Correlation analysis on the association of composite dietary antioxidant index with serum cotinine levels in the general adult population
Ning Zhu Nutrition 13 January 2025, 112687
Highlights
• Based on this cross-sectional study using NHANES data from 1999 to 2020, we identified a consistent inverse association between dietary antioxidant intake, as measured by the CDAI, and serum cotinine levels among U.S. adults.
• Subgroup analyses across never smokers, former smokers, and current smokers revealed similar associations without significant interaction effects.
• WQS analysis further substantiated these findings, demonstrating a negative association between combined antioxidant intake and cotinine levels, primarily driven by Vitamin A. These findings suggest that increased dietary intake of antioxidants, such as Vitamins A, C, and E, and carotenoids, may potentially mitigate the impact of tobacco exposure in U.S. adults.
• Future research should prioritize intervention studies focusing on antioxidant-rich diets to explore preventive strategies against tobacco-related health risks. Higher dietary antioxidant intake, particularly vitamins A, is associated with lower serum cotinine levels, suggesting potential protective effects against tobacco exposure in U.S. adults.
Objective
This study utilized data from the National Health and Nutrition Examination Survey (NHANES, 1999–2020) to explore the relationship between dietary antioxidant intake and serum cotinine levels among U.S. adults.
Methods
A total of 41,132 participants were included after exclusions. The composite dietary antioxidant index (CDAI), incorporating vitamins A, C, and E, zinc, selenium, and carotenoids, was derived from 24-hour dietary recalls. Associations were assessed using multiple linear regression and weighted quantile sum (WQS) models.
Results
Higher CDAI quartiles were significantly associated with lower serum cotinine levels in the overall population, indicated by a β coefficient of -0.42 (95% CI: -0.51, -0.33). Subgroup analyses revealed that Quartile 4 showed an inverse association with serum cotinine levels compared to quartile 1 (β = -0.34, 95% CI: -0.45, -0.23; P < 0.001) among never smokers, with stronger effects observed among former and current smokers. Specifically, among former smokers, Quartile 4 exhibited a β coefficient of -0.53 (95% CI: -0.77, -0.30; P < 0.001), and among current smokers (n = 8,280), quartile 4 had a β coefficient of -0.44 (95% CI: -0.58, -0.30; P < 0.001). Importantly, no significant interaction was observed between CDAI and smoking status. WQS analysis demonstrated a negative association between combined antioxidant intake and cotinine levels (β = -0.073 [-0.087, -0.059], p < 0.001), with vitamin A exerting the most significant influence (36.30%).
Conclusion
Higher dietary antioxidant intake, particularly vitamins A, is associated with lower serum cotinine levels, suggesting potential protective effects against tobacco exposure in U.S. adults. Future research should focus on longitudinal studies to examine the potential role of dietary antioxidants in mitigating the effects of tobacco exposure.