Relative Validity of Dietary Total Antioxidant Capacity for Predicting All-Cause Mortality in Comparison to Diet Quality Indexes in US Adults

Fruit and Vegetable Consumption and Risk of All-Cause and Cause-Specific Mortality in Individuals With Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies

CONTEXT

Controversy exists regarding the association between fruit and vegetable consumption and all-cause and cause-specific mortality among individuals with type 2 diabetes (T2D).

OBJECTIVE

This study aims to inform dietary recommendations and add to the body of evidence by providing a thorough investigation of the association between the consumption of fruits and vegetables and the mortality risk in patients with T2D. The literature on this association was evaluated by a comprehensive systematic review and meta-analysis.

DATA SOURCES

PubMed, Scopus, and Web of Science were searched up to 29 June 2024.

DATA EXTRACTION

Prospective cohort studies involving participants with diabetes aged over 18 years reporting risk estimates for the association between total fruit and vegetable intake and all-cause or cause-specific mortality (including cardiovascular disease [CVD], coronary heart disease, and stroke) were included.

DATA ANALYSIS

A random-effects approach was applied for combining risk estimates, and dose-response relationships were assessed using restricted cubic splines. Overall, 9 studies with 75 082 participants and 7590 deaths were included. Compared with the lowest intake, the highest fruit intake was associated with a decreased risk of all-cause (hazard ratio [HR]: 0.82; 95% CI: 0.75, 0.90; n = 6) and CVD (HR: 0.90; 95% CI: 0.84, 0.97; n = 4) mortality. The highest vegetable intake was also related to reduced all-cause (HR: 0.85; 95% CI: 0.73, 0.98; n = 6) and CVD (HR: 0.97; 95% CI: 0.94, 0.99; n = 2) mortality risk. An additional 200 g/day of fruit and vegetable consumption was associated with a 26% and 14% lower risk of all-cause mortality.

CONCLUSION

This meta-analysis indicates an inverse association between fruit and vegetable intake and mortality from all causes and CVD in T2D patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42024571094.

Adherence to Mediterranean diet and female urinary incontinence: Evidence from the NHANES database

BACKGROUND

Urinary incontinence (UI) is a common condition in female. Oxidative stress and inflammation levels play important roles in UI progression. Mediterranean diet (MD) as a healthy anti-inflammatory dietary pattern has been reported to be associated with several inflammatory diseases. This study aimed to assess the association between the adherence to Mediterranean diet (aMED) and female UI.

METHODS

Data of study women aged ≥18 years old and diagnosed as stress UI and urgency UI were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Dietary intake information was obtained by 24-h dietary recall interview. Covariates included sociodemographic information, physical examination, and history of diseases and medication were extracted from the database. The weighted univariable and multivariate logistic regression models were used to assess the association between aMED and different types of UI, with odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analysis were further evaluated this association based on different age, body mass index (BMI), neutrophil to lymphocyte ratio (NLR), depression and smoking.

RESULTS

Totally, 13,291 women were included, of whom 5,921 (44.55%) had stress UI, 4276 (32.17%) had urgency UI and 2570 (19.34%) had mixed UI. After adjusted all covariates, high aMED score was associated with the lower odds of urgency (OR = 0.86, 95%CI: 0.75-0.98) and mixed UI (OR = 0.84, 95%CI: 0.70-0.99), especially in female, aged 45-60 years old, NLR ≥1.68 and had smoking history. No relationship was found between the aMED and stress UI (P >0.05).

CONCLUSION

Greater aMED was connected with the low odds of urgency UI and mixed UI among female. Adherence to an anti-inflammatory diet in daily life are a promising intervention to be further explored in female UI.

The association of dietary total antioxidant capacity with migraine attack frequency in women

AIMS

There is substantial evidence considering oxidative stress as one of the migraine pathogeneses. It seems higher dietary antioxidant intake could modulate migraine symptoms in sufferers. Therefore, we assessed the relationship between the dietary total antioxidant capacity (TAC) and migraine attack frequency.

METHOD

289 volunteer women with migraine were recruited. The usual participants' dietary intakes were collected using a validated food frequency questionnaire. The dietary total antioxidant capacity of women was determined via three different indices including dTAC, DAI, and DAQs. dTAC was calculated based on the USDA oxygen radical absorbance capacity (ORAC) database. The dietary intakes of vitamins A, E, C, selenium, zinc, and manganese were applied for calculating the DAI (Dietary Antioxidant Index) and DAQs (Dietary Antioxidant Quality score). The multivariate-adjusted ordinal regression was used to assess the relation of three indices scores with migraine attack frequency.

RESULTS

a lower score of dTAC was associated with a higher attack frequency [OR (95%CI) model3= 1.97(1.1-3.54), P-value= 0.02]. The women with DAQs= 1 and 3 had significantly higher migraine attack frequency compared to women with DAQs = 5 [DAQs = 1: OR (95%CI) model 3= 8.59 (1.06- 69.72), P-value = 0.04] and [DAQs = 3: OR (95%CI) model 3= 2.09 (1.13- 3.85), P-value= 0.02]. Moreover, the trend of changes among the DAQs and dTAC levels was significant (P-values for trend < 0.05). There was no significant association between tertiles of DAI and migraine attack frequency (P-value> 0.05).

CONCLUSION

A high-quality diet in terms of antioxidant capacity is related to lower attack frequency in migrainous women.

Sex differences in association of healthy eating pattern with all-cause mortality and cardiovascular mortality

BACKGROUND

Although the Healthy Eating Index (HEI) is widely recommended to reduce the risk of cardiovascular disease and all-cause death, there are significant differences in physiological and nutritional factors between the sexes. The potential impact of sex on adult dietary health is still poorly understood. The study was designed to assess whether the health benefits of diet differed by sex.

METHODS

In a prospective study of 39,567 U.S. adults (51.2% female, age 46.8 ± 17.6 years), we examined sex-specific, multivariable-adjusted associations of HEI with all-cause mortality and cardiovascular disease mortality. Restricted cubic splines (RCS), subgroup analysis, propensity score matching (PSM), random forest feature importance, and sensitivity analysis were also used.

RESULTS

During 328,403 person-years of follow-up, a total of 4754 all-cause deaths were recorded, including 1481 cardiovascular deaths. Compared to the lowest quartile of HEI, the all-cause mortality rate of females and males in the highest quartile array decreased by 34% (HR 0.66 [95% CI 0.55-0.8]) and 15% (HR 0.85 [95% CI 0.73-0.99]), respectively. The restricted cubic spline showed a linear inverse association between baseline HEI and all-cause mortality and CVD mortality, with similar sex-specific results. Similarly, component scores were sex-specific for mortality risk, with females benefiting more from diet. The benefits of dairy products, vegetables, and sodium scores on the risk of all-cause death were higher in males and females. However, the benefits of vegetable, sodium, and fatty acid scores on the risk of cardiovascular death were different.

CONCLUSIONS

In the adult population of the U.S., there are more opportunities for females to reduce the risk of all-cause mortality and cardiovascular mortality from the same dose of healthy dietary intake than males. These findings could reduce the risk of death by motivating the population, especially females, to consume healthy dietary components, especially vegetables and dairy products.

Association between dietary antioxidant capacity and type 2 diabetes mellitus in Chinese adults: a population-based cross-sectional study

BACKGROUND

Higher intakes of dietary antioxidants have been linked to a lower type 2 diabetes mellitus (T2DM) risk. However, few studies have comprehensively examined the overall dietary antioxidant capacity, assessed by dietary antioxidant quality scores (DAQS) and dietary total antioxidant capacity (DTAC), related to T2DM risk, especially in populations consuming relatively monotonous diets. This study aimed to evaluate the associations of DAQS, DTAC, and T2DM among rural Chinese adults.

METHODS

Data from 12,467 participants from the Natural Population Cohort of Northwest China: Ningxia Project was analyzed. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire. DAQS were calculated based on vitamins A, C, and E, zinc (Zn), and selenium (Se) intake. DTAC was estimated using the ferric-reducing ability of plasma assay. Logistic regression models were used to evaluate the associations of DAQS and DTAC with T2DM risk. Restricted cubic splines were used to assess potential non-linear relationships between DTAC and T2DM.

RESULTS

T2DM was observed in 1,238 (9.9%) participants. After adjusting for confounders, compared to the lowest tertiles (T1) of DAQS, the odds ratios (ORs) for T2DM were 1.03 (95% CI 0.82-1.30) in T2 and 0.85 (95% CI 0.68-1.06) in T3 (P = 0.010). Compared to T1, the ORs for T2DM in the highest T3 were 0.78 (95% CI 0.67-0.91, P-trend = 0.008) for vitamin A, 1.34 (95% CI 1.15-1.56, P-trend < 0.001) for vitamin E, 0.83 (95% CI 0.71-0.97, P-trend = 0.007) for Se, and 0.86 (95% CI 0.74-1.01, P-trend = 0.033) for Zn. Compared to the lowest quartile(Q1) of DTAC, the OR in the highest Q4 was 0.96 (95% CI 0.80-1.17, P-trend = 0.024) for T2DM. A non-linear relationship was observed between DATC and T2DM.

CONCLUSION

Higher DAQS and DATC were associated with a lower T2DM risk, suggesting that consuming antioxidant-rich foods may reduce the T2DM risk.

The Healthy Eating Index-2015 and All-Cause/Cause-Specific Mortality: A Systematic Review and Dose-Response Meta-Analysis

This meta-analysis was undertaken to determine the predictive value of Healthy Eating Index (HEI)-2015 in all-cause, cancer-cause, and cardiovascular disease (CVD)-cause mortality. This review was registered with PROSPERO as CRD42023421585. PubMed and Web of Science were searched for articles published by September 15, 2023. The hazard ratio (HR) was calculated with exact confidence intervals (CIs) of 95%. Statistical heterogeneity among studies was measured by Cochran's Q test (χ2) and the I2 statistic. Eighteen published studies were finally identified in this meta-analysis. The results showed that the HEI-2015 was associated with all-cause mortality either as a categorical variable (HR: 0.80; 95% CI: 0.79, 0.82) or continuous variable (HR: 0.90; 95% CI: 0.88, 0.92). The HEI-2015 was also associated with cancer-cause mortality as categorical variable (HR: 0.81; 95% CI: 0.78, 0.83) or continuous variable (HR:  0.90; 95% CI: 0.81, 0.99). The categorical HEI-2015 was also independently correlated with decreasing CVD-cause mortality (HR: 0.81; 95% CI: 0.75, 0.87). A nonlinear dose-response relation between the HEI-2015 and all-cause mortality was found. In the linear dose-response analysis, the risk of mortality from cancer decreased by 0.42% per 1 score increment of the HEI-2015 and the risk of CVD-cause mortality decreased by 0.51% with the increment of the HEI-2015 per 1 score. Our analysis indicated a significant relationship between the HEI-2015 and all-cause, cancer-cause, and CVD-cause mortality.

Physical activity modifies the association of the composite dietary antioxidant index with all-cause mortality in the US osteoarthritis population

Background

It remains unclear how antioxidant intake affects all-cause mortality in osteoarthritis (OA) patients. In this prospective cohort study, we aim to explore the association of the Composite Dietary Antioxidant Index (CDAI) with all-cause mortality and investigate the interaction of physical activity (PA) and CDAI on all-cause mortality in OA populations.

Methods

A total of 3,197 adults with OA in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018 were included in this study. Death outcomes were obtained from National Death Index (NDI) records. Multivariable Cox regression analyses with cubic spines were applied to estimate the association of CDAI with all-cause mortality. The interaction between CDAI and PA on all-cause mortality was further assessed in stratified analysis and interaction tests.

Results

The hazard ratios for all-cause mortality were 0.95 (0.77-1.17) for Q2, 0.75 (0.59-0.97) for Q3, and 0.71 (0.55-0.92) for Q4 (P for trend <0.001), compared with the lowest quartile of CDAI. A negative linear association was found between CDAI and all-cause mortality. In the stratified analyses, CDAI was negatively associated with all-cause mortality in the insufficient PA group. While in the low and sufficient PA group, there were nonlinear relationships of CDAI with all-cause mortality.

Conclusion

A negative linear relationship was observed between CDAI and all-cause mortality in OA patients, and this association was significantly modified by PA. Higher intake of dietary antioxidants might be the interventional objective to reduce the risk of all-cause mortality in the US OA population.

Meal timing of dietary total antioxidant capacity and its association with all-cause, CVD and cancer mortality: the US national health and nutrition examination survey, 1999-2018

BACKGROUND

The association of the meal timing of dietary total antioxidant capacity (DAC) with mortality is unclear. We aimed to investigate the association between the meal timing of DAC and all-cause, cardiovascular disease (CVD), and cancer mortality in general adult populations.

METHODS

A total of 56,066 adults who participated in the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 were recruited for this study. Dietary intake (quantity and timing) was evaluated by nonconsecutive 24-h dietary recalls. The main exposure variables were the DAC across three meals (total, breakfast, lunch, and dinner; without coffee) and the difference between dinner and breakfast DAC (Δ = dinner-breakfast; without coffee). The outcomes were all-cause, CVD, and cancer mortality. The adjusted hazard ratios [aHRs] and 95% confidence intervals [CI] were imputed by Cox proportional hazards regression.

RESULTS

Among the 56,066 participants, there were 8566 deaths from any cause, including 2196 from CVD and 1984 from cancer causes. Compared to participants in the lowest quintiles of the total DAC, those in the highest quintiles had 34% and 27% decreased risks of all-cause and CVD mortality, respectively (all-cause mortality: aHRs 0.66 [95% CI 0.57-0.76]; CVD mortality: aHRs 0.73 [95% CI 0.57-0.94]). More importantly, participants in the highest quintiles of the dinner DAC, but not those in that of breakfast or lunch, had a 24% decrease in all-cause mortality (aHRs 0.76 [95% CI 0.67-0.87]) compared with those in the lowest quintiles. Inverse associations were further confirmed for Δ DAC (aHRs 0.84 [95% CI 0.74-0.96]). Above associations did not change when including DAC from snacks or tea. Mediation analysis showed that the total associations of total, dinner or Δ DACs with reduced all-cause mortality were 24%, 13% and 6%, respectively, mediated by serum CRP. Additionally, all-cause mortality was decreased by 7% in models replacing 10% breakfast DAC (aHRs 0.93 [95% CI 0.9-0.97]) with an equivalent proportion of dinner DAC. For cancer mortality, no statistical significance was detected in the adjusted models.

CONCLUSIONS

The findings emphasize the putative beneficial relationship of a diet rich in antioxidants and meal timing on serum CRP and all-cause mortality.

Dietary Total Antioxidant Capacity, a Diet Quality Index Predicting Mortality Risk in US Adults: Evidence from the NIH-AARP Diet and Health Study

Dietary total antioxidant capacity (TAC) is an index representing the total antioxidant power of antioxidants consumed via the diet. This study aimed to investigate the association between dietary TAC and mortality risk in the US adults using data from the NIH-AARP Diet and Health Study. A total of 468,733 adults aged 50-71 years were included. Dietary intake was assessed using a food frequency questionnaire. Dietary TAC from diet was calculated from antioxidants including vitamin C, vitamin E, carotenoids, and flavonoids, and TAC from dietary supplements was calculated from supplemental vitamin C, vitamin E, and beta-carotene. During a median follow-up of 23.1 years, 241,472 deaths were recorded. Dietary TAC was inversely associated with all-cause (hazard ratio (HR) for quintile 5 vs. quintile 1: 0.97, 95% confidence interval (CI): 0.96-0.99, p for trend < 0.0001) and cancer mortality (HR for quintile 5 vs. quintile 1: 0.93, 95% CI: 0.90-0.95, p for trend < 0.0001). However, dietary supplement TAC was inversely associated with cancer mortality risk only. These findings indicate that consuming a habitual diet high in antioxidants may reduce the risk of all-cause and cancer mortality and TAC from foods might confer greater health benefits than TAC from dietary supplements.

Validation and Comparison of Two Dietary Indexes for Predicting Nonalcoholic Fatty Liver Disease in US Adults

BACKGROUND

Two indexes have been used to describe dietary inflammatory potential: the experiment-based dietary total antioxidant capacity (TAC) and the literature-derived dietary inflammatory index (DII). How robustly each index represents dietary inflammatory potential and the risk of nonalcoholic fatty liver disease (NAFLD) has not yet been established.

OBJECTIVES

We investigated the relation between dietary inflammatory potential and NAFLD, and compared the abilities of the TAC and DII scores to predict NAFLD in US adults.

METHODS

Cross-sectional data from 12,410 participants aged 20-80 y in the NHANES from 2011 to 2018 were identified. TAC and DII scores were calculated using 2 d of 24-h dietary recall data. We examined the association between dietary index and risk of NAFLD using linear and logistic regression models.

RESULTS

Higher energy-adjusted TAC (E-TAC) and inversely energy-adjusted DII (IE-DII) scores (both representing more anti-inflammatory diets) were associated with lower hepatic steatosis index (HSI) and US fatty liver index (USFLI) values after adjusting for potential covariates, and the association for each SD increase in the IE-DII was stronger than the E-TAC (β estimates for HSI: -0.39 compared with -0.25; P-difference = 0.036). In modeling the risk of NAFLD, we observed that participants with IE-DII scores in the highest quartile had the lowest ORs for NAFLD as assessed by either the HSI (OR: 0.77; 95% CI: 0.62, 0.96; P-trend = 0.023) or USFLI (OR: 0.48; 95% CI: 0.35, 0.68; P-trend <0.0001). TAC scores were also associated with NAFLD as assessed by the USFLI.

CONCLUSIONS

An anti-inflammatory diet is beneficial for reducing the risk of NAFLD in US adults. The DII is a stronger predictor of hepatic measures than the TAC, and we recommend that future hepatic health studies use the DII to estimate dietary inflammatory potential.

Composite dietary antioxidant index negatively correlates with osteoporosis among middle-aged and older US populations

OBJECTIVE

To assess whether the composite dietary antioxidant index (CDAI) is associated with osteoporosis (OP) in middle-aged and older US populations.

METHODS

We conducted a cross-sectional survey and identified individuals aged 40-85 years (n=11,664) from secondary datasets from the 2007-2010, 2013-2014, and 2017-2018 National Health and Nutrition Examination Survey (NHANES). Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD), and OP was defined as a BMD T-score ≤-2.5 at the femoral neck or lumbar spine. The CDAI score was calculated based on dietary data from the first NHANES 24-hour dietary recall. Multivariate logistic regression models were used to evaluate the association between CDAI and OP.

RESULTS

Among the 11,664 participants, the average age was 60.3 (11.8), 5,898 (50.6%) were female, and 925 (7.9%) had OP. The median CDAI was -2.0 (interquartile range, -6.9 to 4.2). After adjusting for age, sex, race, family income, body mass index, physical activity, calorie intake, estimated glomerular filtration rate, smoking and drinking status, hypertension, and diabetes, the CDAI was associated with OP (odds ratio (OR), 0.98; 95% CI: 0.96-0.99). Participants in the highest CDAI quantile were at low risk of osteoporosis (OR, 0.61; 95% CI: 0.44-0.85) versus those in the lowest quantile. Moreover, this association was stable in the subgroup and sensitivity analyses.

CONCLUSION

Dietary antioxidant ability assessed by using the CDAI was inversely associated with OP among US adults aged 40-85 years.

Protein-to-carbohydrate ratio is informative of diet quality and associates with all-cause mortality: Findings from the National Health and Nutrition Examination Survey (2007-2014)

Background

Dietary protein and carbohydrate intake and health outcomes have received extensive attention in recent years. However, the nutritional context in which these associations occur is less studied.

Objectives

We aimed to examine the dietary context associating protein-to-carbohydrate ratio and all-cause mortality in US adults.

Methods

Data from 17,814 adults enrolled in the 2007-2014 NHANES was analyzed. Information on mortality was obtained from the US mortality registry updated in December 2015. Diet quality was assessed using the Healthy Eating Index (HEI) and Total Nutrients Index (TNI). ANCOVA was used to test the mean differences in HEI and TNI scores across %E P:C quintiles. Linear regression examined the association of HEI and TNI with %E P:C. Cox proportional hazards regression evaluated the association between %E P:C and all-cause mortality. A restricted cubic spline examined the non-linear relationship between %E P:C and death.

Results

Low %E P:C was associated with lower HEI and TNI scores while higher %E P:C was associated with healthier HEI and TNI scores. HEI and TNI were positively associated with %E P:C (β = 0.22, 95% CI: 0.19-0.25, and β = 0.16, 95% CI: 0.14-0.18), respectively. Low %E P:C was associated with an increased risk of death from all-cause. The higher HRs (95% CIs) of all-cause mortality were 1.97(1.46-2.65), and 7.35 (2.57-21.03) in the second quintile for the age-sex-ethnicity model, and the fully adjusted model, respectively. There was a significant reverse U-shape relationship between %E P:C and all-cause mortality with P, non-linearity < 0.001.

Conclusion

This study indicates that a low %E P:C that gives emphasis to unhealthy foods increases the risk of death. Hence, it would be useful to consider the complete diet associated with protein intake when making dietary recommendations for populations.

Decrease of glutathione peroxidase in arrhythmic cardiac pathology in young individuals and its therapeutic implications

Glutathione peroxidase (GPx), as an antioxidant enzyme, is involved in the regulation of processes that cause cellular oxidative stress, with implications in various pathologies. The aim of the present study was to evaluate GPx variations in patients with arrhythmic, non-structural cardiac disorders. The research was performed on 120 patients, with a mean age of 33 years old, divided into 3 equal groups, of which 2 groups included patients with cardiac arrhythmias, the first group, associated with dyslipidemia and the second one, without dyslipidemia, and a control group consisting of healthy individuals. The method for determining GPx was based on the GPx enzyme catalysis reaction of the reduced glutathione (GSH) oxidation reaction by cumene hydroperoxide. The results revealed that GPx variation was decreased in patients with cardiac arrhythmias, with or without dyslipidemia, up to 66 and 74% of mean control values, respectively, the differences being statistically significant, showing the existence of an oxidative stress imbalance, that may be involved in triggering arrhythmogenic electrochemical mechanisms. The GPx deficiency determined in relation to cardiac arrhythmias was in dyslipidemic and non-lipidemic patients as follows: 29-35% in sinus bradycardia, 31-35% in associated cardiac arrhythmias, 30-33% in sinus tachycardia, 27-33% in atrial fibrillation, 32-33% in atrial flutter, 27-32% in atrial extrasystolic arrhythmia, 28-30% in ventricular extrasystolic arrhythmia and 18-26% in paroxysmal supraventricular tachycardia. Collectively, the results revealed that GPx, an antioxidant enzyme, is a specific biomarker, whose decrease indicated the existence of oxidative stress in young individuals with cardiac arrhythmias and its involvement in arrhythmogenic electrochemical processes. In addition, GPx deficiencies were between 18-35% in all types of cardiac arrhythmias, the highest being recorded in sinus bradycardia and the lowest in paroxysmal supraventircular tachycardia. Furthermore, the oxidative stress favored by the decrease of GPx induced lipid oxidation, regardless of the presence or absence of dyslipidemia, which triggered the formation of anti-lipid antibodies and a subclinical endothelial aggression, with early atherosclerotic potential. GPx evaluation may argue for the existence of oxidative stress in non-structural cardiac arrhythmias, and by its proper correction (antioxidants), prophylaxis of atherogenic dysfunction.

Evaluation of The Antioxidant Capacity of Food Products: Methods, Applications and Limitations

Assays of total antioxidant capacity (TAC) are popular in the analysis of food products. This review presents the most popular assays of TAC and their limitations, databases of TAC of food products, their application in clinical studies, and the effect of processing on the TAC of food. The importance of sample preparation for TAC assays and striking effects of digestion in the gastrointestinal tract on the TAC of food are discussed. Critical opinions on the validity of food TAC assays are considered. It is concluded that TAC methods can be useful as screening assays for food quality control and as low-cost, high-throughput tools used to discover potential antioxidant sources and follow changes in the content of antioxidants during food processing. However, effects revealed by TAC assays should be followed and explained using more specific methods.

Association of the Composite dietary antioxidant index with all-cause and cardiovascular mortality: A prospective cohort study

Background

According to epidemiological and experimental data, high individual dietary antioxidant intake is correlated with reduced cancer risk. The correlations between combined dietary antioxidants and the risk of all-cause and cardiovascular mortality remain unclear. Consequently, this study focused on evaluating the correlation between the food-derived Composite Dietary Antioxidant Index (CDAI) and all-cause and cardiovascular mortality.

Materials and methods

Two years of data collected from participants aged ≥20 years were included in this prospective cohort study, which was obtained from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The US NHANES adopted a complicated, multistage probability sampling method to collect health data representing the US population. Data collection was done through in-person interviews, virtual physical examinations, and laboratory tests. Mortality-related follow-up statistics from the start of the survey to 31 December 2019 were available. The shape of the correlation between CDAI and all-cause and cardiovascular mortality was inspected using a restricted cubic spline model. For CDAI and all-cause and cardiovascular mortality, the univariate- and multivariate-adjusted Cox proportional hazard models were estimated and presented as regression coefficients and 95% confidence intervals.

Results

In total, 44,031 NHANES participants represented 339.4 million non-institutionalized residents of the US (age, 47.2 ± 16.9 years; 52.5% women, 70.2% non-Hispanic whites, 10.8% non-Hispanic black people, and 7.5% Mexican Americans). In the 118-month follow-up, 9,249 deaths were reported, including 2,406 deaths resulting from heart disease and 519 deaths due to cerebrovascular disease. In the restricted cubic spline regression models, a linear relationship between CDAI and all-cause mortality was present. The weighted multivariate hazard ratios for all-cause mortality were computed to be 0.97 (0.87–1.07) for Q2, 0.88 (0.81–0.96) for Q3, and 0.90 (0.80–1.00) for Q4 (P for trend = 0.009) upon comparison with the lowest quartile of CDAI, and an identical trend was observed for cardiovascular mortality.

Conclusion

A high CDAI was linked to decreased all-cause and cardiovascular mortality risk. The intake of an antioxidant-rich diet significantly prevents cardiovascular mortality. To shed more light on these outcomes, more itemized investigations such as randomized control trials are required.

Adherence to the dietary approaches to stop hypertension diet and all-cause mortality in patients with a history of heart failure

Background and aims

We investigated the association of adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with all-cause mortality in patients with a history of heart failure.

Methods

We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Dietary information was obtained from a 24-h dietary recall interview. Adherence to the DASH diet was assessed using the DASH score. The primary outcome was all-cause mortality which was confirmed by the end of 2011. Weighted Cox proportional hazards regression models were used to determine the hazard ratios and 95% CI for the association of the DASH score and all-cause mortality with multivariate adjustment.

Results

The median DASH score was 2 among the 832 study participants. There were 319 participants who died after a median follow-up duration of 4.7 years. A higher DASH score (>2 vs. ≤ 2) was not associated with a decrease in the risk of all-cause mortality (adjusted HR 1.003, 95% CI 0.760–1.323, p = 0.983). With respect to the components of the DASH score, a lower sodium intake was not associated with a decreased risk of mortality (adjusted HR 1.045, 95% CI 0.738–1.478, p = 0.803).

Conclusion

A higher DASH score (>2 vs. ≤ 2) was not associated with all-cause mortality in patients with heart failure.

Dietary Total Antioxidant Capacity-A New Indicator of Healthy Diet Quality in Cardiovascular Diseases: A Polish Cross-Sectional Study

This study aimed to assess the relationship between the dietary total antioxidant capacity (DTAC) and the occurrence of cardiovascular diseases (CVDs), as well as healthy diet quality, in a representative sample (n = 5690) of the whole Polish adult population (WOBASZ II study). Daily food consumption was estimated by the single 24 h dietary recall method. Antioxidant vitamins (C, E, and β-carotene) and minerals (Zn, Fe, Mn, and Cu) from the diet and supplements were calculated using 5D Diet software, and dietary total polyphenol intake (DTPI) was determined using the Phenol-Explorer database and our database. Total diet quality was measured by the Healthy Diet Indicator (HDI) based on World Health Organization (WHO) recommendations for the prevention of CVD. DTAC was calculated using the data on food consumption and the antioxidant potential of foods measured by the FRAP (ferric ion reducing antioxidant potential) method. It was shown that higher DTAC was associated with a higher intake of polyphenols, antioxidant vitamins, and minerals. Moreover, a higher quartile of DTAC was associated with a reduced odds ratio for cardiovascular diseases in a Polish population, as well as with a higher HDI. Therefore, dietary recommendations for the prevention and therapy of CVDs should take into account a high DTAC. DTAC, measured by the FRAP method, can be considered an indicator of healthy diet quality.

Lower All-Cause Mortality for Coronary Heart or Stroke Patients Who Adhere Better to Mediterranean Diet-An NHANES Analysis

Consuming a Mediterranean-style diet (MED) is helpful for primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, few studies have compared mortality in ASCVD subjects with different degrees of adherence to the MED diet or have evaluated the contributions of individual diet components. We analyzed National Health and Nutrition Examination Survey (NHANES) participants with a history of coronary heart disease (CHD) or stroke (N = 2052) in a period from 1999 to 2010. Their individual vital status was linked to the National Death Index till the end of 2011. The level of adherence to the MED diet was quantified using a 9-point evaluation score (aMED score). Cox regression models were used to compare the different levels of adherence to the MED diet, and contributions of individual components of the MED diet on cardiovascular, cancer, and all-cause mortality. Among the 2052 subjects with CHD or stroke, 29.0% (596 of 2052) died after a median follow-up of 5.6 years. In Cox regression analysis, higher absolute aMED score (HR 0.798, p = 0.0079) or above median aMED score (score 4–9) (HR 0.646, p = 0.0013) was negatively associated with all-cause mortality. Among various components of the MED diet, intake of more whole grains or nuts was significantly associated with a lower all-cause mortality. In contrast, a higher aMED score was not associated with less cardiovascular mortality. In a secondary analysis that excluded deaths within 2 years of the NHANES study entry, the above median aMED score (score 4–9) was negatively associated with both all-cause and cardiovascular mortality. In conclusion, subjects with a history of CHD or stroke adhering better to the MED diet in the NHANES study had a lower all-cause mortality during follow-ups. Consuming more whole grains or nuts had a lower all-cause mortality. The protective effect of adherence to the MED diet on decreasing cardiovascular mortality was seen only after excluding those who died within first two years of the NHANES study entry.

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

Background

The 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.

Methods

A 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.

Results

A 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.

Conclusion

Higher 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.

Association Between Dietary Total Antioxidant Capacity and Diet Quality in Adults

Background

Diet quality is a major contributor to human health. In addition, antioxidants have a great contribution to several chronic conditions. The purpose of this study was to evaluate if dietary total antioxidant capacity (TAC) can be considered as a measure of diet quality in a Middle Eastern country.

Methods

In this cross-sectional study on 6,724 Iranian adults, we used a validated food frequency questionnaire (FFQ) to assess dietary intakes. Data derived from the FFQ was used to calculate dietary TAC and well-known diet quality scores including alternate healthy eating index (AHEI) and dietary diversity score (DDS). Dietary TAC was calculated based on the ferric reducing-antioxidant power (FRAP) values reported in earlier publications. AHEI and DDS have also been constructed based on previous publications. Cross-classification was used to examine the agreement between these measures.

Results

Mean age and BMI of study participants were 36.89 ± 8.08 y and 24.97 ± 3.87 kg/m², respectively. We found that individuals in the highest tertile of dietary TAC had higher scores of AHEI (57.53 ± 0.20 vs. 52.03 ± 0.20, P < 0.001) and DDS (5.56 ± 0.03 vs. 4.15 ± 0.03, P < 0.001) compared with those in the lowest tertile. Participants' distribution on the basis of the cross-classification analysis indicated that the classifications were in exact agreement for 42.6%, within an adjacent tertile for 33.05%, and in gross misclassification for 20% of individuals. When this was examined between dietary TAC and DDS, we found that exact agreement in the classifications was for 59.2% of participants. Notably, a very low proportion of gross misclassification was seen in this regard such that only 6% of participants were classified in the opposing tertiles, indicating additional support for a good agreement.

Conclusion

We found that dietary TAC might be considered as a proper measure for the assessment of diet quality because it was well correlated with well-known measures of diet quality including DDS and AHEI scores.

Association of Adherence to the Mediterranean Diet with All-Cause Mortality in Subjects with Heart Failure

We investigated the associations of adherence to the Mediterranean diet with all-cause and cardiovascular mortality in patients with heart failure. We analyzed the National Health and Nutrition Examination Survey (NHANES) participants from 1999 to 2010, with their vital status confirmed through to the end of 2011. The alternate Mediterranean Diet Index (aMED) was used to assess study participants’ adherence to the Mediterranean diet according to information on dietary questionnaires. We conducted weighted Cox proportional hazards regression models to determine the associations of adherence to the Mediterranean diet (aMED ≥ median vs. <median) with all-cause and cardiovascular mortality in participants with a history of heart failure. A total of 832 participants were analyzed, and the median aMED was 3. After a median follow-up of 4.7 years, 319 participants had died. aMED ≥ 3 (vs. <3) was not associated with a lower risk of all-cause (adjusted HR 0.797, 95% CI 0.599–1.059, p = 0.116) and cardiovascular (adjusted HR 0.911, 95% CI 0.539–1.538, p = 0.724) mortality. The findings were consistent across several subgroup populations. Among the components of aMED, a lower intake of red/processed meat was associated with a higher risk of mortality (adjusted HR 1.406, 95% CI 1.011–1.955, p = 0.043). We concluded that adherence to the Mediterranean diet was not associated with a lower risk of all-cause and cardiovascular mortality in participants with a history of heart failure. The higher risk of mortality associated with a lower intake of red/processed meat deserves further investigation.

Associations of Adherence to the DASH Diet and the Mediterranean Diet With All-Cause Mortality in Subjects With Various Glucose Regulation States

Background and Aims

A dietary pattern concordant with either the Dietary Approaches to Stop Hypertension (DASH) diet or the Mediterranean diet has been associated with a lower risk of all-cause mortality in general population. We investigated the associations of adherence to the DASH diet and the Mediterranean diet with all-cause mortality across three glucose regulation states (normal glucose tolerance, prediabetes, and diabetes) using data from the National Health and Nutrition Examination Survey (NHANES).

Methods

Data from the NHANES participants from 1999 to 2010, including their vital status linked to the National Death Index through the end of 2011, were analyzed. Adherence to the DASH diet and the Mediterranean diet was assessed using the DASH score and the alternative Mediterranean Diet Index (aMED), respectively. Weighted Cox proportional hazards regression models were used to compare the hazard ratios for the associations of adherence (diet score >median vs. ≤ median) to the DASH diet and the Mediterranean diet with all-cause mortality.

Results

A total of 28,905 participants were analyzed, and 2,598 of them had died after a median follow-up of 6.3 years. The median DASH score and aMED were 2 and 3, respectively. Adherence to the Mediterranean diet (aMED >3 vs. ≤ 3), but not the DASH diet, was associated with a lower risk of all-cause mortality (adjusted HR 0.74, 95% CI 0.66–0.83, p < 0.001) in the overall population. The findings were consistent across the three glucose regulation states. A joint effect of aMED >3 and DASH score >2 (adjusted HR 0.71, 95% CI 0.52–0.99, p = 0.042) was noted in participants with diabetes.

Conclusions

Adherence to the Mediterranean diet (aMED >median) was associated with reduced all-cause mortality in a general population. For people with diabetes, a dietary pattern concordant with both the DASH diet and the Mediterranean diet (DASH score >median and aMED >median) was associated with a lower risk of mortality.

Antioxidant properties of anthocyanins and their mechanism of action in atherosclerosis

Atherosclerosis develops due to lipid accumulation in the arterial wall and sclerosis as result of increased hyperlipidemia, oxidative stress, lipid oxidation, and protein oxidation. However, improving antioxidant status through diet may prevent the progression of atherosclerotic cardiovascular disease. It is believed that polyphenol-rich plants contribute to the inverse relationship between fruit and vegetable intake and chronic disease. Anthocyanins are flavonoid polyphenols with antioxidant properties that have been associated with reduced risk of cardiovascular disease. The consumption of anthocyanins increases total antioxidant capacity, antioxidant defense enzymes, and HDL antioxidant properties by several measures in preclinical and clinical populations. Anthocyanins appear to impart antioxidant actions via direct antioxidant properties, as well as indirectly via inducing intracellular Nrf2 activation and antioxidant gene expression. These actions counter oxidative stress and inflammatory signaling in cells present in atherosclerotic plaques, including macrophages and endothelial cells. Overall, anthocyanins may protect against atherosclerosis and cardiovascular disease through their effects on cellular antioxidant status, oxidative stress, and inflammation; however, their underlying mechanisms of action appear to be complex and require further elucidation.

Dietary total antioxidant capacity and late-life cognitive impairment: the Singapore Chinese Health Study

BACKGROUND

With the dramatically rapid rate of aging worldwide, the maintenance of cognitive function in old age is a major public health priority. The association between total antioxidant capacity (TAC) of midlife diet and cognitive function in late-life is still unclear.

METHODS

The study included 16 703 participants from a prospective cohort study in Singapore. Dietary intakes and selected supplementary use were assessed with a validated 165-item food frequency questionnaires at baseline (1993-1998). Two dietary TACs were calculated from the intake of antioxidant nutrients, the Comprehensive Dietary Antioxidant Index (CDAI) and the Vitamin C Equivalent Antioxidant Capacity (VCEAC). Cognitive function was assessed 20.2 years later using a Singapore-modified version of the Mini-Mental State Examination when subjects were 61-96 years old. Cognitive impairment was defined using education-specific cut-offs. Multivariable logistic regression models were utilized to estimate the associations between dietary TACs, component nutrients and cognitive impairment.

RESULTS

A total of 2392 participants (14.3%) were defined to have cognitive impairment. Both CDAI and VCEAC scores were inversely associated with odds of cognitive impairment in a dose-dependent manner. The odds ratio (95% confidence interval; p-trend) comparing the highest with the lowest quartile was 0.84 (0.73, 0.96; p-trend = .003) for the CDAI and 0.75 (0.66, 0.86; p-trend < .001) for the VCEAC. Higher intakes of vitamin C, vitamin E, carotenoids, and flavonoids were all inversely associated with cognitive impairment.

CONCLUSIONS

Higher dietary total antioxidant capacity was associated with lower odds of cognitive impairment in later life in a Chinese population in Singapore.

Variation of Total Antioxidant Activity in Young People with Non-Lesional Cardiac Arrhythmias

Total antioxidant activity status (TAS) represents the body's response to oxidative stress, important in the pathogenic assessment of oxidations.

AIM

To determine TAS variations in young subjects, with non-lesional cardiac arrhythmias, with/without dyslipidemia and to assess the risk of lipid oxidation.

PATIENTS AND METHODS

The research was performed on 120 young subjects (mean age 33 years), with various types of cardiac arrhythmias, on normal heart, without co-existing lesions. Subjects were divided into 3 groups (40 persons). The first 2 groups included subjects with cardiac arrhythmias. Group I also associated dyslipidemia; group II, without dyslipidemia and group III: control. Determination of TAS values was performed using ABTS (2-azino-di-3-ethylbenzthiazoline sulfonate) colorimetic method. Results were statistically processed.

RESULTS

TAS values were decreased in all patients with cardiac arrhythmias, representing 52-54% of the values of healthy controls, the data being highly statistically significant. The variation of TAS decrease by types of arrhythmias was thus found in patients with arrhythmias and associated dyslipidemia and, respectively, without dyslipidemia, compared to controls. The deficit of antioxidant activity, between 48%-46% triggers electrochemical processes with implications in arrhythmogenesis and lipid oxidation. Coffee and vegetables-rich diet have antioxidant effect, reducing TAS deficiency.

CONCLUSIONS

1. TAS was decreased in all subjects with non-lesional arrhythmias. The study showed decreasing TAS level at 52-54% in patients with arrhythmias, with/without dyslipidemia, compared to controls. 2. TAS deficiency was associated with various types of dysrhythmias, ranging from 62% to 33%. 3. Decreased TAS also triggers lipid oxidation, as risk factor for early atherosclerotic lesions.

Associations of low-carbohydrate and low-fat intakes with all-cause mortality in subjects with prediabetes with and without insulin resistance

BACKGROUND & AIMS

We investigated the associations of low-carbohydrate and low-fat diets with all-cause mortality in people with prediabetes according to insulin resistance status using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

We analyzed the NHANES participants with prediabetes from 2005 to 2008, and their vital status was linked to the National Death Index through the end of 2011. Low-carbohydrate and low-fat diets were defined as ≦40% and ≦30% of calories from carbohydrate and fat, respectively. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to determine insulin resistance. Weighted Cox proportional hazards regression models were used to compare the hazard ratios for the associations of low-carbohydrate and low-fat diets with all-cause mortality.

RESULTS

Among the 1687 participants with prediabetes, 96 of them had died after a median follow-up of 4.5 years. Participants with a HOMA-IR >3.0 had an increase in all-cause mortality compared with those who had a HOMA-IR ≦3.0 (HR 1.797, 95% CI 1.110 to 2.909, p = 0.019). Participants with ≦40% of calories from carbohydrate and >30% from fat (3.75 per 1000 person-years) had a lower all-cause mortality rate compared with those who had >40% from carbohydrate and >30% from fat (10.20 per 1000 person-years) or >40% from carbohydrate and ≦30% from fat (8.09 per 1000 person-years), with statistical significance observed in those who had a HOMA-IR ≦3.0.

CONCLUSIONS

A low-carbohydrate intake (≦40%) was associated with a lower all-cause mortality rate in people with prediabetes.