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. 2025 Jun 19:12:1609759.
doi: 10.3389/fnut.2025.1609759. eCollection 2025.

Do serum vitamins, carotenoids, and retinyl esters influence mortality in osteoarthritis? Insights from a nationally representative study

Yifan Lu  1   2 , Junjie Duan  1 , Rong You  1 , Simin Tang  1 , Xinyu Qi  2 , Boyu Wu  3 , Gonghui Jian  2 , Tao Wang  1 , Jianhui Duan  1 , Zhuo Yang  1
Affiliations

Do serum vitamins, carotenoids, and retinyl esters influence mortality in osteoarthritis? Insights from a nationally representative study

Yifan Lu et al. Front Nutr. .

Abstract

Background: The relationship between serum vitamins, carotenoids, and retinyl esters and mortality risk among individuals with osteoarthritis (OA) remains unclear. This study aimed to investigate these associations.

Methods: Based on data from NHANES 2001 to 2018 and the National Death Index (NDI), a total of 3,626 patients with OA were included. Cox proportional hazards models were used to evaluate the associations between serum nutrient levels and all-cause, cardiovascular, and cancer mortality. Nonlinear effects were assessed using smooth curve fitting and piecewise regression models. Subgroup analyses, sensitivity analyses, and validation in non-OA populations were conducted. Additionally, interactions between vitamin levels and OA status were examined.

Results: Higher levels of vitamin D, retinyl palmitate, and stearic acid were associated with a reduced risk of all-cause mortality in patients with OA, with consistent results in sensitivity analyses. A nonlinear inverse association was observed between vitamin D and all-cause mortality in women, with a threshold at 30.5 nmol/L. Vitamin C was associated with cardiovascular mortality, while retinyl palmitate and stearic acid were linked to a reduced risk of cancer-related death. The protective effect of vitamin D was stronger among individuals with lower educational levels. In the non-OA population, only vitamin D was associated with mortality. Interaction analysis indicated that high vitamin levels may attenuate the adverse impact of OA on mortality risk.

Conclusions: Elevated serum levels of vitamin D, retinyl palmitate, and stearic acid may be associated with reduced all-cause and cause-specific mortality among individuals with OA, highlighting their potential role in the management of OA.

Keywords: NHANES; carotenoids; mortality; osteoarthritis; serum vitamins.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart (vitamin D).
Figure 2
Figure 2
Kaplan–Meier curves for the associations between serum vitamin and retinyl ester levels and mortality risk in patients with osteoarthritis. (A) Vitamin D and all-cause mortality; (B) retinyl palmitate and all-cause mortality; (C) retinyl stearate and all-cause mortality; (D) vitamin C and cardiovascular mortality; (E) retinyl palmitate and cancer mortality; (F) retinyl stearate and cancer mortality.
Figure 3
Figure 3
The association between serum vitamin, carotenoid, and retinyl ester levels and mortality risk in patients with OA.
See this image and copyright information in PMC

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References

    1. Tang S, Zhang C, Oo WM, Fu K, Risberg MA, Bierma-Zeinstra SM, et al. Osteoarthritis. Nat Rev Dis Primers. (2025) 11:10. 10.1038/s41572-025-00594-6 - DOI - PubMed
    1. Courties A, Kouki I, Soliman N, Mathieu S, Sellam J. Osteoarthritis year in review 2024: epidemiology and therapy. Osteoarthritis Cartilage. (2024) 32:1397–404. 10.1016/j.joca.2024.07.014 - DOI - PubMed
    1. Cao F, Xu Z, Li XX, Fu ZY, Han RY, Zhang JL, et al. Trends and cross-country inequalities in the global burden of osteoarthritis, 1990-2019: a population-based study. Ageing Res Rev. (2024) 99:102382. 10.1016/j.arr.2024.102382 - DOI - PubMed
    1. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res. (2020) 72:149–62. 10.1002/acr.24131 - DOI - PMC - PubMed
    1. Juhl C, Christensen R, Roos EM, Zhang W, Lund H. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol. (2014) 66:622–36. 10.1002/art.38290 - DOI - PubMed

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