Clinical and Translational Research
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Aug 15, 2024; 15(8): 1742-1752
Published online Aug 15, 2024. doi: 10.4239/wjd.v15.i8.1742
Association between composite dietary antioxidant index and stroke among individuals with diabetes
Hong-Qiang Zhang, Jie Shi, Tong Yue, Jia-Hao Weng, Xu-Lin Wang, Hao Wang, Xiao-Yu Su, Xue-Ying Zheng, Si-Hui Luo, Yu Ding, Chao-Fan Wang
Hong-Qiang Zhang, Department of Cardiology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Jie Shi, Tong Yue, Jia-Hao Weng, Xu-Lin Wang, Xue-Ying Zheng, Si-Hui Luo, Yu Ding, Department of Endocrinology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Hao Wang, Xiao-Yu Su, Graduate School, Bengbu Medical College, Bengbu 233030, Anhui Province, China
Chao-Fan Wang, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, Guangdong Province, China
Co-first authors: Hong-Qiang Zhang and Jie Shi.
Co-corresponding authors: Chao-Fan Wang and Yu Ding.
Author contributions: Wang CF and Ding Y designed the research; Zhang HQ and Shi J performed data processing and statistical analysis, drafted the manuscript, and revised the manuscript; Zheng XY, Luo SH, and Yue T provided valuable insights and guidance throughout the research process; Weng JH, Wang XL, Wang H, and Su XY participated in the revision of the manuscript; Wang CF and Ding Y contributed to data interpretation and manuscript discussion; All authors contributed to the article and approved the final manuscript. Zhang HQ and Shi J contributed equally to this work as co-first authors. The reasons for designating Zhang HQ and Shi J as co-first authors are as follows. First, Zhang HQ and Shi J provided their respective specialized skills and knowledge, playing a critical role in data analysis and interpretation. Second, Zhang HQ and Shi J conducted extensive literature reviews together, providing a solid theoretical foundation for the study. Third, they played a significant role in writing and revising the manuscript, ensuring its high quality and rigor. In summary, Zhang HQ and Shi J were actively involved in every stage of the project, from initial design to data collection and final analysis, demonstrating their comprehensive involvement and substantial contributions. There are several reasons for designating Wang CF and Ding Y as co-corresponding authors. First, they provided important guidance and supervision throughout the study, ensuring scientific rigor and accuracy. Second, they combined expertise and skills from different fields, offering a comprehensive perspective that enriched the diversity of the research. Third, Wang CF and Ding Y played key roles in resource coordination and project management, and both provided funding support, facilitating the smooth conduct of the study. Additionally, they will continue to support and guide the research in the post-submission stages, ensuring the ongoing quality and impact of the research findings. This dual leadership also enhanced the credibility and reliability of the manuscript, reflecting the team’s collaborative spirit and interdisciplinary approach. In conclusion, designating Zhang HQ and Shi J as co-first authors and Wang CF and Ding Y as co-corresponding authors not only reflects the highly collaborative spirit of our team during the research process but also highlights the equal contributions and diverse expertise of each member in their respective fields. This team collaboration model ensures the comprehensiveness, rigor, and innovation of the research, making our findings more reliable and impactful.
Supported by Strategic Priority Research Program of Chinese Academy of Sciences, No. XDB38010100; Construction and Validation of an Early Identification System for Cardiovascular Disease Associated with Glucose Metabolism Disorders, No. 202204295107020026; and Science and Technology Projects in Guangzhou, No. 2023A04J1087.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chao-Fan Wang, MD, Associate Chief Physician, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, No. 600 Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. wangchf25@mail.sysu.edu.cn
Received: March 19, 2024
Revised: May 23, 2024
Accepted: June 26, 2024
Published online: August 15, 2024
Processing time: 129 Days and 5.9 Hours
Abstract
BACKGROUND

Recent research has underscored the potentially protective role of dietary antioxidants against chronic conditions, such as cardiovascular diseases and stroke. The composite dietary antioxidant index (CDAI), which reflects the overall intake of key dietary antioxidants, has been identified as a crucial metric for exploring this relationship. Although previous research has shown a negative correlation between CDAI levels and stroke risk in prediabetic individuals, there remains a substantial gap in understanding this association among individuals with dia-betes, who are at an inherently greater risk for cerebrovascular events.

AIM

To investigate the association between CDAI and stroke risk in individuals with diabetes.

METHODS

Using a cross-sectional study design, this investigation analyzed data from the National Health and Nutrition Examination Survey spanning from 2003 to 2018 that included 6735 participants aged over 20 years with diabetes. The CDAI was calculated from 24-h dietary recalls to assess intake of key antioxidants: Vitamins A, C, and E; carotenoids; selenium; and zinc. Multivariate logistic regression and restricted cubic spline analysis were used to rigorously examine the relationship between CDAI and stroke risk.

RESULTS

The participant cohort, with an average age of 59.5 years and a slight male majority, reflected the broader demographic characteristics of individuals with diabetes. The analysis revealed a strong inverse relationship between CDAI levels and stroke risk. Remarkably, those in the highest quintile of CDAI demonstrated a 43% lower prevalence of stroke compared to those in the lowest quintile, even after adjustments for various confounders. This finding not only highlights the negative association between CDAI and stroke risk but also underscores the significant potential of antioxidant-rich diets in reducing stroke prevalence among patients with diabetes.

CONCLUSION

Our findings suggested that CDAI was inversely associated with stroke prevalence among patients with diabetes. These results suggest incorporating antioxidant-rich foods into dietary regimens as a potential strategy for stroke prevention.

Keywords: Stroke, Diabetes, Composite dietary antioxidant index, National Health and Nutrition Examination Survey, Cross-sectional study

Core Tip: Previous research on the composite dietary antioxidant index (CDAI) and its impact on stroke risk among individuals with diabetes is limited. Our study addressed this gap by examining the association between higher CDAI scores and stroke prevalence. Our findings revealed that higher CDAI scores correlated with reduced stroke risk in this population, indicating that a diet rich in diverse antioxidants may play a crucial role in mitigating stroke risk among individuals with diabetes.