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

Abstract

Objectives: To examine associations between serum antioxidant levels and mortality (all-cause, cancer, and cardiovascular disease (CVD)) among U.S. 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% confidence intervals (CIs). Setting: The National Health and Nutrition Examination Survey (NHANES) 1999-2002 were follow-up through December 31, 2015. Participants: The NHANES 1999-2002 cohort included 8,758 participants aged ≥20 years. Serum carotenoid levels were only assessed for the 1999-2000 cycle. Therefore, sample size for each assessed antioxidant ranged from 4,633 to 8,758. Results: Serum vitamin E level was positively associated with all-cause mortality (HR= 1.22, 95% CI: 1.04, 1.43, highest vs. 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 vs. first quartile), and total carotenoids levels with reduced risk of CVD mortality (HR=0.26; 95% CI: 0.07, 0.97, second vs. 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.

Vitamin A and Vitamin E: Will the Real Antioxidant Please Stand Up?

“…Some reports often simply list, group, and/or consider vitamin A as an antioxidant and not as a transcriptional regulator. This oversight is apparent in some recent reports (e.g., 7,25,101). The authors of some but not all of these reports try to fit their findings solely into the context of "vitamin A is an antioxidant" and often fail to provide consideration of their findings in the context of "vitamin A is a potent transcriptional regulator."…”

Overall and Sex-Specific Associations of Serum Lipid-Soluble Micronutrients with Metabolic Dysfunction-Associated Steatotic Liver Disease among Adults in the United States

“…Thus, higher circulating α-tocopherol levels observed in individuals with MASLD relative to those without the condition may suggest a pathophysiological condition associated with the disease and a poor health status in general. Our previous study also found that serum α-tocopherol levels were positively associated with all-cause mortality using NHANES 1999–2002 data [ 33 ].…”

Associations of Dietary Lipid-Soluble Micronutrients with Hepatic Steatosis among Adults in the United States

“…The associations between lipid-soluble micronutrients from diet or in circulation with health and diseases may differ among racial/ethnic groups. Our previous study using a nationally representative sample suggests there might be race/ethnicity-specific thresholds for the associations with all-cause or cause-specific mortality for serum levels of total vitamin E, α -tocopherol and total carotenoids [ 30 ]. To our knowledge, no studies have assessed race/ethnicity-specific relationships between lipid-soluble micronutrients and NAFLD using a nationally representative sample.…”