Table_1_Associations of multiple carotenoid co-exposure with all-cause and cause-specific mortality in US adults: a prospective cohort study.DOCX

BackgroundEpidemiological evidence regarding circulating carotenoids and mortality risk remains conflicting, and most studies focus on the impact of individual carotenoids. This study aimed to elucidate the effects of co-exposure to multiple serum carotenoids on mortality risk.
MethodsWe enrolled 22,472 participants aged ≥20 from the National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and NHANES 2003–2006. Baseline serum levels of five major carotenoids (α-carotene, β-carotene, lycopene, β-cryptoxanthin, and lutein/zeaxanthin) were measured, and individuals were followed up until December 31, 2019. Carotenoid co-exposure patterns were identified using the K-means method. Cox proportional hazard models were used to investigate the associations between carotenoid exposure and mortality risk.
ResultsDuring a median follow-up of 16.7 years, 7,901 deaths occurred. K-means clustered participants into low-level, low-lycopene, high-lycopene, and high-level exposure groups. In the fully adjusted model, low-lycopene, high-lycopene, and high-level exposure groups had significantly lower all-cause mortality risks compared to the low-level exposure group, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 0.79 (0.72, 0.87), 0.75 (0.67, 0.84), and 0.67 (0.61, 0.74), respectively. For cardiovascular disease mortality, the high-lycopene exposure group had a 27% reduced risk (HR: 0.73, 95% CI: 0.61–0.86), and the high-level exposure group had a 21% reduced risk (HR: 0.79, 95% CI: 0.67–0.93). For cancer mortality, the high-lycopene and high-level exposure groups had 30% and 35% lower risks, with HRs (95% CIs) of 0.70 (0.57, 0.86) and 0.65 (0.54, 0.79), respectively.
ConclusionThis study revealed that co-exposure to multiple serum carotenoids was associated with reduced mortality risk, highlighting the potential health benefits of increased carotenoid intake. Further investigation is warranted to elucidate the underlying mechanisms of interactions among different carotenoids.

研究背景 目前关于循环类胡萝卜素与死亡风险的流行病学证据仍存在争议，且多数研究仅聚焦于单一类胡萝卜素的影响。本研究旨在阐明多种血清类胡萝卜素联合暴露对死亡风险的作用。
研究方法 本研究从1988-1994年美国国家健康与营养调查（National Health and Nutrition Examination Survey III, NHANES III）及2003-2006年NHANES中纳入22472名年龄≥20岁的参与者。检测5种主要血清类胡萝卜素的基线水平，包括α-胡萝卜素、β-胡萝卜素、番茄红素、β-隐黄质以及叶黄素/玉米黄质，并对所有参与者进行随访至2019年12月31日。采用K-means聚类法识别类胡萝卜素联合暴露模式，使用Cox比例风险模型探究类胡萝卜素暴露与死亡风险之间的关联。
研究结果 在中位随访16.7年期间，共发生7901例死亡事件。通过K-means聚类将参与者分为低水平暴露组、低番茄红素暴露组、高番茄红素暴露组以及高水平暴露组。在完全校正模型中，与低水平暴露组相比，低番茄红素、高番茄红素及高水平暴露组的全因死亡风险均显著降低，风险比（hazard ratio, HR）及95%置信区间（confidence interval, CI）分别为0.79（95%CI: 0.72, 0.87）、0.75（95%CI: 0.67, 0.84）及0.67（95%CI: 0.61, 0.74）。针对心血管疾病死亡风险，高番茄红素暴露组风险降低27%（HR=0.73, 95%CI: 0.61~0.86），高水平暴露组风险降低21%（HR=0.79, 95%CI: 0.67~0.93）。对于癌症死亡风险，高番茄红素暴露组和高水平暴露组的风险分别降低30%和35%，对应的HR（95%CI）分别为0.70（0.57, 0.86）和0.65（0.54, 0.79）。
研究结论 本研究表明，多种血清类胡萝卜素联合暴露与死亡风险降低相关，提示增加类胡萝卜素摄入可能具有潜在健康益处。未来仍需开展进一步研究，以阐明不同类胡萝卜素之间相互作用的潜在机制。