L-shaped association between dietary zinc intake and the risk of developing cardiovascular disease in Chinese adults: A cohort study

Abstract

Background: Although the association of zinc (Zn) with cardiovascular disease (CVD) has been studied, no consensus has been reached on this relationship, particularly dietary Zn intake. The purpose of this study was to assess the effect of dietary Zn intake on the risk of CVD and to analyze whether this effect varied according to zinc consumption using representative data from China.

Methods: 11,470 adults from the China Health and Nutrition Survey (CHNS) were eventually enrolled. The dietary information was collected by the 3 day 24-h dietary recalls combined with dietary weighting method. CVD was defined as participants with self-reported physician-diagnosed apoplexy and/or myocardial infarction during the follow-up. Cox regression was used to calculate the hazard ratios (HRs) of CVD with 95% confidence intervals. Restricted cubic spline function plus Cox regression was used to visualize the influence trend of dietary Zn intake on new-onset CVD and to test whether this trend is linear. 2-segment Cox regression was established to address the nonlinear trend.

Results: 431 participants developed CVD, including 262 strokes and 197 myocardial infarctions. Compared with the lowest quintile (Q1), the adjusted hazard ratios and 95% confidence interval (CI) of CVD in Q2 to Q5 of dietary Zn intake were 0.72 (0.54, 0.97), 0.59 (0.42, 0.81), 0.50 (0.34, 0.72) and 0.44 (0.27, 0.71), respectively. The influence trend of dietary Zn intake on new-onset CVD was nonlinear and L-shaped. When dietary Zn intake <13.66 mg/day, increased dietary Zn intake was significantly associated with decreased risk of developing CVD (HR = 0.87, 95% CI: 0.82-0.92, p-value <0.0001).

Conclusion: An L-shaped trend was observed between dietary Zn intake and the risk of developing CVD, indicating that dietary Zn intake should be improved moderately, but not excessively, for the benefit of cardiovascular disease.

Keywords: CHNS; adults; cardiovascular; cohort study; dietary zinc.

Figure 1

Study flow diagram.

Figure 2

Relation of zinc intake from (A) total, (B) meat, and (C) other sources with risk of new-onset CVD*. *Adjusted for age, gender, race, energy intake, residence, marital status, education level, activity level, smoking status, drinking status, BMI, hypertension, diabetes, dietary fiber, niacin, vitamin C, vitamin E, calcium, iron, selenium, magnesium, copper, and manganese.

Figure 3

Stratified analysis by potential effect modifiers for the association between dietary zinc intake and new-onset CVD in various subgroups divided by 13.662 mg/day. (A) Dietary zinc intake <13.662 mg/day. (B) Dietary zinc intake ≥3.662 mg/day. Incident rate is presented as per 1,000 person-years of follow-up. Adjusted, if not stratified, age, gender, race, energy intake, residence, marital status, education level, activity level, smoking status, drinking status, BMI, hypertension, diabetes, dietary fiber, niacin, vitamin C, vitamin E, calcium, iron, selenium, magnesium, copper, and manganese; Incidence density: 1/1000 person-year.