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Nutritional Epidemiology

A Dietary Oxidative Balance Score of Vitamin C, ß-Carotene and Iron Intakes and Mortality Risk in Male Smoking Belgians^{1 ,2}

Pascale G. A. Van Hoydonck^*3, Elisabeth H. M. Temme^* and Evert G. Schouten^*,

^* University of Leuven, Department of Public Health, Division of Nutritional Epidemiology, 3000 Leuven, Belgium and Wageningen University, Human Nutrition and Epidemiology, 6700 EV Wageningen, The Netherlands

³To whom correspondence should be addressed. E-mail: Pascale.Vanhoydonck{at}med.kuleuven.ac.be.

The purpose of this study was to investigate, in smokers, whether the oxidative balance of their dietary pattern affected mortality risk. To evaluate the oxidative balance of the dietary pattern, an oxidative balance score was constructed that summarized the combined intake of dietary antioxidants (vitamin C and ß-carotene) and a prooxidant (iron). The low oxidative balance score group included smokers with a diet high in vitamin C and ß-carotene and/or low in iron and the high oxidative balance score group included those with a diet low in vitamin C and ß-carotene and/or high in iron. Using the 10-y follow-up mortality data from the Belgian Interuniversity Research on Nutrition and Health (BIRNH) study, the association of this oxidative balance score with all-cause, cardiovascular disease (CVD) and total cancer mortality was investigated in 2814 male smokers. In multivariate-adjusted Cox models, men in the highest oxidative balance score group had a higher relative risk (RR) of all-cause [RR = 1.44, 95% confidence interval (CI): 1.13, 1.82] and of total cancer mortality (RR = 1.62, 95% CI: 1.07, 2.45) compared with men in the lowest score group. This association was less pronounced for CVD mortality risk and was not significant (RR = 1.31, 95% CI: 0.86, 2.00). The risk of all-cause and total cancer mortality was driven principally by the high score group, which suggested a threshold effect for risk rather than a linear trend. The findings are consistent with the hypothesis that the oxidative balance of the diet is associated with subsequent mortality. Smokers whose diet is unbalanced in terms of anti- and prooxidants may therefore benefit from a recommendation to consume more servings of fresh fruits and vegetables and less meat.

KEY WORDS: • vitamin C • ß-carotene • iron • cohort study • male smokers • mortality risk • cardiovascular disease • cancer

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