The role of dietary antioxidant index and index of nutritional quality in MS onset: finding from an Iranian population-based incident case–control study

Vitamin, antioxidant and micronutrient supplementation and the risk of developing incident autoimmune diseases: a systematic review and meta-analysis

Background

Autoimmune diseases pose significant health challenges worldwide and affect millions. In recent years, there has been growing interest in exploring preventive strategies through nutritional interventions using vitamins, antioxidants, and micronutrients to reduce the risk of developing autoimmune diseases. However, excessive supplementation has also been associated with toxicity.

Objective

We aim to assess how the intake of vitamins, antioxidants and micronutrients affect the risk of developing autoimmune diseases.

Methods

This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase and Cochrane for controlled studies that evaluated the risk of incident autoimmune diseases after supplementation. Random effects meta-analyses were used for primary analysis.

Results

18 studies were included. Overall meta-analyses observed that vitamin D did not influence the risk of autoimmune diseases (RR=0.99, 95%CI: 0.81-1.20). However, among the different vitamin D dosages, subgroup analysis demonstrated that those who were supplemented with 600-800IU/day may have a statistically significant reduction in risk (RR=0.55, 95%CI: 0.38; 0.82). Systematic review suggested that consumption of most vitamins, micronutrients and antioxidants may not have any effect on the risk of autoimmune diseases. Smoking, age, physical or outdoor activity and diet were significant confounding factors that affected the efficacy of such interventions.

Conclusion

We studied the effect of various vitamins, micronutrients and antioxidants on the risk of developing autoimmune diseases. Our study contributes to the evolving landscape of nutritional immunology, providing a foundation for future research to unravel more definite relationships with supplementation and the development of incident autoimmune diseases.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024504796.

Androgenic alopecia is associated with higher dietary inflammatory index and lower antioxidant index scores

Background

Androgenic alopecia (AGA), the most prevalent hair loss type, causes major psychological distress and reduced quality of life. A definite and safe cure/prevention for this condition is still lacking. The role of oxidative stress and inflammation in AGA pathogenesis prompted us to investigate the association between dietary antioxidant index (DAI) and energy-adjusted dietary inflammatory index (E-DII) with AGA.

Methods

The investigation was designed based on data from 10,138 participants from the Fasa Adult Cohort Study (FACS). DAI and energy-adjusted DII (E-DII) were calculated utilizing a validated 125-item food frequency questionnaire (FFQ). A physician diagnosed AGA. Logistic regression models were utilized to evaluate the association of DAI and E-DII with AGA.

Results

After exclusion, 9,647 participants (44.0% men, mean age: 48.6 ± 9.5 years) consisting of 7,348 participants with AGA entered the analyses. Higher DAI was associated with 10% lower AGA odds, while higher E-DII showed 4% higher AGA odds after adjusting for various confounding variables. However, significant associations were found only among women, and adjusting for metabolic syndrome (MetS) made the E-DII-AGA association insignificant.

Conclusion

Antioxidant-rich diets protect against AGA, while pro-inflammatory diets increase the risk, likely through developing MetS. Patient nutrition is frequently overlooked in clinical practice, yet it plays a crucial role, especially for women genetically predisposed to androgenetic alopecia. Dietary changes, such as reducing pro-inflammatory foods (like trans and saturated fats) and increasing anti-inflammatory options (fruits and vegetables), can help prevent hair loss and mitigate its psychological impacts, ultimately lowering future treatment costs.

Effects of crocin on inflammatory biomarkers and mental health status in patients with multiple sclerosis: A randomized, double-blinded clinical trial

BACKGROUND

Multiple sclerosis (MS), as a demyelinating disease correlated with inflammation and oxidative stress, affects the central nervous system and causes a wide range of complications, including psychiatric disorders. Considering the anti-inflammatory and antioxidant properties associated with the bioactive components of saffron, such as crocin (trans-crocetin bis(β-d-gentiobiosyl) ester), and their potential impact on ameliorating psychiatric symptoms, our study aimed to investigate the effect of crocin on biomarkers of inflammation, oxidative stress, and mental health, e.g., depression and anxiety in individuals with MS.

METHOD

Patients with MS were randomized into two groups, taking either 15 mg crocin tablets twice a day (n = 25; 30 mg/day) or placebo tablets (n = 25) for 8 weeks. The valid and reliable Beck depression and anxiety scale questionnaire was recorded, and fasting blood samples were collected to measure biomarkers, including high-sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), and nitric oxide (NO) at baseline and week 8 following the intervention.

RESULTS

The data analysis using ANCOVA showed that supplementation with crocin for 8 weeks significantly lowered hs-CRP levels (p-value= 0.01). In addition, within-group comparisons showed crocin significantly decreased anxiety (p-value= 0.01). However, crocin did not affect serum MDA and NO after 8 weeks of intervention.

CONCLUSION

Our findings suggest that crocin may keep promise in attenuating inflammation, evidenced by reducing hs-CRP in patients with MS. However, supplementation for 8 weeks may not be sufficient to improve mental health, and future clinical studies with higher sample sizes and various doses and durations are recommended.

Dietary antioxidant status indices may not interact with CETP Taq1B polymorphism on lipid profile and severity of coronary artery stenosis in patients under coronary angiography

The association of CETP Taq1B polymorphism with some metabolic traits is still controversial. The interaction of adherence to dietary indices with this polymorphism on the severity of coronary artery stenosis and serum lipid parameters needs to be investigated. This study aimed to test this hypothesis. This cross-sectional study included 453 patients who were referred from Afshar Hospital of Yazd and undergoing coronary angiography from 2020 to 2021. Dietary intake was evaluated by a 178-item validated and reliable dietary questionnaire. Dietary indices such as dietary antioxidant index (DAI), dietary antioxidant quality score (DAQS), and dietary phytochemical index (DPI) are determined according to dietary guidelines. The Taq1B variant was genotyped by the polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFLP). Two-way ANOVA was used to test the interaction between Taq1B polymorphism and dietary indices. The results of the frequency analysis of Taq1B genotypes showed that 10.4% were B1B1, 72.4% B1B2, and 17.2% B2B2. No significant interaction was found between the Taq1B variant with high adherence to DAQS, DAI, and DPI on total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglyceride (TG) levels, and Gensini score (GS) and Syntax score (SS). In high-adherence dietary indices, lipid profile and coronary artery stenosis scores did not differ significantly in Taq1B genotypes. Due to the insignificant results in this research, further studies are needed to investigate the role of Taq1B SNP in modulating dyslipidemia and the severity of the CAD in interaction with dietary indices.

Female infertility and dietary antioxidant index (DAI); a case-control study

BACKGROUND

Adequate intake of natural antioxidants may improve female fertility. The aim of this study was to examine the link between female infertility and dietary antioxidant index (DAI).

METHODS

This case-control study was conducted on 125 women with recently diagnosis of reduced ovarian reserves (AMH < 1.1) as the case group and 125 women with normal ovarian reserve as the control group in Rasht, Iran. The amount of food intake was assessed using the food frequency questionnaire (FFQ) and the DAI was calculated to estimate the antioxidant capacity of the diet.

RESULTS

Regarding dietary intake, the infertile women had a lower intake of potassium (2789.25 ± 777 vs. 2593.68 ± 443 mg/d, P = 0.02), magnesium (204.12 ± 66 vs. 189.73 ± 34 mg/d, P = 0.03), copper (0.93 ± 0.40 vs. 0.82 ± 0.20 mg/d, P < 0.01), vitamin C (133.99 ± 46 vs. 122.62 ± 24 mg/d, P = 0.02), and fiber (14.53 ± 3 vs. 13.44 ± 2 g/d, P < 0.05), and a higher intake of cholesterol (205.61 ± 58 vs. 227.02 ± 46 mg/d, P < 0.01) than the control group (All P < 0.05). The DAI was negatively associated with infertility (OR: 0.94, CI 95%: 0.88-0.97, P = 0.03). The association remained significant after adjustments for age, BMI, the underlying diseases, fertility frequency, IVF failure, and calorie intake.

CONCLUSION

Following an antioxidant-rich diet may reduce the risk of infertility. More longitudinal studies are warranted to confirm these results and discover the underlying mechanisms.

Associated between Dietary Antioxidant Index (DAI) and Odds of Breast Cancer and Correlation between DAI with Pathobiological Markers: Hospital-Based Incidence Case-Control Study

Background: The relationship between dietary antioxidants and breast cancer (BrCa) has been investigated in various studies. As a limitation, they generally investigate the relationship between one specific antioxidant and the risk/odds of BrCa, and synergistic or inhibitory effects are less considered. Dietary antioxidant index (DAI) is a reliable nutritional tool that evaluates total nutritional antioxidant capacity and is validated with serum total antioxidant capacity (TAC) and Malondialdehyde (MDA). Our study aimed to investigate the association between the DAI and the odds of BrCa and the correlation between the DAI and pathobiological markers. We hypnotized a correlation between DAI and pathobiological markers, and there is an association between DAI and the odds of BrCa.Methods: Our study included 145 incidence cases of BrCa and 148 hospital-based controls. Controls were randomly selected from patients attending the same center and were frequency-matched on age (±10 years). DAI was calculated based on a valid semi-quantitative 168-item food frequency questionnaire data. DAI standardizes intake of major dietary antioxidants, including vitamins A, E, C, selenium, zinc, and magnesium, and presents them as summarized scores.Results: Modeling with multivariable regressions adjusting for major confounders including age, education, body mass index, occupation, alcohol, smoking, pregnancy, history of cancer, menarche age, metabolic equivalent of task, hormone replacement therapy, and total energy intake, there was a significant association between odds of BrCa and DAI (odds ratio = 0.18; 95% confidence interval:0.09-0.37; p-value= <0.01). After multiple controls, there was a significant and weak reverse correlation between DAI and the number of lymph node(s) (correlation coefficient= -.140; p-value = 0.05).Conclusion: Our study supports the hypothesis that dietary antioxidants intake is associated with a reduced odds of BrCa. Evidently, DAI can reveal these relationships better than a single study of antioxidants. However, further studies are needed to confirm or refute these results.

Overview of diet and autoimmune demyelinating optic neuritis: a narrative review

This review summarizes the cellular and molecular underpinnings of autoimmune demyelinating optic neuritis (ADON), a common sequela of multiple sclerosis and other demyelinating diseases. We further present nutritional interventions tested for people with multiple sclerosis focusing on strategies that have shown efficacy or associations with disease course and clinical outcomes. We then close by discuss the potential dietary guidance for preventing and/or ameliorating ADON.

The immunomodulatory effects of all-trans retinoic acid and docosahexaenoic acid combination treatment on the expression of IL-2, IL-4, T-bet, and GATA3 genes in PBMCs of multiple sclerosis patients

OBJECTIVES

Multiple sclerosis (MS) is a potentially disabling autoimmune disease of the central nervous system. Neither the pathogenesis nor the effectiveness of treatment of MS has been fully understood. This in vitro trial evaluated the beneficial immunomodulatory effects of single and combined treatments of all-trans retinoic acid (ATRA) and docosahexaenoic acid (DHA) on the peripheral blood mononuclear cells (PBMCs) of relapsing-remitting MS (RRMS) patients who were receiving interferon beta (IFN-β).

METHODS

The PBMCs of 15 RRMS patients were isolated, cultured, and treated with single and combined treatments of ATRA and DHA. The expressions of IL-2, IL-4, T-bet, and GATA3 genes were evaluated using real-time PCR.

RESULTS

The results showed that a single treatment of ATRA could significantly suppress the gene expression of the pro-inflammatory cytokine, IL-2 (P < 0.05), and related transcription factor, T-bet (P < 0.001). The gene expression level of the anti-inflammatory cytokine, IL-4, and its transcription factor, GATA3, were not significantly changed. The expression of IL-2 and T-bet genes was significantly decreased in combination treatments of ATRA and DHA (P < 0.001). Significant suppression of IL-2 and T-bet (P < 0.001) was observed in ATRA and DHA combination therapy with half doses of their single treatment, which suggested a synergistic effect of these components.

DISCUSSION

Co-administration of vitamin A and DHA, an omega-3 fatty acid derivative, may exert a synergistic effect in modulating the immune system in MS patients; however, more studies are needed to evaluate the exact effects and mechanism of their actions on the immune cells.

The Association between Index of Nutritional Quality (INQ) and Obesity: Baseline Data of Kharameh Cohort

Obesity is an increasing problem that can lead to noncommunicable diseases. The role of dietary factors on one's obesity is confirmed in many studies. One nutritional approach that can be used for assessment of the foods and diets is the Index of Nutritional Quality (INQ). Our study is aimed at exploring the association between INQ and obesity. Our hypothesis is that enriched and high-quality diets reduce the risk of overweight or obesity. This study was carried out on 6248 overweight and obese participants, from whom 4356 (69.7%) and 1892 (30.3%) were overweight and obese, respectively. To assess the dietary intake for the participants, a valid food frequency questionnaire (FFQ) with 130 food items was utilized. The analysis revealed an inverse association between the overweight and the INQ of iron, thiamin, riboflavin, B6, folate, zinc, magnesium, calcium, and vitamin C and E. For the obese group, this inverse association was found for iron, B6, folate, zinc, magnesium, calcium, and vitamin C and E. These results approved our hypothesis that a rich nutrition diet may lead to a lower risk of obesity.

The association between dietary inflammatory index, dietary antioxidant index, and mental health in adolescent girls: an analytical study

BACKGROUND

Diet is considered as one of the modifiable factors that appears to exert a vital role in psychological status. In this way, we designed this study to examine the association between dietary inflammatory index (DII), dietary antioxidant index (DAI), and mental health in female adolescents.

METHODS

This cross-sectional study included 364 female adolescents selected from high schools in the five regions of Tabriz, Iran. A 3-day food record was used to extract the dietary data and calculate DII/DAI scores. DII and DAI were estimated to assess the odds of depression, anxiety, and stress based on the Depression Anxiety Stress Scales-21. Adjusted relationships of the DII and DAI with depression, anxiety, and stress were determined using multiple regression after adjusting for age, energy intake, BMI, family income and mother and father education. Overweight was defined as body mass index (BMI)-for-age >  + 1 z-score relative to world health organization standards.

RESULTS

Depression, anxiety, and stress were observed in 21.4%, 26.6%, and 25.7% of subjects, respectively. The percentage of overweight among adolescents was 19.4%. The association between DII and score of mental health profile was positive among subjects in the third tertile of DII compared to subjects in the first tertile. However, this association was not statistically significant after adjusting for confounding variables. Moreover, there was a significant inverse association between DAI and depression and anxiety; and a statistically insignificant association between DAI and stress after adjusting for confounders.

CONCLUSIONS

Our results highlighted the importance of a healthy and anti-inflammatory diet on mental health in female adolescents. Therefore, modifying unhealthy dietary habits are likely to be effective in the management of psychosocial disorders.

Dietary variety relates to gut microbiota diversity and abundance in humans

PURPOSE

We aim to investigate the relationship between gut microbiota and dietary variety in a Chinese population using Dietary Variety Score (DVS), an index of dietary variety, as little has studied the relationship of dietary variety and gut microbiota in a general population.

METHODS

In this cross-sectional study, recruited participants were conducted with face-to-face interview to collect information on 24-h food intake and dietary consumption using a valid food frequency questionnaire. Subjects (n = 128) were divided as high and low DVS groups by the median of DVS after rigorously matching for confounding factors. The gut microbiota was assessed by 16S rRNA sequencing and the correlations between key phylotypes and DVS, Index of Nutritional Quality (INQ) and clinical indices were examined using generalized linear model in negative binomial regression.

RESULTS

Higher score of DVS, INQVB6, INQVE and INQZn exhibited higher α-diversity. DVS was correlated with INQ and six genera. Among the DVS-correlated genera, Turicibacter, Alistipes and Barnesiella were positively correlated with INQVE, INQZn and INQCu, individually or in combination, while Cetobacterium was negatively correlated with INQCu, INQZn and INQVE. The abundance of Coprococcus and Barnesiella increased with the elevated cumulative scores of INQVE, INQVB6 and INQZn. The combination of Alistipes, Roseburia and Barnesiella could moderately predict dietary variety status.

CONCLUSION

Higher DVS was correlated with higher microbial diversity and more abundance of some potentially beneficial bacteria but with less some potentially pathogenic bacteria. A high variety dietary, therefore, should be recommended in our daily life.

The correlation between serum inflammatory, antioxidant, glucose handling biomarkers, and Dietary Antioxidant Index (DAI) and the role of DAI in obesity/overweight causation: population-based case-control study

BACKGROUND

Obesity is a multifactorial disease, and about 40% of world adults are overweight, and about 20% are obese. Diet is one of the most important factors in the causality of obesity. The interactions between the diet and gut microbiota or chronic inflammation pathways highlight the importance of its various aspects in the incidence and prevalence of obesity. At the same time, diet is a combination of several antioxidants that are needed together for the body's antioxidant system. The Dietary Antioxidant Index (DAI) is a valid nutritional tool, and its correlation has been studied concerning total antioxidant capacity and malondialdehyde. The study aimed to examine the relationship between the DAI and the odds of obesity. We hypothesized that a higher DAI score indicating a predominantly antioxidant diet has a protective effect against odds of obesity.

METHODS

In this population-based case-control study, 812 participants with a higher body mass index (BMI) than 25 were selected as the case group. Also, 793 participants with BMI in the range of 17.9-24.9 were selected as the control group. A valid and reliable 124-item food frequency questionnaire (FFQ) was used to assess dietary intake. Based on FFQ data, we summed up the standardized intake of the major dietary antioxidants, including vitamin A, E, C, selenium, zinc, and manganese, to calculate DAI.

RESULTS

In a multivariable adjusting model, there was a significant association between DAI (as a continuous variable) and BMI (odds ratio (OR) = 0.95; 95% CI: 0.92-0.99; P value = 0.02). Also, there was a significant association between DAI (as a categorized variable) and body surface area with multivariable adjusting model (OR = 0.79; 95% CI: 0.64-0.98; P value = 0.04).

CONCLUSION

In conclusion, the DAI can accurately predict some serum antioxidant and anti-inflammatory levels along with glucose handling markers.

Index of Nutritional Quality (INQ) and the Risk of Obesity in Male Adolescents: a Case-Control Study

Dietary factors may play a key role in the etiology of obesity. The Index of Nutritional Quality (INQ) provides a comprehensive overview of the nutrients content of the diet. This study aimed to investigate the association between INQ and obesity in male adolescents. We hypothesize that receiving a high-quality diet reduces the risk of overweight or obese. This study was carried out on 214 obese/overweight as the case group and 321 normal-weight male adolescents as the control group. Dietary intakes of the participants were collected using a food frequency questionnaire (FFQ). The FFQ-derived dietary data were used to calculate the INQ scores. After adjustments for age and height, an inverse association was found between obesity and INQ of iron, vitamin B6, and magnesium, and a positive association was found between obesity and INQ of zinc (all P < 0.05). After further adjustments for nutritional knowledge and calorie intake, an inverse association was observed between obesity and INQ of vitamin C, iron, vitamin B6, pantothenic acid, selenium, and magnesium (all P < 0.05). The positive association of obesity and INQ of zinc remained significant after adjustments. A higher intake of vitamin C, iron, vitamin B6, pantothenic acid, selenium, and magnesium and a lower intake of zinc may be protective against adolescent obesity. More longitudinal studies are required to investigate the relationship between these nutrients and obesity.

The Association Among Maternal Index of Nutritional Quality, Dietary Antioxidant Index, and Odds of Miscarriage Incidence: Case-Control Study

OBJECTIVE

Miscarriage is a pregnancy condition in which the fetus or embryo naturally dies before being able to survive independently. According to studies, diet and dietary factors are associated with the risk of miscarriage (pregnancies <20 weeks). A 168-item semi-quantitative feed frequency questionnaire was used to estimate the Dietary Antioxidant Index (DAI) and the Index of Nutritional Quality (INQ). We aimed to assess the relationship between INQ and DAI with odds of miscarriage.

METHOD

In summary, 135 Iranian women with a history of three or more miscarriages were included. We calculated the INQ using the following formula: INQ = consumed amount of a nutrient per 1,000 kcal/Recommended Dietary Allowance of that nutrient per 1,000 kcal. We standardized each dietary vitamins/minerals by subtracting the global mean and dividing the result by the universal standard deviation to compute DAI. We computed the DAI by summing up the standardized intakes of these vitamins and minerals and equal weight.

RESULTS

Regression models were used to extract the odds ratios (ORs) and 95% confidence intervals (CIs) in crude and multivariate adjustments. Controls significantly had higher INQ of vitamin B12, niacin, vitamin D, vitamin E, vitamin C, and zinc. Modeling INQs of vitamin D (OR: 0.004, 95% CI, 0.00-0.025) and B12 (OR: 0.04, 95% CI, 0.005-0.41) as a continuous variable showed a significant and protective effect in multivariate adjustment. Modeling DAI as a categorical variable showed a significant protective effect (OR_{DAI<0.054vs.DAI ≥0.054} = 0.43, 95% CI, 0.20-0.91).

CONCLUSIONS

Recommending a diet rich in antioxidants such as vitamin E, C, zinc, and selenium and a quality diet containing vitamins B12 and D can be considered an effective strategy to reduce the odds of miscarriage in women with a history of recurrent miscarriage.

The association between dietary antioxidant index (DAI) and nonalcoholic fatty liver disease (NAFLD) onset; new findings from an incident case-control study

BACKGROUND

Evidence suggests an increasing global trend in non-alcoholic fatty liver disease (NAFLD) prevalence. Researchers have noted the importance of the role of dietary antioxidants in reducing the incidence of NAFLD. The dietary antioxidant index (DAI) is a valid indicator that considers the -diet's total antioxidant properties. The present study was designed and conducted to investigate the relationship between DAI and NAFLD. We hypothesized that there is a link between the DAI and the NAFLD.

METHODS

This case-control study included 295 patients with NAFLD and 704 controls. The patients' dietary intake was assessed through a valid and reliable semi-quantitative food frequency questionnaire. We standardized each of vitamin A, C, E, and selenium, manganese, and zinc by subtracting the global mean and dividing by the global SD to calculate the DAI.

RESULTS

Subjects with DAI score -0.46 < were at higher odds of having NAFLD compared to subjects with DAI -0.46 ≥ (ORDAI<-0.46/≥-0.46 = 0.55; 95% CI = 0.41-0.73). After adjustment for age, gender, and total energy intake (model B) a reverse and significant association was seen (ORDAI<-0.46/≥-0.46 = 0.57; 95% CI = 0.39-0.82).

CONCLUSION

The role of antioxidants in reducing the odds of NAFLD is fundamental. Taking antioxidants such as vitamins A, E, C, zinc, selenium, and manganese through food can effectively reduce NAFLD odds. On the other hand, studies should examine DAI's sensitivity and specificity in various settings and outcomes to use it in clinical work.