Skip to main content

Advertisement

SpringerLink
Log in

Dose–response relationship between dietary antioxidant intake and diabetic kidney disease in the US adults with diabetes

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Aim

The effects of dietary antioxidants on numerous diseases have been widely studied. However, the evidence regarding composite dietary antioxidant index (CDAI) and diabetic kidney disease (DKD) in individuals with diabetes is scarce. This study aimed to investigate the associations of CDAI with DKD and mortality in adults with diabetes mellitus (DM).

Methods

This study utilized data from 5676 adult DM participants from the National Health and Nutrition Examination Survey (NHANES) of 2007–2018. The study followed up on death outcomes by linking the data to records from the National Death Index until December 31, 2019. CDAI was evaluated using a well-established method that included six food-sourced antioxidants derived from 24-h dietary recall: selenium, zinc, vitamin A, vitamin C, vitamin E and carotenoids. The regression models were used to estimate the relationships of CDAI with DKD and mortality in diabetic individuals.

Results

The weighted mean CDAI level for the 5676 participants, which represented 31.36 million noninstitutionalized residents of the US, was 0.33. Based on CDAI quartiles, participants were classified into four groups. CDAI levels were significantly associated with age, gender, race, physical activity, estimated glomerular filtration rate and the prevalence of albuminuria, DKD and hyperuricemia. DKD occurred in 36.44% of diabetic participants, and higher CDAI levels were independently associated with a lower risk of DKD (OR 0.74, 95%CI 0.59–0.94, p for trend = 0.004) in diabetic individuals after multivariate adjustment. During a median follow-up of 67 months (38–104 months), a total of 1065 (15.80%) diabetic individuals died from all causes. Diabetic individuals with higher CDAI levels (Q4) demonstrated a lower risk of all-cause mortality (HR 0.67, 95% CI: 0.52–0.86, p for trend = 0.01) after adjusting for age, gender and race.

Conclusions

Maintaining an adequate antioxidant diet, as reflected in higher CDAI levels, may lower the risk of DKD and mortality in diabetic individuals. These findings offer a promising approach to managing diabetes and highlight the potential of food-based antioxidants as a preventative measure. Further research is warranted to explore the underlying mechanism linking dietary antioxidants and DKD and mortality in diabetic individuals.

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
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Publicly available datasets were analyzed in this study. These data can be found here: https://www.cdc.gov/nchs/nhanes/index.htm.

References

  1. Diabetes around the world in 2021. The IDF Diabetes Atlas 10th Edition ed: International Diabetes Federation. Available from https://diabetesatlas.org/

  2. Alicic RZ, Rooney MT, Tuttle KR (2017) Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol: CJASN 12:2032–2045

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Wheeler DC, Stefánsson BV, Jongs N et al (2021) Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol 9:22–31

    Article  CAS  PubMed  Google Scholar 

  4. Shaman AM, Bain SC, Bakris GL, et al (2021) Effect of the glucagon-like peptide-1 receptor agonists semaglutide and liraglutide on kidney outcomes in patients with type 2 diabetes: a pooled analysis of SUSTAIN 6 and LEADER Trials. Circulation

  5. Sharma K (2015) Mitochondrial hormesis and diabetic complications. Diabetes 64:663–672

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Tan BL, Norhaizan ME, Liew WP, Sulaiman Rahman H (2018) Antioxidant and oxidative stress: a mutual interplay in age-related diseases. Front Pharmacol 9:1162

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bolignano D, Cernaro V, Gembillo G, Baggetta R, Buemi M, D’Arrigo G (2017) Antioxidant agents for delaying diabetic kidney disease progression: a systematic review and meta-analysis. PLoS ONE 12:e0178699

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zhong O, Hu J, Wang J, Tan Y, Hu L, Lei X (2022) Antioxidant for treatment of diabetic complications: a meta-analysis and systematic review. J Biochem Mol Toxicol 36:e23038

    Article  CAS  PubMed  Google Scholar 

  9. Maugeri A, Hruskova J, Jakubik J et al (2019) Dietary antioxidant intake decreases carotid intima media thickness in women but not in men: a cross-sectional assessment in the Kardiovize study. Free Radical Biol Med 131:274–281

    Article  CAS  Google Scholar 

  10. Yu YC, Paragomi P, Wang R et al (2022) Composite dietary antioxidant index and the risk of colorectal cancer: findings from the Singapore Chinese Health Study. Int J Cancer 150:1599–1608

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Luu HN, Wen W, Li H et al (2015) Are dietary antioxidant intake indices correlated to oxidative stress and inflammatory marker levels? Antioxid Redox Signal 22:951–959

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. KDIGO (2021) Clinical practice guideline for the management of glomerular diseases. Kidney Int 2021(100):S1-s276

    Google Scholar 

  13. Rattan P, Penrice DD, Ahn JC et al (2022) Inverse association of telomere length with liver disease and mortality in the US population. Hepatol Commun 6:399–410

    Article  CAS  PubMed  Google Scholar 

  14. Fowler JR, Tucker LA, Bailey BW, LeCheminant JD (2020) Physical activity and insulin resistance in 6500 NHANES adults: the role of abdominal obesity. J Obesity 2020:3848256

    Article  Google Scholar 

  15. Wright ME, Mayne ST, Stolzenberg-Solomon RZ et al (2004) Development of a comprehensive dietary antioxidant index and application to lung cancer risk in a cohort of male smokers. Am J Epidemiol 160:68–76

    Article  PubMed  Google Scholar 

  16. Wang W, Wang X, Cao S et al (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

    Article  PubMed  PubMed Central  Google Scholar 

  17. Huang DD, Shi G, Jiang Y, Yao C, Zhu C (2020) A review on the potential of resveratrol in prevention and therapy of diabetes and diabetic complications. Biomed Pharmacother 125:109767

    Article  CAS  PubMed  Google Scholar 

  18. Chen H, Li X, Epstein PN (2005) MnSOD and catalase transgenes demonstrate that protection of islets from oxidative stress does not alter cytokine toxicity. Diabetes 54:1437–1446

    Article  CAS  PubMed  Google Scholar 

  19. Rafighi Z, Shiva A, Arab S, Yusuf RM (2013) Association of dietary vitamin C and e intake and antioxidant enzymes in type 2 diabetes mellitus patients. Global J Health Sci 5:183–187

    Article  Google Scholar 

  20. Montonen J, Knekt P, Jarvinen RI, Reunanen A (2004) Dietary antioxidant intake and risk of type 2 diabetes. Diabetes Care 27:362–366

    Article  CAS  PubMed  Google Scholar 

  21. Slonim AE, Surber ML, Page DL, Sharp RA, Burr IM (1983) Modification of chemically induced diabetes in rats by vitamin E. Supplementation minimizes and depletion enhances development of diabetes. J Clin Invest 71:1282–1288

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Bahmani F, Kia M, Soleimani A, Asemi Z, Esmaillzadeh A (2016) Effect of Selenium supplementation on glycemic control and lipid profiles in patients with diabetic nephropathy. Biol Trace Element Res 172:282–289

    Article  CAS  Google Scholar 

  23. Huang YC, Combs GF Jr, Wu TL et al (2022) Selenium status and type 2 diabetes risk. Arch Biochem Biophys 730:109400

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Sumaily KM (2022) The roles and pathogenesis mechanisms of a number of micronutrients in the prevention and/or treatment of chronic hepatitis, COVID-19 and type-2 diabetes mellitus. Nutrients, 14

  25. Xu Q, Qian X, Sun F, Liu H, Dou Z, Zhang J (2022) Independent and joint associations of dietary antioxidant intake with risk of post-stroke depression and all-cause mortality. J Affect Disorders

  26. 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

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gaede P, Poulsen HE, Parving HH et al (2001) Double-blind, randomised study of the effect of combined treatment with vitamin C and E on albuminuria in type 2 diabetic patients. Diabet Med: J Br Diabet Assoc 18:756–760

    Article  CAS  Google Scholar 

  28. Farvid MS, Jalali M, Siassi F, Hosseini M (2005) Comparison of the effects of vitamins and/or mineral supplementation on glomerular and tubular dysfunction in type 2 diabetes. Diabetes Care 28:2458–2464

    Article  PubMed  Google Scholar 

  29. Bahmani F, Kia M, Soleimani A, Mohammadi AA, Asemi Z (2016) The effects of selenium supplementation on biomarkers of inflammation and oxidative stress in patients with diabetic nephropathy: a randomised, double-blind, placebo-controlled trial. Br J Nutr 116:1222–1228

    Article  CAS  PubMed  Google Scholar 

  30. Vrzhesinskaya OA, Leonenko SN, Kodentsova VM et al (2022) Vitamin supply of patients with type 2 diabetes mellitus complicated by nephropathy. Vopr Pitan 91:58–71

    CAS  PubMed  Google Scholar 

  31. Jaafarinia A, Kafami B, Sahebnasagh A, Saghafi F (2022) Evaluation of therapeutic effects of crocin in attenuating the progression of diabetic nephropathy: a preliminary randomized triple-blind placebo-controlled trial. BMC Complement Med Ther 22:262

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Lonn E, Yusuf S, Hoogwerf B et al (2002) Effects of vitamin E on cardiovascular and microvascular outcomes in high-risk patients with diabetes: results of the HOPE study and MICRO-HOPE substudy. Diabetes Care 25:1919–1927

    Article  CAS  PubMed  Google Scholar 

  33. Yokoyama M, Torita M, Yoshizawa M, Usuda R (2001) Indication of vitamin E on microalbuminuria in patients with incipient diabetic nephropathy. Diabetes Metab 27:611–612

    CAS  PubMed  Google Scholar 

  34. Otsuka R, Tange C, Nishita Y, et al (2020) Dietary diversity and all-cause and cause-specific mortality in Japanese community-dwelling older adults. Nutrients, 12

  35. Zhang P, Li T, Wu X, Nice EC, Huang C, Zhang Y (2020) Oxidative stress and diabetes: antioxidative strategies. Front Med 14:583–600

    Article  PubMed  Google Scholar 

  36. Jakubczyk K, Drużga A, Katarzyna J, Skonieczna-Żydecka K (2020) Antioxidant potential of curcumin-A meta-analysis of randomized clinical trials. Antioxidants (Basel, Switzerland), 9

  37. Neri S, Calvagno S, Mauceri B et al (2010) Effects of antioxidants on postprandial oxidative stress and endothelial dysfunction in subjects with impaired glucose tolerance and type 2 diabetes. Eur J Nutr 49:409–416

    Article  CAS  PubMed  Google Scholar 

  38. Mune M, Uto-Kondo H, Iteya I, Fujii Y, Ikeda S, Ikewaki K (2018) Vitamin E supplementation improves high-densitiy lipoprotein and endothelial functions in end-stage kidney disease patients undergoing hemodialysis
Clin Nephrol 90:212–221

  39. Zhou Z, Sun X, James KY (2002) Metallothionein protection against alcoholic liver injury through inhibition of oxidative stress. Exp Biol Med (Maywood) 227:214–222

    Article  CAS  PubMed  Google Scholar 

  40. Gembillo G, Visconti L, Giuffrida AE, et al (2022) Role of zinc in diabetic kidney disease. Nutrients, 14

Download references

Acknowledgements

This research was supported by the Sichuan Science and Technology Program (No. 2023NSFSC1529).

Author information

Author notes

  1. Junlin Zhang and Yao Chen have contributed equally to this study as co-first authors

Authors and Affiliations

  1. Department of Nephrology, The Third People’s Hospital of Chengdu, Southwest Jiaotong University, No. 37, Qinglong Street, Chengdu, 610014, Sichuan Province, China

    Junlin Zhang, Liang Zou, Lizhu Jin, Bo Yang, Ying Shu & Rong Gong

  2. Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China

    Yao Chen

Authors
  1. Junlin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liang Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lizhu Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bo Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ying Shu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rong Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rong Gong.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was performed according to the Declaration of Helsinki. The study protocols of NHANES were approved by the NCHS Research Ethics Review Board (ethical approval code: Protocol #2005-06, Protocol #2011-17 and Protocol #2018-01).

Informed consent

Not applicable.

Additional information

Publisher's Note

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

This article belongs to the topical collection Diabetic Nephropathy, managed by Giuseppe Pugliese

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 19 kb)

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

Zhang, J., Chen, Y., Zou, L. et al. Dose–response relationship between dietary antioxidant intake and diabetic kidney disease in the US adults with diabetes. Acta Diabetol 60, 1365–1375 (2023). https://doi.org/10.1007/s00592-023-02125-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-023-02125-9

Keywords

Search

Navigation