The inverse associations between composite-dietary-antioxidant-index and sarcopenia risk in US adults

Abstract

Background: It remains unknown whether composite-dietary-antioxidant-index (CDAI) is associated with the risk of sarcopenia. This study investigated the association of CDAI with sarcopenia risk among general US adults.

Methods: A total of 10,093 participants were enrolled in the National Health and Nutrition Examination Surveys (NHANES) from 6 survey cycles (2003-2004, 2005-2006, 2011-2012, 2013-2014, 2015-2016 and 2017-2018). Multivariate logistic regression was carried out to examine the relationship between CDAI and the risk of sarcopenia. Restricted cubic spline (RCS) curves were employed to analyze nonlinear relationships.

Results: In a multi-variable logistic regression model adjusting for demographics, lifestyle, economic status and other dietary factors, higher CDAI score was related to a lower risk of sarcopenia among US adults. Compared the highest quartile of CDAI score with the lowest, the OR and 95%CI were 0.49 (0.31-0.75). Furthermore, the RCS demonstrated a linear dose-response relationship between CDAI and sarcopenia (P _{non-linearity}=0.92). These results remained consistent across subgroups stratified by age, sex, physical activity, drinking status, body mass index (BMI), smoking habits, energy intake, and Healthy Eating Index (HEI) score. In addition, the favorable associations of CDAI were primarily attributed to Vitamin E intake.

Conclusion: A higher CDAI score was associated with a lower risk of sarcopenia. According to these results, a greater adherence to CDAI may benefit sarcopenia prevention in adults.

Keywords: NHANES; composite dietary antioxidant index; observational study; public health; sarcopenia.

Figure 1

The flow chart of participant selection. PIR, poverty income ratio.

Figure 2

Dose-response relationships between CDAI with sarcopenia. Median CDAI score is reference standard. Odds ratio (OR) and 95%CI are based on logistic regression model adjusted for age (continuous, years) and sex (female and male), race (White, Black, Hispanic, Mexican American and others), marital status (married, never married and others), education status (less than high school, high school and more than high school), PIR (continuous), physical activity (continuous, MET-minutes/wk), smoking status (never, former and now), alcohol intake (never, former and now), BMI (continuous, kg/m²), and daily energy intake (continuous, kcal/d), healthy eating index (continuous). Solid lines indicate OR and shadow indicate 95%CI.

Figure 3

ORs and 95%CIs for CDAI and sarcopenia, stratified by several key risk factors. Model was adjusted for age (continuous, years) and sex (female and male), race (White, Black, Hispanic, Mexican American and others), marital status (married, never married and others), education status (less than high school, high school and more than high school), poverty income ratio (continuous), physical activity (continuous, MET-minutes/wk), smoking status (never, former and now), alcohol intake (never, former and now), BMI (continuous, kg/m²), and daily energy intake (continuous, kcal/d), healthy eating index (continuous). In each stratified analysis, the stratification variable was excluded in the adjustments. Chronic diseases include diabetes, hypertension, CVD and cancer. The OR and 95%CI of each subgroup in the figure from the group with the highest CDAI. Likelihood ratio tests were used for assessment of interaction, and two-sided P values (unadjusted for multiple comparisons) are reported.