Serum antioxidant nutrients, vitamin A, and mortality in U.S. Adults.
Serum antioxidant nutrients, vitamin A, and mortality in U.S. Adults.
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DOI：
10.1158/1055-9965.epi-13-0381
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发表时间：
2013-12
期刊：
影响因子：
--
通讯作者：
Siegel AB
中科院分区：
文献类型：
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作者：
Goyal A;Terry MB;Siegel AB
观察性研究表明，抗氧化营养素可能会降低癌症和总体死亡风险。然而，大多数随机试验都未能证明对生存有好处。研究抗氧化剂水平和健康结果之间的非线性关联可以解释这些不同的发现。我们评估了16,008名成人NHANES III(第三次国家健康和营养检查调查，1988-1994)参与者的全因、癌症和心血管死亡风险，这些风险与血清抗氧化剂(维生素C和维生素E、β-胡萝卜素和硒)和维生素A水平的五分位数(Q1-Q5)有关。在14.2年的中位随访期内，共有4225人死亡，其中891人死于癌症，1891人死于心血管疾病。我们观察到，随着维生素C水平的提高，癌症和总死亡风险的剂量反应降低。相比之下，对于维生素A，癌症死亡的风险从第一季度到第二季度下降，风险在较高水平时没有进一步下降。对于维生素E，在第四季度的水平与最低的癌症死亡风险相关。维生素A和维生素E都与全因死亡率呈U型相关。β-胡萝卜素的癌症死亡风险从第一季度到第二季度下降，而硒的风险从第一季度到第四季度下降。然而，对于β-胡萝卜素和硒，总体死亡风险从第一季度到第二季度下降，但随后随着水平的提高没有显著变化。抗氧化剂补充剂的使用应结合总体死亡率和其他相互竞争的死亡率风险进行研究。这些数据表明，可能使用新的干预研究，其中这些药物的剂量是根据血清水平以及可能的氧化应激和全身炎症反应的标记物进行个性化的。
Observational studies have suggested that antioxidant nutrients may reduce cancer and overall mortality risks. However, most randomized trials have failed to demonstrate survival benefits. Examining non-linear associations between antioxidant levels and health outcomes may explain these discrepant findings. We evaluated all-cause, cancer and cardiovascular mortality risks associated with quintiles (Q1–Q5) of serum antioxidant (vitamins C and E, beta-carotene, and selenium) and vitamin A levels, in 16,008 adult NHANES III (The Third National Health and Nutrition Examination survey, 1988–1994) participants. Over a median follow-up period of 14.2 years, there were 4,225 deaths, including 891 from cancer, and 1,891 from cardiovascular disease. We observed a dose-response decrease in cancer and overall mortality risks with higher vitamin C levels. In contrast, for vitamin A, risk of cancer death decreased from Q1–Q2, with no further decline in risk at higher levels. For vitamin E, having levels in Q4 were associated with the lowest cancer mortality risk. Both vitamin A and E had U-shaped associations with all-cause mortality. Cancer mortality risks decreased from Q1–Q2 for beta-carotene and from Q1–Q4 for selenium. However, for beta-carotene and selenium, overall mortality risks decreased from Q1–Q2 but then did not change significantly with higher levels. Antioxidant supplement use should be studied in the context of overall mortality and other competing mortality risks. These data suggest the possible use of novel intervention studies where doses of these agents are individualized based on serum levels, and possibly, markers of oxidative stress and systemic inflammatory response.