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Association of serum levels of antioxidant micronutrients with mortality in US adults: National Health and Nutrition Examination Survey 1999–2002

Published online by Cambridge University Press:  13 November 2020

Noah C Peeri
Affiliation:
Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, Fort Worth, TX 76107, USA
Weiwen Chai
Affiliation:
Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE, USA
Robert V Cooney
Affiliation:
Office of Public Health Studies, University of Hawai’i at Manoa, Honolulu, HI, USA
Meng-Hua Tao*
Affiliation:
Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, Fort Worth, TX 76107, USA
*
*Corresponding author: Email menghua.tao@unthsc.edu
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Abstract

Objective:

To examine associations between serum antioxidant levels and mortality (all-cause, cancer and CVD) among US adults.

Design:

We examined the risk of death from all-cause and cause-specific mortality associated with serum antioxidant (vitamin E and carotenoids) and vitamin A levels using Cox regression models to estimate hazards ratios (HR) and 95 % CI.

Setting:

The National Health and Nutrition Examination Survey (NHANES) 1999–2002 was followed up through 31 December 2015.

Participants:

The NHANES 1999–2002 cohort included 8758 participants aged ≥ 20 years. Serum carotenoid levels were only assessed for the 1999–2000 cycle. Therefore, sample size for each assessed antioxidant ranged from 4633 to 8758.

Results:

Serum vitamin E level was positively associated with all-cause mortality (HR = 1·22, 95 % CI 1·04, 1·43, highest v. lowest quartile). No other antioxidants were associated with mortality in overall analysis. In race/ethnicity-specific analyses, high vitamin E and α-tocopherol levels were associated with increased risk of all-cause mortality among non-Hispanic Whites. Among non-Hispanic Blacks, serum α-tocopherol level was associated with decreased risk of cancer mortality (HR = 0·30, 95 % CI 0·12, 0·75, third v. first quartile) and total carotenoid levels with reduced risk of CVD mortality (HR = 0·26; 95 % CI 0·07, 0·97, second v. lowest quartile). Hispanics with high β-carotene levels had reduced risk of CVD mortality.

Conclusions:

Serum antioxidant levels may be related to mortality; these associations may differ by race/ethnicity and appeared to be non-linear for all-cause and cause-specific mortality. Further studies are needed to confirm our results.

Information

Type
Research paper
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Nutrition Society
Figure 0

Fig. 1 Study participants flow chart

Figure 1

Table 1 Serum antioxidant nutrient levels among adults ≥ 20 years, NHANES 1999–2002

Figure 2

Table 2 All-cause and cause-specific mortality and serum antioxidant level, NHANES 1999–2002*

Figure 3

Table 3 All-cause mortality and serum antioxidant level by race/ethnicity, NHANES 1999–2002*

Figure 4

Fig. 2 Lipid-soluble antioxidants serum levels and all-cause mortality by race/ethnicity*.*Interaction tests were performed evaluating a multiplicative term using the Wald test. (a) Vitamin A, (b) vitamin E, (c) α-Tocopherol, (d) γ-Tocopherol, (e) total carotenoids, (f) β-carotene. NH, non-Hispanic; , NH White; , NH Black; , Hispanic

Supplementary material: PDF

Peeri et al. supplementary material

Tables S1-S2

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