Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Nutr Res. 2011 Mar;31(3):178-89. doi: 10.1016/j.nutres.2011.03.003.
Evidence regarding the health benefits of carotenoids is controversial. Effects of serum carotenoids and their interactions on mortality have not been examined in a representative sample of US adults. The objective was to examine whether serum carotenoid concentrations predict mortality among US adults. The study consisted of adults aged ≥20 years enrolled in the Third National Health and Nutrition Examination Survey, 1988 to 1994, with measured serum carotenoids and mortality follow-up through 2006 (N = 13,293). Outcomes were all-cause, cardiovascular disease, and cancer mortality. In adjusted Cox proportional hazards models, participants in the lowest total carotenoid quartile (<1.01 μmol/L) had significantly higher all-cause mortality (mortality rate ratio, 1.38; 95% confidence interval, 1.15-1.65; P = .005) than those in the highest total carotenoid quartile (>1.75 μmol/L). For α-carotene, the highest quartile (>0.11 μmol/L) had the lowest all-cause mortality rates (P < .001). For lycopene, the middle 2 quartiles (0.29-0.58 μmol/L) had the lowest all-cause mortality rates (P = .047). Analyses with continuous carotenoids confirmed associations of serum total carotenoids, α-carotene, and lycopene with all-cause mortality (P < .001). In a random survival forest analysis, very low lycopene was the carotenoid most strongly predictive of all-cause mortality, followed by very low total carotenoids. α-Carotene/β-cryptoxanthin, α-carotene/lutein+zeaxanthin and lycopene/lutein+zeaxanthin interactions were significantly related to all-cause mortality (P < .05). Low α-carotene was the only carotenoid associated with cardiovascular disease mortality (P = .002). No carotenoids were significantly associated with cancer mortality. Very low serum total carotenoid, α-carotene, and lycopene concentrations may be risk factors for mortality, but carotenoids show interaction effects on mortality. Interventions of balanced carotenoid combinations are needed for confirmation.
关于类胡萝卜素对健康益处的证据存在争议。尚未在具有代表性的美国成年人样本中研究血清类胡萝卜素及其相互作用对死亡率的影响。本研究的目的是检验血清类胡萝卜素浓度是否可预测美国成年人的死亡率。该研究包括 1988 年至 1994 年参加第三次国家健康和营养检查调查的年龄≥20 岁的成年人，这些人有测量的血清类胡萝卜素数据，并随访至 2006 年的死亡率（N=13293）。结局是全因死亡率、心血管疾病死亡率和癌症死亡率。在调整后的 Cox 比例风险模型中，总类胡萝卜素最低四分位数（<1.01 μmol/L）的参与者全因死亡率显著较高（死亡率比，1.38；95%置信区间，1.15-1.65；P=0.005），高于总类胡萝卜素最高四分位数（>1.75 μmol/L）的参与者。对于α-胡萝卜素，最高四分位数（>0.11 μmol/L）的全因死亡率最低（P<0.001）。对于番茄红素，中间两个四分位数（0.29-0.58 μmol/L）的全因死亡率最低（P=0.047）。用连续类胡萝卜素进行的分析证实了血清总类胡萝卜素、α-胡萝卜素和番茄红素与全因死亡率之间的关联（P<0.001）。在随机生存森林分析中，极低的番茄红素是预测全因死亡率的最有力的类胡萝卜素，其次是极低的总类胡萝卜素。α-胡萝卜素/β-隐黄质、α-胡萝卜素/叶黄素+玉米黄质和番茄红素/叶黄素+玉米黄质相互作用与全因死亡率显著相关（P<0.05）。低α-胡萝卜素是唯一与心血管疾病死亡率相关的类胡萝卜素（P=0.002）。没有类胡萝卜素与癌症死亡率显著相关。血清总类胡萝卜素、α-胡萝卜素和番茄红素浓度极低可能是死亡率的危险因素，但类胡萝卜素对死亡率有相互作用的影响。需要进行平衡类胡萝卜素组合的干预来证实。
