Department of Nephrology, The Third People's Hospital of Chengdu, Southwest Jiaotong University, No. 37, Qinglong Street, Chengdu, 610014, Sichuan Province, China.
Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
Acta Diabetol. 2023 Oct;60(10):1365-1375. doi: 10.1007/s00592-023-02125-9. Epub 2023 Jun 22.
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).
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.
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.
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.
大量研究表明，饮食抗氧化剂对许多疾病都有影响。然而，关于糖尿病患者复合饮食抗氧化指数（CDAI）与糖尿病肾病（DKD）的证据还很有限。本研究旨在探讨 CDAI 与糖尿病患者 DKD 和死亡率之间的关系。
本研究利用了 2007 年至 2018 年全国健康与营养调查（NHANES）中 5676 名成年糖尿病患者的数据。通过将数据与国家死亡指数的记录相链接，对死亡结局进行了随访，截至 2019 年 12 月 31 日。使用一种经过验证的方法评估 CDAI，该方法包括从 24 小时膳食回忆中得出的六种食物来源的抗氧化剂：硒、锌、维生素 A、维生素 C、维生素 E 和类胡萝卜素。使用回归模型来估计 CDAI 与糖尿病患者 DKD 和死亡率之间的关系。
代表美国 3136 万非机构居民的 5676 名参与者的加权平均 CDAI 水平为 0.33。根据 CDAI 四分位区间，参与者被分为四组。CDAI 水平与年龄、性别、种族、体力活动、估计肾小球滤过率以及白蛋白尿、DKD 和高尿酸血症的患病率显著相关。在糖尿病患者中，36.44%发生了 DKD，并且在进行多变量调整后，较高的 CDAI 水平与 DKD 风险降低相关（OR 0.74，95%CI 0.59-0.94，p 趋势=0.004）。在中位随访 67 个月（38-104 个月）期间，共有 1065 名（15.80%）糖尿病患者死于各种原因。在调整年龄、性别和种族后，CDAI 水平较高的（Q4）糖尿病患者全因死亡率较低（HR 0.67，95%CI：0.52-0.86，p 趋势=0.01）。
保持充足的抗氧化饮食，如 CDAI 水平较高，可能会降低糖尿病患者发生 DKD 和死亡率的风险。这些发现为管理糖尿病提供了一种有前途的方法，并强调了食物来源的抗氧化剂作为预防措施的潜力。需要进一步研究来探讨饮食抗氧化剂与糖尿病患者 DKD 和死亡率之间的潜在机制。
