Dietary Overall Antioxidant Intake Associates With All-Cause And Cause-Specific Mortality Among Adults With Depression: Result from the National Health and Nutrition Examination Survey (2005-2018)

Background: Higher intake of individual antioxidant nutrients such as vitamins A, C, E, and selenium, etc., has been associated with mortality in the general population, but the association of overall antioxidant intake with mortality especially among depressed adults remains unclear. To investigate whether dietary overall antioxidant intake is associated with all-cause and cause-specific mortality among depressed adults. Method This study included 3051 US adults with depression, who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. The depression scores (Patient Health Questionnaire-9, PHQ-9) were used to define depression and evaluate depression severity. Dietary antioxidant quality score (DAQs) and Dietary antioxidant index (DAI) were calculated based on the intakes of vitamins A, C, E, zinc, selenium, and magnesium. Multivariable-adjusted Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs for the associations of individual and overall antioxidant intakes with all-cause, cardiovascular disease (CVD) and cancer mortality among adults with depression. Results The weight mean age (SE) was 46.00 (0.39) and 1928 (63.7%) were women. Higher DAQs and DAI were significantly associated with lower depression scores (PHQ-9) at baseline (all P trend <0.05). For individual antioxidants, the significant negative associations of vitamin A and E with all-cause mortality were observed. For overall antioxidant intake, DAQs and DAI were inversely associated with all-cause and cancer mortality. Compared with participants in the lowest categories of DAQs and DAI, the corresponding HRs (95% CIs) in the highest categories were 0.63 (0.42–0.93) and 0.70 (0.49–0.98) for all-cause mortality, 0.39 (0.17–0.87) and 0.43 (0.21–0.88) for cancer mortality, respectively. Conclusion Dietary overall antioxidant intake was significantly associated with all-cause and cancer mortality risk. These findings suggest that comprehensive dietary antioxidant intake may improve depressive symptoms and lower mortality risk among adults with depression.