Dietary total antioxidant capacity is inversely associated with all-cause and cardiovascular disease death of US adults

The association between dietary consumption habits and psoriasis: a two-sample Mendelian randomization study

Background

Psoriasis is a chronic inflammatory skin disease characterized primarily by erythema and scales, having a wide-ranging impact globally. Previous studies have suggested that dietary consumption habits may influence psoriasis. The objective of this study was to determine the causal relationship between dietary consumption habits and psoriasis using the Mendelian Randomization (MR) approach.

Methods

SNP data for 29 dietary consumption habits and psoriasis were obtained from the GWAS catalog database and the FinnGen database, respectively. The Mendelian Randomization analysis was performed using R software, with the 29 dietary consumption habits as the exposure factors and psoriasis as the outcome. Three MR analysis methods-Inverse Variance Weighted (IVW), Weighted Median Estimator (WME), and MR-Egger regression-were employed to study the causal relationship between dietary consumption habits and psoriasis.

Results

The IVW analysis indicated an OR (95%CI) of 0.065 (0.008-0.555), p = 0.012, demonstrating a negative correlation between the consumption of dried fruit and psoriasis.

Conclusion

Among the 29 dietary consumption habits analyzed, the intake of dried fruits is a protective factor against psoriasis. Therefore, it is clinically advisable to appropriately increase the intake of dried fruits among patients with psoriasis, serving as a nutritional therapy method in conjunction with pharmacological treatment.

A diet-wide Mendelian randomization analysis: causal effects of dietary habits on type 2 diabetes

Background

Traditional clinical studies have indicated a link between certain food intakes and type 2 diabetes (T2D), but the causal relationships between different dietary habits and T2D remain unknown. Using Mendelian randomization (MR) approaches, we investigated the potential causal association between dietary habits and T2D risk.

Methods

We collected publicly available genome-wide association studies' summary statistics for 18 dietary habits from the UK Biobank and T2D data from the DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) consortium. We applied the inverse variance weighted (IVW) method, supplemented with the MR-Egger method, weighted median method (WMM), simple method, weighted mode, MR-Egger regression, and the MR pleiotropy residual sum and outlier test to determine whether a particular diet was causal for T2D.

Results

Reliable and robust MR estimates demonstrated that poultry intake has a causal effect on a higher risk of T2D (IVW: OR 6.30, 95% CI 3.573-11.11, p = 2.02e - 10; WMM: OR 5.479, 95% CI 0.2758-10.88, p = 1.19e - 06). Conversely, dried fruit intake (IVW: OR 0.380, 95% CI 0.237-0.608, p = 5.57e - 05; WMM: OR 0.450, 95% CI 0.321-0.630, p = 3.33e - 06) and cereal intake (IVW: OR 0.455, 95% CI 0.317-0.653, p = 1.924e - 05; WMM: OR 0.513, 95% CI 0.379-0.694, p = 1.514e - 05) were causally associated with T2D as protective factors. Sensitivity analyses confirmed the reliability and robustness of these findings.

Discussion

Our study established the causal effects of poultry intake, dried fruit intake, and cereal intake on T2D, identifying poultry intake as a risk factor and the other two as protective factors. Further research into potential mechanisms is required to validate these novel findings.

Dried fruit intake and lower risk of type 2 diabetes: a two-sample mendelian randomization study

BACKGROUND

Previous studies have shown controversy about whether dried fruit intake is associated with type 2 diabetes. This study aimed to examine the potential causal effect of dried fruit intake on type 2 diabetes by conducting a two-sample Mendelian randomization study.

METHODS

We used genome-wide association study (GWAS) summary statistics for MR analysis to explore the causal association of dried fruit intake with T2D. The inverse-variance weighted (IVW) method was used as the main analytical method for MR analysis. In addition, the MR-Egger method and the weighted median method were applied to supplement the IVW method. Furthermore, Cochrane's Q test, MR-Egger intercept test, and leave-one-out analysis were used to perform sensitivity analysis. The funnel plot was used to assess publication bias.

RESULTS

The results from the IVW analysis indicated that dried fruit intake could reduce the risk of T2D [odds ratio (OR) = 0.392, 95% confidence interval (CI): 0.241-0.636, p-value = 0.0001]. In addition, the result of additional method Weighted median is parallel to the effects estimated by IVW. Furthermore, the sensitivity analysis illustrates that our MR analysis was unaffected by heterogeneity and horizontal pleiotropy. Finally, the results of the leave-one-out method showed the robustness of our MR results. And the funnel plot shows a symmetrical distribution.

CONCLUSION

Our study provides evidence for the benefits of dried fruit intake on T2D. Therefore, a reasonable consumption of dried fruit may provide primary prevention.

Dietary antioxidants and hypertension among menopausal women in Rafsanjan Cohort Study

Studies on the beneficial role of dietary antioxidants in preventing or managing hypertension in postmenopausal women are infrequent. The present cross-sectional study aimed to assess the association between dietary antioxidants and hypertension among menopausal women in Rafsanjan, a city located in the southeast of Iran. This study was based on data from the Rafsanjan Cohort Study (RCS), as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Among 2359 postmenopausal women, finally, 1936 women were included in this study. Participants were grouped as having normal blood pressure (BP), elevated BP, stage 1 hypertension, or stage 2 hypertension as defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline. A food frequency questionnaire (FFQ), was utilized to ascertain the levels of various nutrients and dietary antioxidants in the diet. The association between dietary intakes of antioxidants and blood pressure groups was evaluated by crude and adjusted models in the multinominal logistics regression analysis. Normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension were observed in 35.69%, 3.62%, 10.59%, and 50.10% of postmenopausal women respectively. In the adjusted model, in subjects with higher consumption of β-carotene, the odds ratios of elevated BP in the 3rd quartile was about 2 times (OR: 2.04 (1.06-3.93) higher than 1st quartile. Also, in subjects with medium quality of DAQS, the odds ratios of elevated BP and stage 1 blood pressure were about 2 times (OR: 2.09 (1.05-4.17) and 1.69 times (OR: 1.69 (1.09-2.63) higher than subjects with low quality respectively. Furthermore, we did not find any statistically significant association between increased intake of dietary antioxidants and decreased odds of hypertension. After controlling the effects of confounding variables, increased dietary intake of selenium, carotenoids, vitamin A, vitamin C, and vitamin E did not decrease the odds of hypertension in postmenopausal women. Accordingly, it is suggested that this association be further investigated in the follow-up phase of this prospective study.

Dietary inflammatory index, dietary total antioxidant capacity, and frailty among older Chinese adults

OBJECTIVES

Frailty is an age-related syndrome associated with poor health outcomes. Studies in developed countries indicate that the dietary inflammatory index (DII) and dietary total antioxidant capacity (DTAC) are important dietary factors influencing the risk of frailty in older adults. However, few studies have explored the association between DII, DTAC, and frailty among older Chinese adults. The objective of the current study was to examine whether DII and DTAC were associated with pre-frailty or frailty among older Chinese adults.

DESIGN

A cross-sectional study.

SETTING

Community-based.

PARTICIPANTS

We included 6414 participants aged ≥60 years.

MEASUREMENTS

Dietary intake was assessed using a validated food frequency questionnaire (FFQ). The DII and energy-adjusted DII (E-DII) were calculated using food parameters. DTAC was estimated using two widely adopted antioxidant scores: DTAC based on ferric reducing antioxidant power and dietary antioxidant quality score (DAQS) obtained from vitamins (vitamins A, C, and E) and minerals (zinc and selenium) with antioxidant functions. Frailty was assessed using the frailty index (FI) calculated from 28 health-related deficits. Individuals were classified as robust (FI ≤ 0.10), pre-frailty (FI > 0.10 to <0.25), or frailty (FI ≥ 0.25). Multiple logistic regression models were used to evaluate the associations of DII and DTAC with pre-frailty and frailty.

RESULTS

After adjusting for confounding factors, individuals in the highest DII quintile (Q5) were more likely to have pre-frailty (odds ratio [OR] = 1.56; 95% confidence interval [CI]: 1.25-1.93; P for trend <0.001) than those in the lowest Q1. A similar positive association was detected for E-DII and pre-frailty. A significant association was found between DII and frailty. Compared with the lowest Q1, the highest Q5 of DTAC was negatively correlated with pre-frailty (OR = 0.66; 95% CI: 0.52-0.84; P for trend <0.001) and frailty (OR = 0.71; 95% CI: 0.50-0.1.03; P for trend <0.001). The DAQS yielded results similar to pre-frailty results (OR = 0.72; 95% CI: 0.58-0.89; P < 0.001). There was no evidence suggesting an association between DAQS and frailty.

CONCLUSIONS

More proinflammatory diets were linked to higher pre-frailty risk, whereas higher levels of dietary antioxidants were associated with lower pre-frailty and frailty risk among older Chinese adults.

Role of Natural Antioxidants in Cancer

The oxidative stress defined as an event caused by an imbalance between production and accumulation of reactive oxygen species (ROS), which lead to a damage in the structure of proteins, lipids, and DNA. Therefore, the production of ROS may alter the normal physiological process by provoking damage to multiple cellular organelles and processes. Oxidative stress has been linked to heart disease, cancer, respiratory diseases, immune deficiency, stroke, Parkinson's disease, and other inflammatory or ischemic conditions. Antioxidants are substances that can prevent or slow damage to cells and tissues caused by ROS, unstable molecules that the body produces as a reaction to environmental and other pressures. The β-carotene, catechins, flavonoids, polyphenols, lycopene, lutein, selenium, vitamins A, C, D, E, and zeaxanthin are all common types of antioxidants and found in plant-based foods, especially fruits and vegetables. Each antioxidant has its own role and can interact with others to process and remove free radicals efficiently. Several studies have been conducted to investigate whether the use of dietary antioxidant supplements is associated with decreased risks of developing cancer in humans, mixed results were reported. For instance, daily use of supplement such as vitamin c, vitamin E, β-Carotene, and minerals such as selenium and zinc have shown its effectiveness by reducing the risk of developing prostate cancer among men and skin cancer among women.

The Brazilian Cardioprotective Nutritional (BALANCE) Program improves diet quality in patients with established cardiovascular disease: Results from a multicenter randomized controlled trial

Dietary modifications are essential strategies for cardiovascular disease prevention. However, studies are needed to investigate the diet quality of individuals undergoing secondary prevention in cardiology and who received dietary intervention based on cardiovascular disease management. We prospectively evaluated the diet quality in the Brazilian Cardioprotective Nutritional Program Trial (BALANCE Program Trial). We hypothesized that the BALANCE Program could improve patients' dietary pattern according to different indices of diet quality such as the Dietary Inflammatory Index (DII); the dietary total antioxidant capacity; overall, healthful, and unhealthful Plant-Based Diet Index (PDI, hPDI, and uPDI, respectively); and modified Alternative Healthy Eating Index (mAHEI). This multicenter randomized, controlled trial included patients aged ≥45 years randomly assigned to either the experimental or control group. Data from 2185 participants at baseline and after 12, 24, 36, and 48 months showed that the intervention group (n = 1077) had lower mean values of DII and higher dietary total antioxidant capacity, PDI, hPDI, and mAHEI than the control group. The results also showed differences between the follow-up times for DII, hPDI, and uPDI (48 months vs baseline) and for PDI and mAHEI (24 months vs baseline), regardless of group. The interaction analysis demonstrated that the intervention group showed better results than the control group at 12, 24, 36, and 48 months for the DII and at months 12, 36, and 48 for the mAHEI. Our results provide prospective evidence that the BALANCE Program improved the diet quality in those in secondary cardiovascular prevention according to different indices, with the intervention group showing better results than the control group.

Association between the Composite Dietary Antioxidant Index and Atherosclerotic Cardiovascular Disease in Postmenopausal Women: A Cross-Sectional Study of NHANES Data, 2013-2018

The relationship between composite dietary antioxidant index (CDAI) levels and the risk of atherosclerotic cardiovascular disease (ASCVD) in postmenopausal women is unknown. In total, 3109 women from the National Health and Nutrition Examination Survey 2013-2018 were included in this cross-sectional study. We evaluated the association between CDAI levels and the risk of ASCVD by using three logistic regression models and restricted cubic splines. A stratified analysis and sensitivity analysis were also conducted. The restricted cubic splines exhibited an L-shaped dose-response association between CDAI levels and the ASCVD risk. Logistic regression analysis found that CDAI levels were negatively associated with the occurrence of ASCVD. The ORs associated with a per-SD increase in CDAI were 0.67 (95% CI: 0.51-0.88) for ASCVD risk. Similarly, women in the group with high CDAI levels were less likely to have ASCVD (OR = 0.71, 95% CI: 0.50-0.98) compared to those in the group with low CDAI levels. When the CDAI levels were divided into quartiles, it was found that the ORs for ASCVD with CDAI levels in Q2 (-1.04-1.11), Q3 (1.11-3.72), and Q4 (3.72-43.87) were 0.63 (0.44, 0.90), 0.64 (0.42, 0.94), and 0.51 (0.27, 0.97), respectively, compared to those with CDAI levels in Q1 (-6.83--1.04). In addition, age, high-density lipoprotein cholesterol levels, and smoking behaviors acted as potential modifiers, and ORs were more significant in women aged 40-69 years, in individuals with low high-density lipoprotein cholesterol levels, and in smokers (p for interaction <0.05). These findings may offer valuable insights into the role of CDAI levels in the development of ASCVD among postmenopausal women.

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.

Cardioprotective potential of vanillic acid

Nowadays, cardiovascular diseases (CVDs) are a global threat to public health, accounting for almost one-third of all deaths worldwide. One of the key mechanistic pathways contributing to the development of CVDs, including cardiotoxicity (CTX) and myocardial ischaemia-reperfusion injury (MIRI) is oxidative stress (OS). Increased generation of reactive oxygen species (ROS) is closely associated with decreased antioxidant capacity and mitochondrial dysfunction. Currently, despite the availability of modern pharmaceuticals, dietary-derived antioxidants are becoming more popular in developed societies to delay the progression of CVDs. One of the antioxidants derived from herbs, fruits, whole grains, juices, beers, and wines is vanillic acid (VA), which, as a phenolic compound, possesses different therapeutic properties, including cardioprotective. Based on experimental evidence, VA improves mitochondrial function as a result of the reduction in ROS production, aggravates antioxidative status, scavenges free radicals, and reduces levels of lipid peroxidation, thereby decreasing cardiac dysfunction, in particular CTX and MIRI. Considering the role of OS in the pathophysiology of CVDs, the purpose of this study is to comprehensively address recent evidence on the antioxidant importance of VA in the cardiovascular system.

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.

Causal associations between dried fruit intake and cardiovascular disease: A Mendelian randomization study

Background

Previous studies have shown controversy about whether dried fruit intake is associated with cardiovascular disease. This study aimed to examine the potential causal effect of dried fruit intake on cardiovascular disease by conducting a two-sample Mendelian randomization study.

Methods

We used genome-wide association study (GWAS) summary statistics for MR analysis to explore the causal association of dried fruit intake with CVD. The inverse-variance weighted (IVW) method was used as the main analytical method for MR analysis. In addition, the MR-Egger method and the weighted median method were applied to supplement the IVW method. Furthermore, Cochrane's Q test, MR-Egger intercept test, MR-PRESSO global test, and leave-one-out analysis were used to perform sensitivity analysis.

Results

The results from the IVW analysis indicated that dried fruit intake could reduce the risk of heart failure [odds ratio (OR) = 0.6014, 95% confidence interval (CI): 0.4243-0.8522, p-value = 0.0043], total ischemic stroke (OR = 0.4547, 95% CI: 0.2950-0.7010, p-value = 0.0004), and small vessel stroke (OR = 0.3499, 95% CI: 0.1466-0.8349, p-value = 0.0180). In addition, the results of two additional methods (MR Egger and Weighted median) were parallel to the effects estimated by IVW. Furthermore, the sensitivity analysis illustrates that our MR analysis was unaffected by heterogeneity and horizontal pleiotropy. Finally, the results of the leave-one-out method showed the robustness of our MR results.

Conclusion

Our study provides evidence for the benefits of dried fruit intake on CVD. Therefore a reasonable consumption of dried fruit may provide primary prevention.

Serum levels of vitamin A, selenium and better dietary total antioxidant capacity are related to lower oxidative DNA damage: a cross-sectional study of individuals at cardiovascular risk

The risk for cardiovascular diseases (CVR) has been associated with oxidative DNA damage, but the genetic and environmental factors involved in the antioxidant and DNA repair system contributing to this damage are unknown. The aim was to evaluate the levels of oxidative DNA damage in CVR subjects and how it is related with some genetic and nutritional factors. The cross-sectional study evaluated 136 individuals of both sexes, aged 20-59 years, with at least one cardiovascular risk factor. The global risk score was used to classify individuals at low, intermediate and high cardiovascular risk. The dietary total antioxidant capacity (DTAC) was calculated using table with FRAP values. The oxidative DNA damage was verified by the comet assay. The variants null of Glutathione-S-transferases Mu1 and Theta 1(GSTM1 and GSTT1) and rs25487 of X-Ray Repair Cross Complementing Protein 1 (XRCC1) were analyzed by real-time PCR and PCR-RFLP, respectively. The oxidative DNA damage was higher in patients with intermediate/high CVR than in patients with low CVR (p=0.01). Individuals with GSTT1/GSTM1 null genotypes or arg/gln + gln/gln genotypes of the XRCC1 (rs25487) gene showed similar levels of oxidative DNA damage compared wild genotype. Multivariate regression analysis demonstrated that oxidative DNA damage in individuals with CVR depends on serum levels of vitamin A, selenium and DTAC independently of the other factors [F(6.110)=8.213; p<0.001; R2=0.330]. These findings suggest that nutritional factors such as DTAC, vitamin A and selenium may have a protective effect against oxidative DNA damage in these individuals.

Dietary total antioxidant capacity and mortality outcomes: the Singapore Chinese Health Study

PURPOSE

To evaluate the relations of dietary total antioxidant capacity (DTAC) with mortality outcomes in a Chinese population.

METHODS

The study included 62,063 participants from the Singapore Chinese Health Study. The participants were 45-74 years at baseline (1993-1998) when dietary data were collected with a validated 165-item food frequency questionnaire. The DTAC was derived using two widely adopted scores of integrated dietary consumption of antioxidant nutrients, i.e., the Comprehensive Dietary Antioxidant Index (CDAI) and Vitamin C Equivalent Antioxidant Capacity (VCEAC). We used Cox proportional hazard model to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations with adjustment for potential confounders.

RESULTS

During 1,212,318 person-years of follow-up, 23,397 deaths [cardiovascular diseases (CVD): 7523; respiratory diseases: 4696; and cancer: 7713] occurred. In multivariable models, the HR (95% CI) comparing participants in the highest vs. lowest quartile of CDAI was 0.85 (0.82, 0.88) for all-cause mortality, 0.82 (0.76, 0.88) for CVD mortality, 0.76 (0.70, 0.83) for respiratory disease mortality (all P-trend < 0.001), and 0.94 (0.88, 1.00) for cancer mortality (P-trend = 0.16). Similar associations were found with the VCEAC index. Higher intakes of the DTAC components, i.e., vitamin C, vitamin E, carotenoids, and flavonoids, were all associated with lower mortality risk.

CONCLUSION

Diet with a higher antioxidant capacity in midlife was associated with a lower risk of all-cause, cardiovascular and respiratory disease mortality in the Singapore Chinese population, supporting the public health recommendation of consuming more plant-based foods that are rich in antioxidant nutrients.

Nutraceuticals in the Management of Cardiovascular Risk Factors: Where is the Evidence?

Cardiovascular disease continues to rise at an alarming rate, and research focuses on possible therapies to reduce the risk and slow down its progression. Several epidemiological studies have indicated that dietary modifications, such as increased consumption of fruits and vegetables play an important role in reducing cardiovascular disease risk factors. Food sources rich in antioxidants, anti-inflammatory, hypolipidemic, and hypoglycemic properties are thought to ameliorate the progression of cardiovascular disease and serve as a potential treatment mode. Many in vivo and in vitro studies using turmeric, cinnamon, mango, blueberries, red wine, chocolate, and extra virgin olive oil have demonstrated significant improvements in cholesterol profiles, toxic reactive oxygen species, inflammation, obesity, and hypertension. In this review, we summarize recent evidence on the cardioprotective effect of different food groups, outline their potential mechanisms involved in slowing down the progression of cardiovascular disease, and highlight the beneficial effects associated with increased consumption.

The Association of Dietary Total Antioxidant Capacity with Inflammatory Biomarkers and Anthropometric Indices in Patients Who Candidate for Coronary Artery Bypass Graft Surgery: a Cross-sectional Study

Antioxidant compounds can attenuate inflammation and delay degenerative processes especially in the cardiovascular system. This study aimed to determine the relationship between dietary total antioxidant capacity (DTAC) and serum biomarkers in patients undergoing coronary artery bypass graft surgery. In this cross-sectional study, 146 patients who had referred to Imam Ali Hospital in Kermanshah were recruited and demographic, anthropometric, physical activity and dietary data were collected. Fasting blood glucose (FBG), serum levels of lipid profile, inflammatory markers (interleukin [IL]-17, intercellular and vascular cell adhesion molecules [ICAM, VCAM]), and total antioxidant capacity (TAC) were also measured. A regression model adjusted for confounding variables presented that the coefficients of ICAM and VCAM (ng/dL) in the third tertile of DTAC were lower than those in the first tertile (β = -417.2, 95% confidence interval [CI] = -509.9 to -324.5, p < 0.001; β = -293.2, 95% CI = -334.3, -252.1, p < 0.001, respectively). The β of serum TAC (ng/dL) in the third tertile was 0.86 (95% CI = 0.77, 0.95, p < 0.001) higher than that in the first tertile. DTAC had no statistically significant relationship with lipid profile, FBG, and IL-17 levels, and anthropometric indices. In this study DTAC was associated with increased serum TAC and decreased cell adhesion molecules. Therefore, diet antioxidants may be beneficial in attenuating of inflammation in coronary artery diseases.

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.

Higher dietary total antioxidant capacity (TAC) reduces the risk of cardio-metabolic risk factors among adults: An updated systematic review and meta-analysis

Background: Numerous studies have revealed the protective role of dietary antioxidants against hypertension and diabetes. In the current systematic review and meta-analysis, we evaluated the possible role of dietary total antioxidant capacity (TAC) against metabolic parameters in the adult population. Methods: A literature search of authentic electronic resources including PubMed, Scopus, Web of Sciences, and Cochrane had been performed to retrieve the qualified observational studies that reported the mean plus/minus the SD for the parameter in subjects of the highest versus lowest dietary TAC categories up to July 2020. Results: Totally, the number of included studies was 13 for fasting blood sugar (FBS), 12 for systolic blood pressure (SBP), and 12 for diastolic blood pressure (DBP), with the participants' number of 26349. The results of the current study showed that being at highest category of TAC significantly reduces serum FBS (WMD: -2.381; CI: -3.445, -1.316; P<0.001), SBP (WMD: -1.080; CI: -1.458, -0.701; P<0.001) and DBP (WMD: -0.854; CI: -1.655, -0.052; P<0.001), while no significant difference in the serum insulin, HOMA-IR values, prevalence of type 2 diabetes (T₂DM) (P=0.37) and hypertension (HTN) (P=0.09) was observed. Subgroup analysis revealed the geographical location, dietary assessment tool, sample size, and gender as possible sources of heterogeneity. Conclusion: Higher intake of dietary TAC was associated with reduced SBP, DBP, and FBS in the current observational studies of this meta-analysis. These findings further confirm the clinical importance of dietary antioxidants in the prevention of different metabolic disorders.

Dietary and supplemental antioxidant intake and risk of major adverse cardiovascular events in older men: The concord health and ageing in men project

BACKGROUND AND AIMS

The role of antioxidant intake in cardiovascular disease remains inconclusive. This study evaluates the association between antioxidant intake and the risk of major adverse cardiovascular events (MACE) among older Australian men.

METHODS AND RESULTS

794 men aged ≥75 years participated in the 3rd wave of the Concord Health and Ageing in Men Project. Dietary adequacy of antioxidant intake was assessed by comparing participants' intake of vitamins A, E, C and zinc to the Nutrient Reference Values (NRV) for Australia. Attainment of NRVs of antioxidants was categorised into a dichotomised variable 'inadequate' (meeting≤2 of 4 antioxidants) or 'adequate' (meeting≥3 of 4 antioxidants). The usage of antioxidant supplements was assessed. The outcome measure was MACE. The composite MACE endpoint was defined as having one of the following: death, myocardial infarction, ischemic stroke, congestive cardiac failure (CCF), and revascularization during the period of observation. There was no significant association between dietary (HR: 1.03, 95% CI: 0.71, 1.48) or supplemental antioxidant intake (HR: 1.10, 95% CI: 0.75, 1.63) and overall MACE. However, a significant association was observed between inadequate antioxidant intake and CCF (HR: 1.32; 95% CI: 1.16, 1.50). The lowest quartile of zinc intake (<11.00 mg/d) was significantly associated with CCF (HR 2.36; 95% CI: 1.04, 5.34). None of the other antioxidants were significantly associated with CCF or other MACE components.

CONCLUSION

Inadequate dietary antioxidant intake, particularly zinc, is associated with increased risk of CCF in older Australian men but not associated with overall MACE.

The lack of association between dietary antioxidant quality score with handgrip strength and handgrip endurance amongst Tehranian adults: A cross-sectional study from a Middle East country

OBJECTIVE

The association between dietary antioxidant quality score (DAQS) and handgrip strength (HS) and handgrip endurance (HE) is still unclear. We aimed to investigate whether adherence to dietary antioxidant quality score (DAQS) is associated with handgrip strength (HS) and handgrip endurance (HE) amongst adults in Tehran.

METHODS

This cross-sectional study was conducted on 270 (43.7% males, mean age 37 years and 56.3% females, mean age 35 years) apparently healthy adult subjects (53.2% were married) selected from different parts of Tehran, Iran. Dietary intake was assessed using a 168-item validated food frequency questionnaire. DAQS was calculated using antioxidant-nutrient intake. Body composition was measured using a body composition analyser. Handgrip strength and endurance were measured by a digital handgrip dynamometer. Relative muscle strength was expressed as the ratio of handgrip strength by body mass index (BMI).

RESULTS

The results showed that DAQs had no significant association with HS (P = .67, adjusted R²  = .60) and HE (P = .19, adjusted R²  = .08) after adjusting for potential confounders. However, a significant positive association was found between selenium intake and HE even after adjusting for potential confounders (P = .01, adjusted R²  = .10). After controlling for potential confounders no differences in the mean of HS (P = .29) and also HE (P = .61) amongst tertiles of DAQS was found. Positive linear association was found between vitamin C (P = .02, adjusted R²  = .53) and vitamin E (P = .03, adjusted R²  = .55) intake with relative muscle strength.

CONCLUSION

Our results revealed that no significant association between DAQS and HE and HS. It was found that more intake of selenium was positively linked to HE. Dietary intake of vitamin C and vitamin E are associated with higher relative muscle strength. It is evident that more prospective studies are needed to confirm the veracity of our results.

Antioxidant Phytochemicals in Pulses and their Relation to Human Health: A Review

Pulses are a staple food cultivated since ancient times, which play an important role in the human diet. From a nutritional point of view, pulses are very interesting foods as they are rich in proteins, carbohydrates and dietary fibre. Dietary antioxidants are a complex mixture of hydrophilic and lipophilic compounds usually present in foods of plant origin, including pulses. In the present study, the phytochemical composition of selected pulses (common beans, fava beans, lentils, chickpeas, peas and lupins) has been reviewed in terms of their content of antioxidant compounds. The content of hydrosoluble antioxidants (organic acids, phenolic compounds), liposoluble antioxidants (tocopherols, carotenoids) and other compounds which exert antioxidant properties, such as dietary fibre and minerals (zinc, selenium), has been studied, reporting that pulses are an interesting source of these compounds, which have important health benefits, including a preventing role in cardiovascular diseases, anticarcinogenic or neuroprotective properties. It is important to take into account that pulses are not usually consumed raw, but they must be processed before consumption in order to improve their nutritional quality and their palatability, therefore, the effect of different technological and heat treatments (germination, cooking, boiling, extrusion) on the antioxidant compounds present in pulses has been also reviewed. In this regard, it has been observed that as a consequence of processing, the content of phytochemicals with antioxidant properties is usually decreased, but processed pulses maintain relevant amounts of these compounds, preserving their beneficial health effect.

Ascorbic acid supplementation in type 2 diabetes mellitus: A protocol for systematic review and meta-analysis

BACKGROUND

Diabetes is one of the most common chronic diseases in the world. In recent years, with the continuous improvement of people's living standards and changes in dietary structure, the incidence of diabetes is gradually increasing. Studies have shown that ascorbic acid supplementation can reduce blood glucose, increase insulin synthesis and secretion, improve insulin resistance, and reduce the occurrence and development of complications of type 2 diabetes mellitus (T2DM). However, relevant studies have common problems such as the lack of large sample studies and low quality of included studies. Therefore, it is needed that we meta-analyze the clinical trials with high quality to elucidate the efficacy and safety of ascorbic acid supplementation in patients with T2DM.

METHODS

We will search randomized controlled trials published by PubMed, Embase, the Cochrane Library, Web of Science, and the Clinical Trials.gov website from inception to August 2020 on the effects of ascorbic acid supplementation on blood glucose, glycosylated hemoglobin, serum insulin, insulin resistance and other variables in T2DM patients with no language restrictions. The retrieval adopts the combination of medical subject headings and random words, and traces the references of the included literature to supplement the acquisition of relevant literature. Two researchers will independently screen the retrieved literature, extract the data and cross-check, and the Review Manage software V5.3.0 will be utilized for meta-analysis.

RESULTS

Our study will provide a high-quality and in-depth comprehensive analysis of the effects of ascorbic acid supplementation on blood glucose control, glycosylated hemoglobin and insulin resistance in type 2 diabetic patients.

CONCLUSION

This systematic review and meta-analysis concerning randomized controlled trials of ascorbic acid supplementation for type 2 diabetic patients will provide a new direction and strong evidence to evaluate whether ascorbic acid supplementation is of benefit to glucose control and insulin resistance in T2DM.

PROSPERO REGISTRATION NUMBER

CRD 42019146826.

Dietary total antioxidant capacity (TAC), general and central obesity indices and serum lipids among adults: An updated systematic review and meta-analysis

Background: In the present meta-analysis, we aimed to summarize the relationship between dietary total antioxidant capacity (TAC), general and central obesity indices and lipid profile in adult population. Methods: The electronic databases of Web of Sciences, PubMed, Scopus and Cochrane library were searched for relevant studies from inception to October 2019. The effect size was indicated as weighted mean difference (WMD) and 95% confidence intervals (CI) by using random effects model. The I² index and Cochran's Q-test were used for evaluating heterogeneity. Results: From 2,469 studies identified, thirty-four studies (nineteen cross-sectional studies, thirteen cohort studies, two case-control studies) were included in the meta-analysis. According to our results, higher categories of TAC were associated with significantly lower serum triglyceride concentartions (TG; WMD: -7.58; CI: -11.42, -3.75; P < 0.001) and waist circumference (WC; WMD: -1.17; 95% CI: -1.47, -0.87; P < 0.001); while no significant change in body mass index (BMI; WMD: -0.17; 95% CI: -0.35, 0.01; P = 0.12), high density lipoprotein cholesterol (HDL-C; WMD: 0.61; 95% CI: -0.16, 1.40; P = 0.12), low density lipoprotein cholesterol (LDL-C; WMD: 1.34; 95% CI: -0.61, 3.30; P = 0.17) and total cholesterol (TC; WMD: 1.19; 95% CI: -1.46, 3.855; P = 0.37) was reported. Conclusion: Higher dietary TAC was related to reduced prevalence of central obesity, reduced WC and TG concentrations in the current meta-analysis. Moreover, subgroup analysis showed that TAC measurement index, geographical area, dietary assessment tool, health status and gender were potential sources of heterogeneity.

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

While traditionally diet quality index scores (DQIS) as noted later in this abstract have been used to predict health outcomes, dietary total antioxidant capacity (TAC), a useful tool for assessing total antioxidant power in the diet, may also be a novel predictor. This study evaluated the associations between dietary TAC and DQIS and all-cause mortality. Based on the National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2006, 23,797 US adults were followed-up until 2015. Dietary TAC and DQIS including the Healthy Eating Index-2015 (HEI-2015), Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH) were calculated using a 1-day 24 h dietary recall. US adults in the highest quintiles of DQIS had lower rates of all-cause mortality compared to those in the lowest quintiles (HEI-2015 hazard ratio (HR): 0.87, 95% confidence interval (CI): 0.77-0.98; AHEI-2010 HR: 0.84, 95% CI: 0.74-0.94; aMED HR: 0.79, 95% CI: 0.69-0.90; DASH HR: 0.80, 95% CI: 0.70-0.92). Similarly, those in the highest quintile of dietary TAC also had a lower all-cause mortality than those in the lowest quintile (HR: 0.88, 95% CI: 0.79-0.98). These findings suggest that dietary TAC might be a relatively valid predictor of all-cause mortality in the US population compared to the DQIS.

Total Antioxidant Capacity and Pancreatic Cancer Incidence and Mortality in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

BACKGROUND

Total antioxidant capacity (TAC) reflects an individual's overall antioxidant intake. We sought to clarify whether higher TAC is associated with lower risks of pancreatic cancer incidence and mortality in the U.S. general population.

METHODS

A total of 96,018 American adults were identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. A ferric-reducing ability of plasma score was used to reflect an individual's TAC intake from diet and/or supplements. Cox regression was used to calculate hazard ratios (HR) for pancreatic cancer incidence, and competing risk regression was used to calculate subdistribution HRs for pancreatic cancer mortality. Restricted cubic spline regression was used to test nonlinearity.

RESULTS

A total of 393 pancreatic cancer cases and 353 pancreatic cancer-related deaths were documented. Total (diet + supplements) TAC was found to be inversely associated with pancreatic cancer incidence (HR _{quartile 4 vs. quartile 1} = 0.53; 95% confidence interval, 0.39-0.72; P _trend = 0.0002) and mortality (subdistribution HR _{quartile 4 vs. quartile 1} = 0.52; 95% confidence interval 0.38-0.72; P _trend = 0.0003) in a nonlinear dose-response manner (all P _nonlinearity < 0.01). Similar results were observed for dietary TAC. No association of supplemental TAC with pancreatic cancer incidence and mortality was found.

CONCLUSIONS

In the U.S. general population, dietary but not supplemental TAC level is inversely associated with risks of pancreatic cancer incidence and mortality in a nonlinear dose-response pattern.

IMPACT

This is the first prospective study indicating that a diet rich in antioxidants may be beneficial in decreasing pancreatic cancer incidence and mortality.

Higher Dietary Non-enzymatic Antioxidant Capacity Is Associated with Decreased Risk of All-Cause and Cardiovascular Disease Mortality in Japanese Adults

BACKGROUND

Few studies have assessed associations of non-enzymatic antioxidant capacity (NEAC) in the overall diet with all-cause or specific mortality, and their results have been inconsistent.

OBJECTIVES

The present study investigated the association between dietary NEAC and all-cause or cause-specific mortality.

METHODS

The study was a large-scale population-based prospective cohort study in Japan consisting of 42,520 men and 50,207 women aged 44-76 y, who had no history of cancer, stroke, ischemic heart disease, or chronic liver disease. We evaluated FFQ-based dietary NEAC with use of published databases in which the NEACs of individual foods were analyzed by ferric reducing antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC) assays. Dietary NEAC was calculated by multiplying the estimated NEAC with the consumed amount and summing up those values for all foods, and was categorized in quartiles. We identified death and cause of death with use of residential registry and death certificates. HRs and 95% Cls for death from the second survey, which was conducted from April 1995 to December 2014 were estimated with Cox proportional hazards regression analysis.

RESULTS

After 1,498,308 person-years of follow-up, 12,978 total deaths occurred. The multivariable-adjusted HRs (95% Cls) for all-cause mortality for the highest compared with the lowest quartile of FRAP and ORAC were 0.85 (0.80, 0.89) and 0.84 (0.79, 0.89), respectively. Dietary NEACs were inversely associated with mortality from cardiovascular disease (CVD), but not from cancer. The multivariable-adjusted HRs (95% Cls) for CVD for the highest compared with the lowest quartile of FRAP and ORAC were 0.83 (0.75, 0.92) and 0.79 (0.70, 0.89), respectively.

CONCLUSIONS

Higher dietary NEACs from FRAP and ORAC were associated with lower risk of all-cause mortality and mortality from CVD in Japanese adults.

Dietary and circulating vitamin C, vitamin E, β-carotene and risk of total cardiovascular mortality: a systematic review and dose-response meta-analysis of prospective observational studies

OBJECTIVE

The present review aimed to quantify the association of dietary intake and circulating concentration of major dietary antioxidants with risk of total CVD mortality.

DESIGN

Systematic review and meta-analysis.

SETTING

Systematic search in PubMed and Scopus, up to October 2017.ParticipantsProspective observational studies reporting risk estimates of CVD mortality across three or more categories of dietary intakes and/or circulating concentrations of vitamin C, vitamin E and β-carotene were included. A random-effects meta-analysis was conducted.

RESULTS

A total of fifteen prospective cohort studies and three prospective evaluations within interventional studies (320 548 participants and 16 974 cases) were analysed. The relative risks of CVD mortality for the highest v. the lowest category of antioxidant intakes were as follows: vitamin C, 0·79 (95 % CI 0·68, 0·89; I 2=46 %, n 10); vitamin E, 0·91 (95 % CI 0·79, 1·03; I 2=51 %, n 8); β-carotene, 0·89 (95 % CI 0·73, 1·05; I 2=34 %, n 4). The relative risks for circulating concentrations were: vitamin C, 0·60 (95 % CI 0·42, 0·78; I 2=65 %, n 6); α-tocopherol, 0·82 (95 % CI 0·76, 0·88; I 2=0 %, n 5); β-carotene, 0·68 (95 % CI 0·52, 0·83; I 2=50 %, n 6). Dose-response meta-analyses demonstrated that the circulating biomarkers of antioxidants were more strongly associated with risk of CVD mortality than dietary intakes.

CONCLUSIONS

The present meta-analysis demonstrates that higher vitamin C intake and higher circulating concentrations of vitamin C, vitamin E and β-carotene are associated with a lower risk of CVD mortality.

Dietary Antioxidants, Circulating Antioxidant Concentrations, Total Antioxidant Capacity, and Risk of All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Observational Studies

The associations of various dietary or circulating antioxidants with the risk of all-cause mortality in the general population have not been established yet. A systematic search was performed in PubMed and Scopus, from their inception up to October 2017. Prospective observational studies reporting risk estimates of all-cause mortality in relation to dietary intake and/or circulating concentrations of antioxidants were included. Random-effects meta-analyses were conducted. Forty-one prospective observational studies (total n = 507,251) involving 73,965 cases of all-cause mortality were included. The RRs of all-cause mortality for the highest compared with the lowest category of circulating antioxidant concentrations were as follows: total carotenes, 0.60 (95% CI: 0.46, 0.74); vitamin C, 0.61 (95% CI: 0.53, 0.69); selenium, 0.62 (95% CI: 0.45, 0.79); β-carotene, 0.63 (95% CI: 0.57, 0.70); α-carotene, 0.68 (95% CI: 0.58, 0.78); total carotenoids, 0.68 (95% CI: 0.56, 0.80); lycopene, 0.75 (95% CI: 0.54, 0.97); and α-tocopherol, 0.84 (95% CI: 0.77, 0.91). The RRs for dietary intakes were: total carotenoids, 0.76 (95% CI: 0.66, 0.85); total antioxidant capacity, 0.77 (95% CI: 0.73, 0.81); selenium, 0.79 (95% CI: 0.73, 0.85); α-carotene, 0.79 (95% CI: 0.63, 0.94); β-carotene, 0.82 (95% CI: 0.77, 0.86); vitamin C, 0.88 (95% CI: 0.83, 0.94); and total carotenes, 0.89 (95% CI: 0.81, 0.97). A nonsignificant inverse association was found for dietary zinc, zeaxanthin, lutein, and vitamin E. The nonlinear dose-response meta-analyses demonstrated a linear inverse association in the analyses of dietary β-carotene and total antioxidant capacity, as well as in the analyses of circulating α-carotene, β-carotene, selenium, vitamin C, and total carotenoids. The association appeared to be U-shaped in the analyses of serum lycopene and dietary vitamin C. The present study indicates that adherence to a diet with high antioxidant properties may reduce the risk of all-cause mortality. Our results confirm current recommendations that promote higher intake of antioxidant-rich foods such as fruit and vegetables.

Association between dietary total antioxidant capacity and hepatocellular ballooning in nonalcoholic steatohepatitis: a cross-sectional study

PURPOSE

Nonalcoholic steatohepatitis (NASH) is characterized by steatosis, lobular inflammation, ballooning, and in some cases, fibrosis, which can progress to cirrhosis and carcinoma. The progression of NASH is closely related to oxidative stress. Dietary intake of antioxidants has been suggested in protection against oxidative damage and related clinical complications. Thus, we evaluated the potential association of dietary total antioxidant capacity (TAC) with disease severity in NASH patients, as well as with anthropometric and body composition markers and biochemical parameters.

METHODS

Thirty-three outpatients with a mean age of 48.4 ± 1.9 years were evaluated. Dietary TAC was estimated from a quantitative food frequency questionnaire. NASH severity, determined by liver biopsy, lifestyle characteristics, occurrence of comorbidities, anthropometry, body composition, and biochemical parameters were assessed.

RESULTS

NASH patients who had a higher dietary TAC had fewer ballooned hepatocytes compared to those with a lower TAC (p = 0.024). The patients with the highest dietary TAC had a reduction of approximately 20% in the risk of having many ballooned hepatocytes (OR 0.791; 95% CI 0.643-0.974; p = 0.027). There was no association of steatosis, lobular inflammation, and fibrosis with dietary TAC. The same occurred for lifestyle characteristics, occurrence of comorbidities, anthropometry, body composition, and biochemical parameters.

CONCLUSION

Dietary TAC is higher in patients with lower hepatic injury (ballooning), suggesting a possible role of food intake naturally high in its antioxidant capacity in reducing free radical production and, consequently, oxidative stress.