Association between Dietary Total Vitamin A, β-carotene, and Retinol Intake and Risk of cardiometabolic multimorbidity: Results from the China Health and Nutrition Survey, 1997-2015

Abstract

Background: The association between vitamin A and single cardiometabolic diseases has been extensively studied, but the relationship between dietary vitamin A intake and the risk of cardiometabolic multimorbidity (CMM) has not been studied. Therefore, the present study was conducted to explore the association with CMM risk by analyzing different sources of vitamin A.

Methods: This study utilized 13,603 subjects aged ≥ 18 years from 1997-2015 from the China Health and Nutrition Survey (CHNS). Dietary intake was calculated from 3 consecutive 24-h dietary recalls combined with a house hold food inventory. CMM is defined as the development of at least two cardiometabolic diseases.

Results: After a median follow-up of 9.1 years, there were 1050 new cases of CMM. The risk of CMM was significantly lower in those with higher vitamin A intake (Q1 vs Q5 HR 0.66, 95% CI 0.54-0.81). β-carotene (Q1 vs Q5 HR 0.82, 95% CI 0.66-1.02) and retinol (Q1 vs Q5 HR 0.59, 95%CI 0.48-0.73) intake had a similarly negative correlation. Using restricted cubic spline found an L-shaped relationship between retinol intake and CMM (p non-linear < 0.001). In subgroup analyses, protective effects were stronger for participants aged ≥ 44 years (HR 0.72, 95%CI 0.57-0.92) and for the female group (HR 0.62, 95%CI 0.45-0.84).

Conclusion: Dietary vitamin A was a protective factor for CMM, and this effect was stronger in age ≥ 44 years and in the female group. There was a ceiling effect on the protective effect of retinol intake on the risk of CMM.

Keywords: Cardiometabolic multimorbidity; Prospective cohort study; retinol; vitamin A; β-carotene.

Figure 1

Flowchart of participant selection from the China Health and Nutrition Survey (CHNS) 1997–2015.

Figure 2

Cubic spline curves for the associations between intakes of total vitamin A (A), β-carotene (B) and retinol (C) with CMM risk. HR (95% CI) was based on a mixed-effects Cox proportional hazards model adjusted for age, sex, region, area, education, smoking, alcohol consumption, income, BMI classification, physical activity, total energy, total protein, total carbohydrates, total dietary fiber, sodium-to-potassium intake ratio, calcium, zinc intake. Histogram showing the distribution of intake of vitamin A, β-carotene, and retinol.