Association of dietary total antioxidant capacity with all-cause and cardiovascular mortality in patients with chronic kidney disease: based on two retrospective cohort studies of NHANES

Yue Li; Gui-Chen Ling; Rui-Bin Ni; Shi-Hao Ni; Shu-Ning Sun; Xin Liu; Jian-Ping Deng; Xiao-Lu Ou-Yang; Jin Li; Shao-Xiang Xian; Ling-Jun Wang; Tao-Chun Ye; Lu Lu

doi:10.1080/0886022X.2023.2205950

Association of dietary total antioxidant capacity with all-cause and cardiovascular mortality in patients with chronic kidney disease: based on two retrospective cohort studies of NHANES

Ren Fail. 2023 Dec;45(1):2205950. doi: 10.1080/0886022X.2023.2205950.

Authors

Yue Li^{1

2

3}, Gui-Chen Ling⁴, Rui-Bin Ni⁵, Shi-Hao Ni^{1

2

3}, Shu-Ning Sun^{1

2

3}, Xin Liu^{1

2

3}, Jian-Ping Deng^{1

2

3}, Xiao-Lu Ou-Yang^{1

2

3}, Jin Li^{1

2

3}, Shao-Xiang Xian^{1

2

3}, Ling-Jun Wang^{1

2

3}, Tao-Chun Ye^{1

2

3}, Lu Lu^{1

2

3}

Affiliations

¹ The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
² Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China.
³ University Key Laboratory of Traditional Chinese Medicine Prevention and Treatment of Chronic Heart Failure, Guangdong Province, Guangzhou, China.
⁴ The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China.
⁵ The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.

Abstract

Background: The relationship between dietary total antioxidant capacity (DTAC) and death risk among CKD populations remains unclear.

Methods: Based on vitamin C equivalent antioxidant capacity (VCEAC) and the component dietary antioxidant index (CDAI) indices, we analyzed two cohorts to investigate the association of DTAC with all-cause and CVD mortality in CKD patients using data from National Health and Nutrition Examination Survey (2007-2018). VCEAC (n = 6330) and CDAI (n = 6300) cohorts with mortality follow-up data available through 2018 were included. Cox models with restricted cubic splines was used to model the nonlinear association between VCEAC/CDAI and outcomes in CKD patients.

Results: Our results showed L-shaped associations of DTAC with all-cause mortality among individuals with CKD stages 1-2 in both cohorts. Compared to the lowest quartile, higher dietary total antioxidant intake was associated with lower all-cause mortality risks among CKD stages 1-2 after adjustment for covariates, with HRs (95%CI) of 1.00, 0.91 (0.71,1.17), 0.69 (0.53,0.90), and 0.70 (0.54,0.91) in VCEAC, and similar respective estimate trends in CDAI. After sensitivity and subgroup analyses, there were no benefits for patients with stage 3-5 CKD or albuminuria. Mediation analysis revealed that the proportions mediated in both cohorts were less consistent.

Conclusions: Moderate dietary total antioxidants intake has potential benefits for early-stage CKD patients. However, further evidence is needed to confirm whether patients with worsening CKD can benefit in the long term.

Keywords: Dietary total antioxidant capacity; NHANES; chronic kidney disease; component dietary antioxidant index; mortality; vitamin C equivalent antioxidant capacity.

MeSH terms

Antioxidants* / administration & dosage
Ascorbic Acid / administration & dosage
Cardiovascular Diseases* / mortality
Mortality
Nutrition Surveys
Renal Insufficiency, Chronic* / mortality
Retrospective Studies

Substances

Antioxidants
Ascorbic Acid

Grants and funding

This study was funded by the National Science Foundation of China (No. 81973776, and No. 82174316), the Young Elite Scientists Sponsorship Program by CAST (CACM-2021-QNRC2-B30), Natural Science Foundation of Guangdong Province/Guangzhou City (2023A1515030146,2021A1515011457 and 202102080228) and Guangzhou Science and Technology Project (202206080015), National Clinical Research Base of Traditional Chinese Medicine (No. [2018]131). National Natural Science Foundation of China Youth Project (82205236).