Although evidence strongly supports that antioxidant-rich diets reduce risk of chronic disease and mortality, findings from the previous studies on the effect of individual antioxidants on mortality have been inconsistent. The aim of this study was to assess the relationship between dietary total antioxidant capacity (TAC) and all-cause and disease-specific mortality in a representative sample of the US population.
A total of 23,595 US adults aged 30 years and older in NHANES 1988–1994 and 1999–2004 were selected for this study. Dietary TAC was calculated from 1-day 24-h diet recall data at baseline and all-cause, cancer and cardiovascular disease (CVD) mortality was assessed through December 31, 2011.
During a mean follow-up of 13 years, deaths from all-cause, cancer and CVD were 7157, 1578, and 2155, respectively. Using cause-specific Cox proportional hazards models, inverse associations and linear trends were observed between dietary TAC and all-cause mortality [highest quartile (Q4) versus Q1 ref. HR 0.78; 95% CI 0.71–0.86], cancer mortality (Q4 versus Q1 ref. HR 0.75; 95% CI 0.60–0.93), and CVD mortality (Q4 versus Q1 ref. HR 0.83; 95% CI 0.69–0.99), respectively, after adjusting for age, sex, ethnicity, and total energy intake. The inverse association and linear trend still remained between dietary TAC and all-cause mortality (Q4 versus Q1 ref. HR 0.79; 95% CI 0.71–0.87) and CVD mortality (Q4 versus Q1 ref. HR 0.74; 95% CI 0.61–0.89) when further adjusted for relevant covariates.
These findings support that antioxidant-rich diets are beneficial to reducing risk of death from all-cause and CVD.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Yoon PW, Bastian B, Anderson RN, Collins JL, Jaffe HW, Centers for Disease Control and Prevention (2014) Potentially preventable deaths from the five leading causes of death–United States, 2008–2010. Morb Mortal Wkly Rep 63:369–374
Reuter S, Gupta SC, Chaturvedi MM, Aggarwal BB (2010) Oxidative stress, inflammation, and cancer: how are they linked? Free Radic Biol Med 49:1603–1616
Bielli A, Scioli MG, Mazzaglia D, Doldo E, Orlandi A (2015) Antioxidants and vascular health. Life Sci 143:209–216
Leenders M, Boshuizen HC, Ferrari P, Siersema PD, Overvad K, Tjonneland A, Olsen A, Boutron-Ruault MC, Dossus L, Dartois L et al (2014) Fruit and vegetable intake and cause-specific mortality in the EPIC study. Eur J Epidemiol 29:639–652
Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, Hu FB (2014) Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 349:g4490
Stepaniak U, Micek A, Grosso G, Stefler D, Topor-Madry R, Kubinova R, Malyutina S, Peasey A, Pikhart H, Nikitin Y, Bobak M, Pajak A (2016) Antioxidant vitamin intake and mortality in three Central and Eastern European urban populations: the HAPIEE study. Eur J Nutr 55:547–560
Kubota Y, Iso H, Date C, Kikuchi S, Watanabe Y, Wada Y, Inaba Y, Tamakoshi A, Group JS (2011) Dietary intakes of antioxidant vitamins and mortality from cardiovascular disease: the Japan Collaborative Cohort Study (JACC) study. Stroke 42:1665–1672
Mink PJ, Scrafford CG, Barraj LM, Harnack L, Hong CP, Nettleton JA, Jacobs DR Jr (2007) Flavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women. Am J Clin Nutr 85:895–909
Mursu J, Voutilainen S, Nurmi T, Tuomainen TP, Kurl S, Salonen JT (2008) Flavonoid intake and the risk of ischaemic stroke and CVD mortality in middle-aged Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Br J Nutr 100:890–895
Zamora-Ros R, Jimenez C, Cleries R, Agudo A, Sanchez MJ, Sanchez-Cantalejo E, Molina-Montes E, Navarro C, Chirlaque MD, Maria Huerta J et al (2013) Dietary flavonoid and lignan intake and mortality in a Spanish cohort. Epidemiology 24:726–733
Klipstein-Grobusch K, Geleijnse JM, den Breeijen JH, Boeing H, Hofman A, Grobbee DE, Witteman JC (1999) Dietary antioxidants and risk of myocardial infarction in the elderly: the Rotterdam Study. Am J Clin Nutr 69:261–266
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 138:344–350
Dietrich M, Jacques PF, Pencina MJ, Lanier K, Keyes MJ, Kaur G, Wolf PA, D’Agostino RB, Vasan RS (2009) Vitamin E supplement use and the incidence of cardiovascular disease and all-cause mortality in the Framingham Heart Study: does the underlying health status play a role? Atherosclerosis 205:549–553
Serafini M, Del Rio D (2004) Understanding the association between dietary antioxidants, redox status and disease: is the total antioxidant capacity the right tool? Redox Rep 9:145–152
Puchau B, Zulet MA, de Echavarri AG, Hermsdorff HH, Martinez JA (2009) Dietary total antioxidant capacity: a novel indicator of diet quality in healthy young adults. J Am Coll Nutr 28:648–656
Henriquez-Sanchez P, Sanchez-Villegas A, Ruano-Rodriguez C, Gea A, Lamuela-Raventos RM, Estruch R, Salas-Salvado J, Covas MI, Corella D, Schroder H et al (2016) Dietary total antioxidant capacity and mortality in the PREDIMED study. Eur J Nutr 55:227–236
Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey III (1988-1994). Available at: https://wwwn.cdc.gov/nchs/nhanes/nhanes3/default.aspx. Accessed 5 Aug 2017
Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey (1999- 2000). Available at: https://wwwn.cdc.gov/nchs/nhanes/default.aspx. Accessed 5 Aug 2017
Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey (2001- 2004). Available at: https://wwwn.cdc.gov/nchs/nhanes/default.aspx. Accessed 5 Aug 2017
Bhagwat S, Haytowitz DB, Holden JM (2014) USDA database for the flavonoid content of selected foods, release 3.1. Available at: http://www.ars.usda.gov/nutrientdata/flav. Accessed 5 Aug 2017
Bhagwat S, Haytowitz DB, Holden JM (2008) USDA database for the isoflavone content of selected foods, release 2.0. Available at: https://www.ars.usda.gov/northeast-area/beltsville-md/beltsville-human-nutrition-research-center/nutrientdata-laboratory/docs/usda-database-for-the-isoflavone-content-of-selected-foods-release-20. Accessed 5 Aug 2017
Bhagwat, S., Haytowitz, DB, and Holden, JM. (2004) USDA Database for the Proanthocyanidin Content of Selected Foods. Available at: https://www.ars.usda.gov/northeast-area/beltsville-md/beltsville-human-nutrition-research-center/nutrientdata-laboratory/docs/usda-database-for-the-proanthocyanidin-content-of-selected-foods-2004. Accessed 5 Aug 2017
Chun OK, Chung SJ, Song WO (2007) Estimated dietary flavonoid intake and major food sources of US adults. J Nutr 137:1244–1252
Kim K, Vance TM, Chun OK (2016) Estimated intake and major food sources of flavonoids among US adults: changes between 1999–2002 and 2007–2010 in NHANES. Eur J Nutr 55:833–843
Floegel A, Kim DO, Chung SJ, Song WO, Fernandez ML, Bruno RS, Koo SI, Chun OK (2010) Development and validation of an algorithm to establish a total antioxidant capacity database of the US diet. Int J Food Sci Nutr 61:600–623
Sinha SK, Ghaskadbi SS (2013) Thearubigins rich black tea fraction reveals strong antioxidant activity. Int J Green Pharm 7:336–344
Centers for Disease Control and Prevention. National Center for Health Statistics: NCHS data linked to mortality files. http://www.cdc.gov/nchs/data_access/data_linkage/mortality/data_files_data_dictionaries.htm. Accessed April 28, 2015
World Health Organization (1992) International statistical classification of disease and related health problems, tenth revision (ICD-10). World Health Organization, Geneva
Willett WC, Howe GR, Kushi LH (1997) Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 65(4):1220S–1228S (discussion 9S–31S)
Ratnasinghe LD, Graubard BI, Kahle L, Tangrea JA, Taylor PR, Hawk E (2004) Aspirin use and mortality from cancer in a prospective cohort study. Anticancer Res 24:3177–3184
Coughlin SS, Calle EE, Patel AV, Thun MJ (2000) Predictors of pancreatic cancer mortality among a large cohort of United States adults. Cancer Causes Control 11:915–923
Beydoun MA, Beydoun HA, Mode N, Dore GA, Canas JA, Eid SM, Zonderman AB (2016) Racial disparities in adult all-cause and cause-specific mortality among us adults: mediating and moderating factors. BMC Public Health 16:1113
Keum N, Giovannucci E (2014) Vitamin D supplements and cancer incidence and mortality: a meta-analysis. Br J Cancer 111:976–980
Patel SA, Winkel M, Ali MK, Narayan KM, Mehta NK (2015) Cardiovascular mortality associated with five leading risk factors: national and state preventable fractions estimated from survey data. Ann Intern Med 163:245–253
Sempos CT, Rehm J, Wu T, Crespo CJ, Trevisan M (2003) Average volume of alcohol consumption and all-cause mortality in African Americans: the NHEFS cohort. Alcohol Clin Exp Res 27:88–92
Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J (1998) Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA 279:1703–1708
Solfrizzi V, D’Introno A, Colacicco AM, Capurso C, Palasciano R, Capurso S, Torres F, Capurso A, Panza F (2005) Unsaturated fatty acids intake and all-causes mortality: a 8.5-year follow-up of the Italian Longitudinal Study on Aging. Exp Gerontol 40:335–343
Bastide N, Dartois L, Dyevre V, Dossus L, Fagherazzi G, Serafini M, Boutron-Ruault MC (2017) Dietary antioxidant capacity and all-cause and cause-specific mortality in the E3N/EPIC cohort study. Eur J Nutr 56:1233–1243
Kim K, Vance TM, Chun OK (2016) Greater total antioxidant capacity from diet and supplements is associated with a less atherogenic blood profile in US adults. Nutrients 8(1):15
Yang M, Chung SJ, Floegel A, Song WO, Koo SI, Chun OK (2013) Dietary antioxidant capacity is associated with improved serum antioxidant status and decreased serum C-reactive protein and plasma homocysteine concentrations. Eur J Nutr 52:1901–1911
Franklin SS, Wong ND (2013) Hypertension and cardiovascular disease: contributions of the framingham heart study. Glob Heart 8:49–57
Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, Levy D (2001) Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 345:1291–1297
Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, Mitch W, Smith SC Jr, Sowers JR (1999) Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 100:1134–1146
Vega GL, Barlow CE, Grundy SM, Leonard D, DeFina LF (2014) Triglyceride-to-high-density-lipoprotein-cholesterol ratio is an index of heart disease mortality and of incidence of type 2 diabetes mellitus in men. J Investig Med 62:345–349
Shankar A, Mitchell P, Rochtchina E, Wang JJ (2007) The association between circulating white blood cell count, triglyceride level and cardiovascular and all-cause mortality: population-based cohort study. Atherosclerosis 192:177–183
Iso H, Cui R, Date C, Kikuchi S, Tamakoshi A, Group JS (2009) C-reactive protein levels and risk of mortality from cardiovascular disease in Japanese: the JACC Study. Atherosclerosis 207:291–297
Koenig W, Khuseyinova N, Baumert J, Meisinger C (2008) Prospective study of high-sensitivity C-reactive protein as a determinant of mortality: results from the MONICA/KORA Augsburg Cohort Study, 1984–1998. Clin Chem 54:335–342
Zacho J, Tybjaerg-Hansen A, Nordestgaard BG (2010) C-reactive protein and all-cause mortality–the Copenhagen City Heart Study. Eur Heart J 31:1624–1632
Ahmadi-Abhari S, Luben RN, Wareham NJ, Khaw KT (2013) Seventeen year risk of all-cause and cause-specific mortality associated with C-reactive protein, fibrinogen and leukocyte count in men and women: the EPIC-Norfolk study. Eur J Epidemiol 28:541–550
Kurl S, Zaccardi F, Onaemo VN, Jae SY, Kauhanen J, Ronkainen K, Laukkanen JA (2015) Association between HOMA-IR, fasting insulin and fasting glucose with coronary heart disease mortality in nondiabetic men: a 20-year observational study. Acta Diabetol 52:183–186
Gast KB, Tjeerdema N, Stijnen T, Smit JW, Dekkers OM (2012) Insulin resistance and risk of incident cardiovascular events in adults without diabetes: meta-analysis. PLoS One 7:e52036
This research received no specific Grant from any funding agency, commercial, or not-for-profit sectors.
Conflict of interest
K Kim, T. M. Vance, M-H. Chen, and O. K. Chun have no conflicts of interest on this manuscript.
About this article
Cite this article
Kim, K., Vance, T.M., Chen, MH. et al. Dietary total antioxidant capacity is inversely associated with all-cause and cardiovascular disease death of US adults. Eur J Nutr 57, 2469–2476 (2018). https://doi.org/10.1007/s00394-017-1519-7
- Total antioxidant capacity
- Cardiovascular disease