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Composite dietary antioxidant index, chronic respiratory disease, and all-cause mortality: National Health and Nutrition Examination Survey, 2003–2018

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Abstract

Purpose

Diet rich in antioxidant may protect against chronic respiratory disease (CRD), but few studies have evaluated the association between composite dietary antioxidant index (CDAI) and CRD. The study aimed to examine the association of CDAI with the risk of CRD and all-cause mortality in CRD patients from the US.

Methods

Data were obtained from the National Health and Nutrition Examination Survey, 2003–2018. Logistic and Cox regression analyses were used to estimate association of CDAI with CRD and all-cause mortality. Dose-response relationship was examined by restricted cubic spline analyses.

Results

Total 44,094 participants were eligible for CRD (aged 1–85 years; mean age: 45.71 years old), and 7,685 CRD patients for all-cause mortality (median follow-up: 7.58 years; 1,136 deaths before 12/31/2019). The risk for CRD, asthma, and chronic obstructive pulmonary disease was significantly decreased by 13–32% with the increase intake of CDAI, even after adjusting for confounders (all P < 0.001). The relationship between CDAI and three respiratory endpoints was U-shaped (all P for nonlinearity < 0.001). There was an obvious declining trend in the magnitude of mortality risk with the increase of intake of CDAI, especially in patients with asthma. Fully adjusted hazard ratio was 0.72 (95% confidence interval: 0.54–0.95), 0.55 (0.42–0.72), and 0.48 (0.34–0.66) for the second, third, and fourth quartile of CDAI in patients with asthma relative to the first quartile, respectively. The association with CRD risk was significantly modified by smoking status (P-interaction: 0.006).

Conclusion

Our findings indicate that high CDAI is a significant protective factor against CRD and all-cause mortality in the US population.

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Fig. 1
Fig. 2

Data availability

The datasets used and/or analyzed for the current study are available from the corresponding authors on reasonable request.

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Funding

This research was supported by the Public Service Development and Reform Pilot Project of Beijing Medical Research Institute (W. Niu).

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Authors and Affiliations

  1. Center for Evidence-Based Medicine, Capital Institute of Pediatrics, No.2 Yabao Rd., Chaoyang District, Beijing, 100020, China

    Jing Wu, Fangjieyi Zheng & Wenquan Niu

  2. China-Japan Friendship Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China

    Kening Chen

  3. Department of Medicine, Division of Gastroenterology, The Warren Alpert Medical School, Rhode Island Hospital/Lifeorgname, Brown University, Providence, RI, 02903, USA

    Xiaoqun Dong

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  1. Jing Wu
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Contributions

Conceptualization, Jing Wu and Wenquan Niu; methodology, Jing Wu and Wenquan Niu; formal analysis, Jing Wu; data curation, Fangjieyi Zheng and Kening Chen; writing-original draft preparation, Jing Wu; writing-review and editing, Jing Wu, Fangjieyi Zheng, Kening Chen, Xiaoqun Dong, Wenquan Niu; supervision, Wenquan Niu; project administration, Wenquan Niu. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Jing Wu or Wenquan Niu.

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Wu, J., Zheng, F., Chen, K. et al. Composite dietary antioxidant index, chronic respiratory disease, and all-cause mortality: National Health and Nutrition Examination Survey, 2003–2018. Eur J Nutr 64, 19 (2025). https://doi.org/10.1007/s00394-024-03508-6

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