The Association between Dietary Antioxidant Quality Score and Cardiorespiratory Fitness in Iranian Adults: a Cross-Sectional Study

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.

Association Between Dietary Antioxidant Quality Score (DAQS) and All-Cause Mortality in Hypertensive Adults: A Retrospective Cohort Study from the NHANES Database

This study aimed to explore the association between the dietary antioxidant quality scores (DAQS) and all-cause mortality in hypertensive adults. In this retrospective cohort study, participants aged ≥ 18 years with hypertension were extracted from the National Health and Nutrition Examination Survey (NAHNES) 2007-2018. Outcome was all-cause mortality of hypertensive participants. DAQS was the exposure variable calculated based on the intake of vitamin A, C, E, zinc, selenium, and magnesium. The weighted univariable and multivariable COX proportional hazards regression models were utilized to explore the association between the DAQS and the all-cause mortality in hypertensive patients and were described as hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses based on different age, gender, diabetes, and cardiovascular disease (CVD) history were further assessed this association. A total of 16,240 participants were finally included in this study. Until 12 December 2019, 2710 (16.69%) all-cause deaths were documented. After adjustment for confounding variables, high DAQS was associated with the lower all-cause mortality (HR = 0.83, 95%CI: 0.72-0.96) in hypertensive patients. Subgroup analyses suggested that the association between DAQS and the all-cause mortality in hypertensive patients remain robust, especially in patients with female (HR = 0.77, 95%CI: 0.63-0.95), aged ≥ 60 years (HR = 0.81, 95%CI: 0.69-0.96). High DAQS was associated with the lower odds of all-cause mortality in adults with hypertension and are a promising intervention to be further explored in hypertensive patients.

Association between dietary antioxidant quality score and periodontitis: A cross-sectional study

Background/purpose

Evidence to date linking relation between dietary antioxidant quality score (DAQS) and periodontitis is limited. This study aimed to investigate the relationship between DAQS and periodontitis.

Materials and methods

In total, 9457 participants from the National Health and Nutrition Examination Survey 2009-2014 were enrolled in this cross-sectional study. The outcome was defined as periodontitis. DAQS was calculated by comparing the daily dietary intake of six micronutrients (vitamin A, C, E, selenium, magnesium and zinc) to the recommended daily intake, which was divided into three groups: low quality (1-2 points), medium quality (3-4 points) and high quality (5-6 points). Weighted logistic regression models were carried out to examine the association of DAQS and periodontitis. Meanwhile, this study investigated the effects of DAQS and periodontitis by stratified specific analyses based on diabetes and dyslipidemia.

Results

There were 4951 participants with periodontitis and 4506 non-periodontitis subjects. Compared with periodontitis group, mean DAQS score in participants with non-periodontitis was higher. After adjusting for all possible confounding factors, the results showed that high quality group of DAQS was related to the decreased risk of periodontitis [odds ratio (OR) = 0.80, 95% confidence interval (CI): 0.67-0.95, P = 0.012]. Subgroup analysis showed that the association between high quality group of DAQS and periodontitis was significant in participants without diabetes nor dyslipidemia (OR = 0.58, 95%CI: 0.39-0.87, P = 0.009).

Conclusion

Based on data from nationally representative data from the US population, DAQS is found to be associated with periodontitis risk.

Relationship between dietary intake components and hepatic fibrosis in those with obesity before and 1 year after bariatric surgery

OBJECTIVES

Non-alcoholic fatty liver disease is highly prevalent in the bariatric population but not all patients develop liver fibrosis. Considering that fibrosis may affect clinical outcomes, it is important to assess and treat contributing factors. In this population, it is not clear whether dietary intake is a contributor. The objective was to determine the relationship between dietary intake components and liver fibrosis before and 1 y after Roux-en-Y gastric bypass (RYGB).

METHODS

This was a prospective cross-sectional (n = 133) study conducted between 2013 and 2022. In addition, a subgroup of 44 patients were followed for 1 y post-RYGB. Anthropometrics, biochemical measurements, and 3-d food records and liver biopsies were obtained presurgery and, in a subgroup of patients, as for the cohort, 1 y post-RYGB.

RESULTS

In the cross-sectional study, 78.2% were female, with a median age of 48 y and body mass index of 46.8 kg/m2; 33.8% had type 2 diabetes mellitus and 57.1% had metabolic syndrome. In a multivariate analysis, age (odds ratio; 95% CI) (1.076; 1.014-1.141), alanine transaminase (1.068; 1.025-1.112), calorie intake (1.001; 1.000-1.002), and dietary copper (0.127; 0.022-0.752) were independently associated with fibrosis (<0.05). At 1 y post-RYGB, no independent risk factors were associated with persistent fibrosis.

CONCLUSIONS

In bariatric patients before surgery, higher age, alanine transaminase, and total calorie and lower copper intakes were independent risk factors associated with liver fibrosis. These relationships were no longer observed after RYGB, likely due to the effect of surgery on weight and similar postsurgery diet among patients.

Dietary Antioxidant Quality Score (DAQS), serum lipids, markers of glucose homeostasis, blood pressure and anthropometric features among apparently metabolically healthy obese adults in two metropolises of Iran (Tabriz and Tehran): a cross-sectional study

BACKGROUND

Oxidative stress (OS) is associated with a variety of non-communicable diseases, including MetS, diabetes mellitus, metabolic syndrome, and cardiovascular disease through increased production of reactive oxygen species (ROS) and impairment of antioxidant defense mechanisms. Antioxidants can protect cells against free radical damage, so it seems important to determine the relationship between the quality of dietary antioxidants intake and chronic diseases. The Dietary Antioxidant Quality Score (DAQS) is obtained by adding the daily intake of known dietary vitamins and minerals, including selenium, zinc, vitamin A, vitamin C, and vitamin E, compared to the recommended daily intake (RDI). Therefore, this study aims to determine the relationship between DAQS, serum lipids, markers of glucose homeostasis, blood pressure and anthropometric features among obese adults.

METHODS

In the present cross-sectional study, 338 individuals who were obese (BMI ≥ 30 kg/m²) aged 20-50 years were recruited from Tabriz and Tehran, Iran. A validated semi-quantitative Food Frequency Questionnaire (FFQ) with 168 food items was used to quantify dietary consumption; accordingly, DAQS was computed. Blood biomarkers were measured using enzyme-linked immunosorbent assay (ELISA) kits. A standard mercury sphygmomanometer was used to assess blood pressure, and bioelectrical impedance analysis (BIA) was performed to determine body composition. The association between the DAQS tertiles and biochemical variables was investigated using multinomial logistic regression.

RESULTS

Participants in the highest tertile of DAQS have a lower diastolic blood pressure (DBP) values in all of the adjusted models [odds ratio (OR) = 0.920; confidence interval (CI)= 0.852-0.993, P-value = 0.03] in the analysis of co-variance (ANCOVA) model. Similarly, subjects at the second tertile of DAQS had lower DBP compared with the first tertile in age and sex-adjusted model [OR= 0.937; CI= 0.882-0.997]. There was no statistically significant difference for other metabolic parameters in different DAQS tertiles.

CONCLUSION

According to our findings, higher DAQS was associated with lower DBP among obese adults with obesity in two major cities of Iran (Tehran and Tabriz). Other studies with interventional design are needed to better elucidate these associations and underlying mechanisms.

Association between dietary antioxidant quality score and severity of coronavirus infection: a case-control study

The purpose of this study was to examine the association between the dietary antioxidant quality score (DAQS) and the severity of Coronavirus disease 2019 (COVID-19). The present case-control study was carried out on 295 patients diagnosed with COVID-19 (≥18 years old), including 104 critical patients (Intensive care unit [ICU] admission) and 191 COVID-19 patients without severe complications (Non-intensive care unit [Non-ICU] patients) as cases. Dietary intake was assessed by a 147-item, semi-quantitative food frequency questionnaire (FFQ). Logistic regression was performed to calculate the odds ratio (OR) and 95% confidence interval (CI) for the considered risk factors. Our outcomes (after multivariate adjustment) suggested that higher adherence to DAQS was significantly associated with a decreased risk of COVID-19 infection severity (OR = 0.12; 95% CI: 0.04-0.29, p < 0.001). Similar results were seen when analyzed by sex [men (OR = 0.02; 95% CI: 0.002-0.15, p < 0.001) and women (OR = 0.21; 95% CI: 0.06-0.68, p = 0.012)]. A significant association between vitamin D3 intake and decreased risk of COVID-19 severity (OR = 0.91; 95% CI: 0.89-0.94, p < 0.001) was also observed. Moreover, multivariate results revealed that there were no significant associations between vitamin C (OR = 1.00; 95% CI: 0.99-1.00, p = 0.067), vitamin E (OR = 0.98; 95% CI: 0.86-1.11, p = 0.798), zinc (OR = 1.02; 95% CI: 0.86-1.20, p = 0.805), and selenium (OR = 0.99; 95% CI: 0.99-1.00, p = 0.077) intakes with the risk of COVID-19 severity. However, subgroup analyses by sex suggested a significant association between vitamin C intake and the risk of COVID-19 infection severity in women (OR = 1.00; 95% CI: 1.00-1.00, p = 0.028). Our findings showed a negative association between DAQS adherence and the risk of COVID-19 infection severity. Our results may be used to develop potential dietary therapies to decrease COVID-19 severity.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Cross sectional determinants of VO2 max in free living Iranians: Potential role of metabolic syndrome components and vitamin D status

BACKGROUND AND AIMS

The purpose of the study was to evaluate the determinants of cardiorespiratory fitness (CRF) in Iranian adults and the potential contribution of vitamin D status.

METHODS

In this cross-sectional study 264 cases (116 men and 147 women aged 18-70 years old were participated. Maximal oxygen consumption (VO_{2 max}) was measured by the Bruce protocol utilizing treadmill exercise testing. Anthropometric data, body composition and fasting blood glucose and lipid concentrations were measured. Serum levels of 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)₂D) were assessed using enzyme-linked immunosorbent assay. Stepwise linear regression analysis was applied to determine significant predictors of VO2 peak. We tested non-linear (quadratic and cubic terms) versus linear association of adjusted (for determinants) VO2 max and vitamin D levels.

RESULTS

Multiple regression results showed that fat free mass, HDL-C and physical activity, waist circumference, age and sex were determinants of VO_{2 peak}. All of these explained the 65.3% of VO2 peak. There was a non-linear cubic association (R² = 0.03, p = 0.046) between serum 25(OH)D and adjusted VO2 peak in which 25(OH)D in people with a high 25(OH)D levels (>60 nmol/L), had better fitness and those with serum 25(OH) less than 20 nmol/L. We found no linear and non-linear associations between serum 1,25(OH)₂ D and adjusted VO_{2 max}.

CONCLUSIONS

Our results showed that waist circumference and HDL-C, as components of metabolic syndrome, contribute ∼2% to the variance in VO_{2 max}. Moreover, high concentrations of 25(OH)D but not 1,25(OH)₂ D may make additional contributions to CRF.

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.