQS was categorised as three groups: low quality (1–2 score), medium quality (3–4 score) and high quality (5–6 score) (19) .…”