Higher Dietary Antioxidant Intake May Improve Prognosis of Stroke Patients and Reduce Depressive Symptoms

by | Jun 1, 2023 | 2023, Antioxidants, Brain Health, Depression, Stroke, Vitamin A

Written by Taylor Woosley, Staff Writer. Higher dietary vitamin A, total carotenoids, and selenium intake were associated with decreased risk of PSD (p < 0.05) after adjusting for potential confounders. 

Brain HealthStroke has become a serious issue in the United States, as more than 795,000 people in the US experience a stroke annually1. Approximately 70% of strokes are caused by occlusion of a major cerebral artery2. Around one-third of stroke patients experience depression, and it is independently associated with mortality and lower quality of life3.

The role of diet in depression risk has been deeply explored, showing that antioxidant diets may prevent and or/help in the treatment of depression4. A possible link between biomarkers of inflammation, oxidative stress, and depression exists and research has shown that daily dietary intake of antioxidants can increase antioxidant defense and reduce oxidative stress5. The consumption of antioxidants, such as carotenoids, flavonoids, and vitamins E and C, can reduce reactive oxygen species and consequently prevent oxidative stress and inflammation6.

Xu et al. conducted a cross-sectional study using nationally representative subjects in the United States to assess the independent and joint associations of dietary antioxidant intake, including vitamin A, vitamin C, vitamin E, total carotenoids, zinc, and selenium, with post-stroke depression (PSD). Secondly, a longitudinal design was then utilized to assess the association between dietary antioxidant intake and all-cause mortality. Data included was from five 2-year cycles (2005-2014) of National Health and Nutrition Examination Survey (NHANES). Participants (n=962) over the age of 20 or older who had a stroke were included in the study. The mean age of stroke patients was 66.52 ± 13.22 years old, and 48.65% were male.

Dietary antioxidant intake and other food component data was obtained from 24-hour dietary recall interviews. Depressive symptoms were assessed using a validated 9-item Patient Health Questionnaire (PHQ-9). Data on all-cause mortality status was determined using a probabilistic match between NHANES and the National Death Index (NDI) death certificate records. Univariate and multivariate logistic regression analyses were utilized to assess the odds ratios (ORs) and 95% confidence intervals (CIs) for the association of dietary antioxidant intake with PSD risk. Furthermore, univariate, and multivariable Cox regression analyses were used to assess the hazard ratios (HRs) and 95% CIs for the association of dietary antioxidant intake with all-cause mortality among subjects with stroke. Restricted cubic splines fitting was utilized to assess the possibility of the non-linear associations between dietary intakes of vitamin A, vitamin C, vitamin E, total carotenoids, zinc, and selenium and PSD risk and all-cause mortality. Significant findings of the study are as follows:

  • The crude logistic regression model showed a negative association between dietary vitamin A, vitamin C, vitamin E, total carotenoids, zinc, and selenium intake and PSD risk (p < 0.05). After adjusting for potential confounders, higher dietary vitamin A, total carotenoids, and selenium intake were associated with decreased risk of PSD (p < 0.05).
  • In multivariate Cox regression model, the highest quartile (Q4) of dietary vitamin A (HR: 0.63, 95 % CI: 0.45, 0.89), vitamin E (HR: 0.69, 95 % CI: 0.48, 0.99), total carotenoids (HR: 0.66, 95 % CI: 0.47, 0.92), zinc (HR: 0.57, 95 % CI: 0.40, 0.81), and selenium (HR: 0.64, 95 % CI: 0.46, 0.90) intakes were significantly associated with decreased all-cause mortality compared with those in the lowest quartile (Q1).
  • Results of using the CDAI to assess joint association showed a negative association between CDAI and PSD risk, with the lowest OR in the third quartile (Q3) (OR: 0.49, 95% CI: 0.30, 0.83). Additionally, the highest quartile (Q4) of CDAI was associated with decreased all-cause mortality compared with those in the lowest quartile (Q1) (HR: 0.56, 95% CI: 0.39, 0.81).

Results of the cross-sectional and longitudinal analysis using data from NHANES indicated that higher intake of dietary antioxidant nutrients was negatively associated with PSD risk. Furthermore, stroke subjects with the highest quartiles of dietary vitamin A, vitamin E, zinc, selenium, and total carotenoid intakes were associated with decreased all-cause mortality compared to stroke subjects in the lowest quartile. Study limitations include the inability to determine causality in the associations of dietary antioxidant intake with the risk of PSD based on the cross-sectional design of the study and the potential for recall bias based on the self-reported nature of the dietary questionnaire.

Source: Xu, Qianqian, Xudong Qian, Fan Sun, Heng Liu, Zhijie Dou, and Jian Zhang. “Independent and joint associations of dietary antioxidant intake with risk of post-stroke depression and all-cause mortality.” Journal of Affective Disorders 322 (2023): 84-90.

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Posted June 1, 2023.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

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