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Dietary antioxidant capacity and all-cause and cause-specific mortality in the E3N/EPIC cohort study



The cellular oxidative stress (balance between pro-oxidant and antioxidant) may be a major risk factor for chronic diseases. Antioxidant capacity of human diet can be globally assessed through the dietary non-enzymatic antioxidant capacity (NEAC). Our aim was to investigate the relationship between the NEAC and all-cause and cause-specific mortality, and to test potential interactions with smoking status, a well-known pro-oxidant factor.


Among the French women of the E3N prospective cohort study initiated in 1990, including 4619 deaths among 1,199,011 persons-years of follow-up. A validated dietary history questionnaire assessed usual food intake; NEAC intake was estimated using a food composition table from two different methods: ferric ion reducing antioxidant power (FRAP) and total radical-trapping antioxidant parameter (TRAP). Hazard ratio (HR) estimates and 95 % confidence intervals (CI) were derived from Cox proportional hazards regression models.


In multivariate analyses, FRAP dietary equivalent intake was inversely associated with mortality from all-causes (HR for the fourth vs. the first quartile: HR4 = 0.75, 95 % CI 0.67, 0.83, p trend < 0.0001), cancer, and cardiovascular diseases. Similar results were obtained with TRAP. There was an interaction between NEAC dietary equivalent intake and smoking status for all-cause and cardiovascular disease mortality, but not cancer mortality (respectively, for FRAP, p inter = 0.002; 0.013; 0.113, results were similar with TRAP), and the association was the strongest among current smokers.


This prospective cohort study highlights the importance of antioxidant consumption for mortality prevention, especially among current smokers.

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Fig. 1



Non-enzymatic antioxidant capacity


Ferric ion reducing antioxidant power


Hydrogen atom transfer


Single electron transfer


Total radical-trapping antioxidant parameter


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The authors are indebted to all participants for providing the data used in the E3N Study and to practitioners for providing pathology reports. They are grateful to M. Fangon, L. Hoang and M. Niravong for their technical assistance, to S. Kangas for her assistance in the construction of non-enzymatic total antioxidant capacity data, to Jessica Pontary for data management of the mortality table, and to the E3N group. The references have been checked for accuracy and completeness by NB. MCBR will act as guarantor for the paper. This material has not been published previously in a substantively similar form. The authors declare that they have no conflict of interest.

Authors contribution

N.B. and M.C.B.R. designed research; N.B., V.D., and M.C.B.R. conducted research; V.D., L.Da., and M.S. contributed to construction of dietary and medical data; N.B., V.D., L.Da., and M.C.B.R. analyzed data; N.B. and M.C.B.R. wrote the paper; M.C.B.R. had primary responsibility for final content; V.D., L.Da., L.Do., G.F., and M.S. revised the article critically. All authors read and approved the final manuscript.

Grant support

The E3N cohort is being carried out with the financial support of the “Mutuelle Générale de l’Education Nationale” (MGEN); European Community; French League against Cancer (LNCC); Gustave Roussy Institute (IGR); French Institute of Health and Medical Research (INSERM). Nadia Bastide was supported by a Fondation de France post-doctoral fellowship.

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Correspondence to Marie-Christine Boutron-Ruault.

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Bastide, N., Dartois, L., Dyevre, V. et al. Dietary antioxidant capacity and all-cause and cause-specific mortality in the E3N/EPIC cohort study. Eur J Nutr 56, 1233–1243 (2017).

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  • Non-enzymatic antioxidant capacity
  • FRAP
  • TRAP
  • All-cause and cause-specific mortality
  • E3N study