Associations of serum carotenoids with risk of cardiovascular mortality among individuals with type 2 diabetes: results from NHANES
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Abstract
OBJECTIVE: Although carotenoids have been suggested to exhibit antioxidant properties, some experimental studies reported that β-carotene may show pro-oxidant effects under certain conditions. Current evidence regarding the cardiovascular effects of carotenoids among patients with type 2 diabetes (T2D) is scarce. This study aimed to prospectively examine the associations of individual serum carotenoid concentrations with cardiovascular mortality among adults with T2D. RESEARCH DESIGN AND METHODS: This analysis included 3,107 individuals with T2D from the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 2001-2006. Cardiovascular mortality was ascertained by linkage to National Death Index records through 31 December 2015. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs. RESULTS: During an average of 14 years of follow-up, 441 cardiovascular deaths occurred. After multivariate adjustment including lifestyles, dietary factors, glucose control, and other major carotenoids, higher serum β-carotene concentrations were significantly associated with an elevated risk of cardiovascular mortality in a dose-response manner. When extreme quartiles of β-carotene were compared, the multivariable-adjusted HR was 2.47 (95% CI 1.62, 3.76) for cardiovascular mortality (Ptrend = 0.002); and per one-unit increment in natural log-transformed serum β-carotene was associated with a 46% higher risk of cardiovascular mortality (P = 0.001). Other individual carotenoids (α-carotene, β-cryptoxanthin, lycopene, and lutein/zeaxanthin) were not significantly associated with the risk of cardiovascular mortality. Consistent results were observed when stratifying by age, sex, race, BMI, smoking status, diabetes duration, and glycated hemoglobin A1c levels. CONCLUSIONS: Higher concentrations of serum β-carotene, but not other individual carotenoids, were significantly associated with an increased risk of cardiovascular mortality among individuals with T2D. Our findings, if replicated, underscore the need to estimate the optimal serum β-carotene concentrations in individuals with T2D.
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Higher serum β-carotene levels are associated with increased CVD mortality in a dose-dependent manner in patients with T2D during an average 14 years of follow-up.
“The harmful effect of serum β-carotene levels on CVD risk was recently reported in patients with T2D, in whom higher serum β-carotene levels were associated with increased CVD mortality in a dose-dependent manner during an average 14 years of follow-up.”
From Micronutrient Supplementation to Reduce Cardiovascular Risk (2022) · cites this paper as [30]
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References 34 · Cited by 202
- Authors
- Qiu, Z., Chen, X., Geng, T., Wan, Z., Lu, Q., Li, L., Zhu, K., Zhang, X., Liu, Y., Lin, X., Chen, L., Shan, Z., Liu, L., Pan, A., & Liu, G.
- Affiliations
- Huazhong University of Science and Technology (CN)
- Corresponding author
- Liu, Gang
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2022-05-27
- Volume
- 45
- Issue
- 6
- Pages
- 1453-1461
- ISSN
- 0149-5992 (ISSN-L)
- OpenAlex
- W4225320108
- Cited by
- 202
- References
- 34
- Citations by year
- 2026: 28 · 2025: 49 · 2024: 89 · 2023: 29 · 2022: 7
- FWCI
- 23.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Natural Science Foundation of China (81930124)
- China Postdoctoral Science Foundation
- Fundamental Research Funds for the Central Universities
- Topics
- Health Sciences › Medicine › Biochemistry › Antioxidant Activity and Oxidative Stress
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Biochemistry › Phytochemicals and Antioxidant Activities
- Keywords
- serum carotenoids, beta-carotene, cardiovascular mortality, type 2 diabetes, alpha-carotene, beta-cryptoxanthin, lycopene, lutein/zeaxanthin, pro-oxidant activity, antioxidant nutrients, dose-response relationship
- MeSH terms
- Adult, Cardiovascular Diseases, Carotenoids, Diabetes Mellitus, Type 2, Humans, Nutrition Surveys, Risk Factors, beta Carotene
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