SpringerLink
Log in

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

  • Research
  • Published:
Biological Trace Element Research Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

The datasets generated and/or analyzed during the current study are available in the NHANES database, https://www.cdc.gov/nchs/nhanes/index.htm.

References

  1. Ji E, Ahn S, Choi JY, Kim CH, Kim KI (2023) Effect of multimorbidity on hypertension management. Sci Rep 13(1):18764. https://doi.org/10.1038/s41598-023-44813-0

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J (2005) Global burden of hypertension: analysis of worldwide data. Lancet 365(9455):217–223. https://doi.org/10.1016/s0140-6736(05)17741-1

    Article  PubMed  Google Scholar 

  3. Murray CJ, Lopez AD (2013) Measuring the global burden of disease. N Engl J Med 369(5):448–457. https://doi.org/10.1056/NEJMra1201534

    Article  CAS  PubMed  Google Scholar 

  4. GBD (2016) Neurology Collaborators (2019) Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 18(5):459–480. https://doi.org/10.1016/S1474-4422(18)30499-X

    Article  Google Scholar 

  5. GBD (2019) Risk Factors Collaborators (2020) Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England) 396(10258):1223–1249. https://doi.org/10.1016/S0140-6736(20)30752-2

    Article  Google Scholar 

  6. Deussen A, Kopaliani I (2023) Targeting inflammation in hypertension. Curr Opin Nephrol Hypertens 32(2):111–117. https://doi.org/10.1097/mnh.0000000000000862

    Article  CAS  PubMed  Google Scholar 

  7. Griendling KK, Camargo LL, Rios FJ, Alves-Lopes R, Montezano AC, Touyz RM (2021) Oxidative stress and hypertension. Circ Res 128(7):993–1020. https://doi.org/10.1161/circresaha.121.318063

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Li H, He P, Lin T, Guo H, Li Y, Song Y, Wang B, Liu C, Liu L, Li J, Zhang Y, Huo Y, Zhou H, Yang Y, Ling W, Wang X, Zhang H, Xu X, Qin X (2020) Association between plasma retinol levels and the risk of all-cause mortality in general hypertensive patients: a nested case-control study. J Clin Hypertens (Greenwich) 22(5):906–913. https://doi.org/10.1111/jch.13866

    Article  CAS  PubMed  Google Scholar 

  9. Zhang Z, Liu C, Liu M, Zhou C, Li Q, He P, Zhang Y, Li H, Qin X (2022) Dietary iron intake and new-onset hypertension: a nationwide cohort study from China. J Nutr Health Aging 26(11):1016–1024. https://doi.org/10.1007/s12603-022-1861-1

    Article  CAS  PubMed  Google Scholar 

  10. He P, Li H, Liu C, Liu M, Zhang Z, Zhang Y, Zhou C, Li Q, Ye Z, Wu Q, Jiang J, Wang G, Liang M, Nie J, Hou FF, Qin X (2022) U-shaped association between dietary copper intake and new-onset hypertension. Clin Nutr (Edinburgh, Scotland) 41(2):536–542. https://doi.org/10.1016/j.clnu.2021.12.037

    Article  CAS  Google Scholar 

  11. He P, Li H, Liu M, Zhang Z, Zhang Y, Zhou C, Li Q, Liu C, Qin X (2022) U-shaped association between dietary zinc intake and new-onset diabetes: a nationwide cohort study in China. J Clin Endocrinol Metab 107(2):e815–e824. https://doi.org/10.1210/clinem/dgab636

    Article  PubMed  Google Scholar 

  12. Wang W, Wang X, Cao S, Duan Y, Xu C, Gan D, He W (2022) Dietary antioxidant indices in relation to all-cause and cause-specific mortality among adults with diabetes: a prospective cohort study. Front Nutr 9:849727. https://doi.org/10.3389/fnut.2022.849727

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Farhangi MA, Moradi F, Najafi M, Jafarabadi MA (2019) 10-year survival in coronary artery bypass grafting surgery patients in Tehran heart center, coronary outcome measurement study: predictive power of dietary inflammatory index a nd dietary antioxidant quality. Nutrition 63–64:22–28. https://doi.org/10.1016/j.nut.2019.01.011

    Article  PubMed  Google Scholar 

  14. Liu Y, Liu F, Zhang L, Li J, Kang W, Cao M, Song F, Song F (2021) Association between low density lipoprotein cholesterol and all-cause mortality: results from the NHANES 1999–2014. Sci Rep 11(1):22111. https://doi.org/10.1038/s41598-021-01738-w

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  15. Ahuja JK, Moshfegh AJ, Holden JM, Harris E (2013) USDA food and nutrient databases provide the infrastructure for food and nutrition research, policy, and practice. J Nutr 143(2):241s–249s. https://doi.org/10.3945/jn.112.170043

    Article  CAS  PubMed  Google Scholar 

  16. Tur JA, Romaguera D, Pons A (2005) Does the diet of the Balearic population, a Mediterranean-type diet, ensure compliance with nutritional objectives for the Spanish population? Public Health Nutr 8(3):275–283. https://doi.org/10.1079/phn2004693

    Article  PubMed  Google Scholar 

  17. Peterson CM, Thomas DM, Blackburn GL, Heymsfield SB (2016) Universal equation for estimating ideal body weight and body weight at any BMI. Am J Clin Nutr 103(5):1197–1203. https://doi.org/10.3945/ajcn.115.121178

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kenwood BM, Zhu W, Zhang L, Bhandari D, Blount BC (2022) Cigarette smoking is associated with acrylamide exposure among the U.S. population: NHANES 2011–2016. Environ Res 209:112774. https://doi.org/10.1016/j.envres.2022.112774

    Article  CAS  PubMed  Google Scholar 

  19. ** B, Veeranki SP, Zhao M, Ma C, Yan Y, Mi J (2017) Relationship of alcohol consumption to all-cause, cardiovascular, and cancer-related mortality in U.S. adults. J Am Coll Cardiol 70(8):913–922. https://doi.org/10.1016/j.jacc.2017.06.054

    Article  PubMed  Google Scholar 

  20. Jellinger PS, Smith DA, Mehta AE, Ganda O, Handelsman Y, Rodbard HW, Shepherd MD, Seibel JA (2012) American association of clinical endocrinologists’ guidelines for management of dyslipidemia and prevention of atherosclerosis. Endocr Pract 18(Suppl 1):1–78. https://doi.org/10.4158/ep.18.s1.1

    Article  PubMed  Google Scholar 

  21. McClure ST, Schlechter H, Oh S, White K, Wu B, Pilla SJ, Maruthur NM, Yeh HC, Miller ER, Appel LJ (2020) Dietary intake of adults with and without diabetes: results from NHANES 2013–2016. BMJ Open Diabetes Res Care 8(1):e001681. https://doi.org/10.1136/bmjdrc-2020-001681

    Article  PubMed  PubMed Central  Google Scholar 

  22. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006

    Article  PubMed  PubMed Central  Google Scholar 

  23. Liu Y, Geng T, Wan Z, Lu Q, Zhang X, Qiu Z, Li L, Zhu K, Liu L, Pan A, Liu G (2022) Associations of serum folate and vitamin B12 levels with cardiovascular disease mortality among patients with type 2 diabetes. JAMA Netw Open 5(1):e2146124. https://doi.org/10.1001/jamanetworkopen.2021.46124

    Article  PubMed  PubMed Central  Google Scholar 

  24. Flack JM, Adekola B (2020) Blood pressure and the new ACC/AHA hypertension guidelines. Trends Cardiovasc Med 30(3):160–164. https://doi.org/10.1016/j.tcm.2019.05.003

    Article  PubMed  Google Scholar 

  25. Ibrahimou B, Azim SI, Sun N (2019) Interaction between blood lead level and chronic obstructive pulmonary disease (COPD) on risk of heart attack or stroke: USA NHANES, 2013–2014. Pulm Pharmacol Ther 58:101805. https://doi.org/10.1016/j.pupt.2019.101805

    Article  CAS  PubMed  Google Scholar 

  26. Mendes MA, da Silva I, Ramires V, Reichert F, Martins R, Ferreira R, Tomasi E (2018) Metabolic equivalent of task (METs) thresholds as an indicator of physical activity intensity. PLoS ONE 13(7):e0200701. https://doi.org/10.1371/journal.pone.0200701

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Ha K, Sakaki JR, Chun OK (2021) Nutrient adequacy is associated with reduced mortality in US adults. J Nutr 151(10):3214–3222. https://doi.org/10.1093/jn/nxab240

    Article  CAS  PubMed  Google Scholar 

  28. Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C (2014) Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 1:Cd007470. https://doi.org/10.1002/14651858.CD007470.pub3

    Article  Google Scholar 

  29. Wang W, Gao J, Li N, Han S, Wu L, Zhang Y, Han T, Shan R, Li Y, Sun C, Wu X (2021) Dietary iron and vitamins in association with mortality. Clin Nutr 40(4):2401–2409. https://doi.org/10.1016/j.clnu.2020.10.038

    Article  CAS  PubMed  Google Scholar 

  30. Zhang N, Li Z, Wu Q, Huang H, Wang S, Liu Y, Chen J, Ma J (2023) Associations of dietary zinc-vitamin B6 ratio with all-cause mortality and cardiovascular disease mortality based on national health and nutrition examination survey 1999–2016. Nutrients 15(2):420. https://doi.org/10.3390/nu15020420

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. He P, Li H, Liu M, Zhang Z, Zhang Y, Zhou C, Ye Z, Wu Q, Liang M, Jiang J, Wang G, Nie J, Hou FF, Liu C, Qin X (2023) J-shaped association between dietary zinc intake and new-onset hypertension: a nationwide cohort study in China. Frontiers of medicine 17(1):156–164. https://doi.org/10.1007/s11684-022-0932-3

    Article  CAS  PubMed  Google Scholar 

  32. Mikolajczyk TP, Szczepaniak P, Vidler F, Maffia P, Graham GJ, Guzik TJ (2021) Role of inflammatory chemokines in hypertension. Pharmacol Ther 223:107799. https://doi.org/10.1016/j.pharmthera.2020.107799

    Article  CAS  PubMed  Google Scholar 

  33. Stepaniak U, Micek A, Grosso G, Stefler D, Topor-Madry R, Kubinova R, Malyutina S, Peasey A, Pikhart H, Nikitin Y, Bobak M, Pająk A (2016) Antioxidant vitamin intake and mortality in three Central and Eastern European urban populations: the HAPIEE study. Eur J Nutr 55(2):547–560. https://doi.org/10.1007/s00394-015-0871-8

    Article  CAS  PubMed  Google Scholar 

  34. Buijsse B, Feskens EJ, Kwape L, Kok FJ, Kromhout D (2008) Both alpha- and beta-carotene, but not tocopherols and vitamin C, are inversely related to 15-year cardiovascular mortality in Dutch elderly men. J Nutr 138(2):344–350. https://doi.org/10.1093/jn/138.2.344

    Article  CAS  PubMed  Google Scholar 

  35. Hajjarzadeh S, Nikniaz Z, Mahdavi R, Shalilahmadi D, Karandish M (2023) The association of dietary total antioxidant capacity with migraine attack frequency in women. Int J Neurosci 1–8. Advance online publication. https://doi.org/10.1080/00207454.2023.2175675

  36. Mohiti S, Zarezadeh M, Naeini F, Tutunchi H, Ostadrahimi A, Ghoreishi Z, Ebrahimi Mamaghani M (2021) Spirulina supplementation and oxidative stress and pro-inflammatory biomarkers: a systematic review and meta-analysis of controlled clinical trials. Clin Exp Pharmacol Physiol 48(8):1059–1069. https://doi.org/10.1111/1440-1681.13510

    Article  CAS  PubMed  Google Scholar 

  37. Shahinfar H, Shahavandi M, Jibril AT, Djafarian K, Clark CCT, Shab-Bidar S (2020) The association between dietary antioxidant quality score and cardiorespiratory fitness in iranian adults: a cross-sectional study. Clin Nutr Res 9(3):171–181. https://doi.org/10.7762/cnr.2020.9.3.171

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nikrad N, Shakarami A, Tousi AZ, Farhangi MA, Ardekani AM, Jafarzadeh F (2023) 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. BMC Endocr Disord 23(1):157. https://doi.org/10.1186/s12902-023-01392-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Shahavandi M, Shahinfar H, Payande N, Sheikhhossein F, Djafarian K, Shab-Bidar S (2020) The association between dietary antioxidant quality score with metabolic syndrome and its components in Iranian adults: a cross-sectional study. Food Sci Nutr 9(2):994–1002. https://doi.org/10.1002/fsn3.2067

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Zhao L, Sun Y, Cao R, Wu X, Huang T, Peng W (2022) Non-linear association between composite dietary antioxidant index and depression. Front Public Health 10:988727. https://doi.org/10.3389/fpubh.2022.988727

    Article  PubMed  PubMed Central  Google Scholar 

  41. Wu D, Wang H, Wang W, Qing C, Zhang W, Gao X, Shi Y, Li Y, Zheng Z (2023) Association between composite dietary antioxidant index and handgrip strength in American adults: Data from National Health and Nutrition Examination Survey (NHANES, 2011–2014). Front Nutr 10:1147869. https://doi.org/10.3389/fnut.2023.1147869

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. De França NA, Camargo MB, Lazaretti-Castro M, Martini LA (2013) Antioxidant intake and bone status in a cross-sectional study of Brazilian women with osteoporosis. Nutr Health 22(2):133–142. https://doi.org/10.1177/0260106014563445

    Article  CAS  PubMed  Google Scholar 

  43. Noori S, Keshavarz SA, Yekaninejad MS, Naghshi S, Mirzaei K (2022) Evaluation of the predictive value of different dietary antioxidant capacity assessment methods on healthy and unhealthy phenotype in overweight and obese women. J Diabetes Metab Disord 21(2):1641–1650. https://doi.org/10.1007/s40200-022-01115-y

    Article  PubMed  PubMed Central  Google Scholar 

  44. Liu G, Guasch-Ferré M, Hu Y, Li Y, Hu FB, Rimm EB, Manson JE, Rexrode KM, Sun Q (2019) Nut consumption in relation to cardiovascular disease incidence and mortality among patients with diabetes mellitus. Circ Res 124(6):920–929. https://doi.org/10.1161/circresaha.118.314316

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Salganik RI (2001) The benefits and hazards of antioxidants: controlling apoptosis and other protective mechanisms in cancer patients and the human population. J Am Coll Nutr 20(5 Suppl):464S-475S. https://doi.org/10.1080/07315724.2001.10719185

    Article  CAS  PubMed  Google Scholar 

  46. Bai R, Guo J, Ye XY, **e Y, **e T (2022) Oxidative stress: the core pathogenesis and mechanism of Alzheimer’s disease. Ageing Res Rev 77:101619. https://doi.org/10.1016/j.arr.2022.101619

    Article  CAS  PubMed  Google Scholar 

  47. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr (2018) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. Hypertension 71(6):1269–1324. https://doi.org/10.1161/hyp.0000000000000066

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by the National Key Research and Development Program of China (Grant No. 2020YFC2007200).

Author information

Author notes

  1. Jiahong Wang and **wen Wang contributed equally to this work.

Authors and Affiliations

  1. The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Institute of Health Management, Bei**g, 100853, China

    Jiahong Wang, **wen Wang, Shuhong Wang & Yijie Guo

  2. Bei**g Institute of Heart, Lung and Blood Vessel Diseases, Bei**g Anzhen Hospital, Affiliated of Capital Medical University, Bei**g, 100029, China

    **g Ma

  3. Bei**g Municipal Bureau of Retired Cadre Service, Bei**g, 100038, China

    Liang Yin

  4. Smart Sports Innovation Center, China Institute of Sport Science, No. 11, Tiyuguan Road, Dongcheng District, Bei**g, 100061, China

    **angchen Li

Authors
  1. Jiahong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. **wen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shuhong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. **g Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Liang Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yijie Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. **angchen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JW and XL designed the study, SW wrote the manuscript, JM and LY collected, analyzed and interpreted the data, XL and critically reviewed, edited the manuscript, all authors read and approved the manuscript.

Corresponding author

Correspondence to **angchen Li.

Ethics declarations

Ethics Approval

Ethical approval was not provided for this study on human participants because NHANES is a publicly available dataset.

Consent to Participate

The patients/participants provided their written informed consent to participate in this study.

Competing Interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, J., Wang, J., Wang, S. et al. Association Between Dietary Antioxidant Quality Score (DAQS) and All-Cause Mortality in Hypertensive Adults: A Retrospective Cohort Study from the NHANES Database. Biol Trace Elem Res (2024). https://doi.org/10.1007/s12011-024-04087-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12011-024-04087-7

Keywords

Search

Navigation