Dietary lycopene is negatively associated with abdominal aortic calcification in US adults: a cross-sectional study

Figures & data

Figure 1. Screening flow of participants included in the research. A total of 10,175 participants from the 2013–2014 NHANES were recruited for this study. The AAC score was measured by a dual-energy X-ray absorptiometry (DXA) scan. A total of 3140 participants completed DXA scans and obtained available data. Diet-derived antioxidants were obtained from 24-h dietary recall interviews. After excluding 243 participants who did not undergo 24-h dietary recall interviews, 2897 participants were included in the analysis. NHANES: National Health and Nutritional Examination Survey; AAC: abdominal aortic calcification.

Figure 2. Subgroup analysis for the association between diet-derived lycopene and AAC. Subgroup analysis stratified by age, hypertension, diabetes, and CKD was also performed using stratified multivariate logistic regression analysis. *Logistic regression model adjusted for variables in age, sex, marital status, race/ethnicity, body mass index, diabetes, hypertension, smoking history, eGFR, Haemoglobin A1c, TC/HDL, mean SBP, mean DBP, and diet-derived antioxidants. AAC: abdominal aortic calcification; CKD: chronic kidney disease; eGFR: estimated glomerular filtration rate; TC: total cholesterol; HDL: high-density lipoprotein; SBP: systolic blood pressure; DBP: diastolic blood pressure; OR: Odds ratio; CI: confidence interval.

Table 1. Characteristics and dietary antioxidant assessment based on no, mild-moderate, and severe calcification in the ACC of participants.

Characteristics	Total, n = 2897	No calcification, n = 2030	Mild–moderate calcification, n = 604	Severe calcification, n = 263	P-value
Age groups, years, no. (%)					<0.001
40–49	811 (28.0)	688 (33.9)	115 (19.0)	8 (3.0)
50–59	734 (25.3)	573 (28.2)	138 (22.8)	23 (8.7)
60–69	731 (25.2)	503 (24.8)	170 (28.1)	58 (22.1)
≥70	621 (21.4)	266 (13.1)	181 (30.0)	174 (66.2)
Male, no. (%)	1395 (48.2)	966 (47.6)	307 (50.8)	122 (46.4)	0.31
Race/ethnicity, no. (%)					<0.001
Non-Hispanic White	1307 (45.1)	831 (40.9)	307 (50.8)	169 (64.3)
Non-Hispanic Black	571 (19.7)	430 (21.2)	104 (17.2)	37 (14.1)
Hispanic	652 (22.5)	501 (24.7)	116 (19.2)	35 (13.3)
Non-Hispanic Asian	306 (10.6)	233 (11.0)	64 (10.6)	19 (7.2)
Multiracial/other	61 (2.1)	45 (2.2)	13 (2.2)	3 (2.1)
Education level, no. (%)					0.11
Below high school	641 (22.1)	445 (21.9)	129 (21.4)	67 (25.5)
High school graduate or GED	650 (22.4)	434 (21.4)	150 (24.9)	66 (25.1)
Some colleges or above	1605 (55.4)	1151 (56.7)	324 (53.7)	130 (49.4)
Poverty, no. (%)	804 (30.0)	559 (29.9)	167 (29.8)	78 (31.2)	0.91
Married, no. (%)	1731 (59.8)	1240 (61.1)	367 (60.8)	124 (47.1)	<0.001
Body mass index, kg/m^2, median (IQR)	27.9 (24.6,31.8)	28.1 (24.6,32.4)	27.7 (24.5,31.0)	26.7 (24.3,30.0)	<0.001
Smoker, no (%)	526 (18.4)	352 (17.5)	123 (20.7)	51 (20.2)	0.15
Diabetes mellitus, no. (%)	644 (22.2)	394 (19.4)	147 (24.3)	103 (39.2)	<0.001
Hypertension, no (%)	1671 (57.7)	1039 (51.2)	404 (66.9)	228 (86.7)	<0.001
CKD, no (%)	589 (21.1)	324 (16.5)	141 (24.3)	124 (49.0)	<0.001
CKD group, no (%)					<0.001
No CKD	2194 (78.8)	1631 (83.4)	438 (75.6)	125 (50.2)
Stage 1–2	269 (9.7)	183 (9.4)	53 (9.2)	33 (13.3)
Stage 3–5	320 (11.5)	141 (7.2)	88 (15.2)	91 (36.5)
eGFR, mL/min/1.73 m2, median (IQR)	86.6 (71.5, 99.3)	89.3 (75.4, 101.6)	82.6 (68.7, 96.2)	66.8 (51.5, 84.4)	<0.001
Haemoglobin A1c, %, median (IQR)	5.6 (5.3, 6.0)	5.6 (5.3, 6.0)	5.7 (5.4, 6.1)	5.9 (5.5, 6.5)	<0.001
Mean SBP, mm Hg, median (IQR)	125.0 (114.0,137.0)	123.0 (113.0, 135.0)	128.0 (116.0, 140.0)	133.0 (121.0, 147.0)	<0.001
Mean DBP, mm Hg, median (IQR)	71.0 (64.0, 78.0)	72.0 (65.0, 79.0)	70.8 (63.0, 77.0)	64.0 (55.0, 72.0)	<0.001
TC/HDL, median (IQR)	3.7 (2.9, 4.6)	3.7 (2.9, 4.7)	3.7 (3.0, 4.6)	3.5 (2.7, 4.6)	0.06
Dietary antioxidants
Retinol, mg, median (IQR)	0.3 (0.2, 0.5)	0.3 (0.2, 0.5)	0.3 (0.2, 0.5)	0.3 (0.1, 0.6)	0.61
β-carotene, mg, median (IQR)	0.8 (0.3, 2.6)	0.8 (0.3,2.6)	0.8 (0.3, 2.6)	0.9 (0.3, 2.7)	0.44
Vitamin B6, mg, median (IQR)	1.8 (1.2, 2.5)	1.8 (1.2, 2.5)	1.7 (1.2, 2.4)	1.6 (1.0, 2.2)	0.002
Vitamin C, mg, median (IQR)	52.2 (21.3, 110.9)	52.8 (21.4, 113.2)	50.9 (20.1, 110.8)	52.5 (22.7, 98.2)	0.30
α-tocopherol, mg, median (IQR)	7.1 (4.6, 10.8)	7.2 (4.6, 11.1)	7.2 (4.6, 10.8)	6.4 (4.4, 9.4)	0.03
Lycopene, mg, median (IQR)	1.3 (0.0, 5.2)	1.3 (0.0, 5.1)	1.6 (0.0, 5.7)	0.8 (0.0, 3.5)	0.04

ACC: abdominal aortic calcification; GED: general educational development test; CKD: chronic kidney disease; IQR: interquartile range; Egfr: estimated glomerular filtration rate; SBP: systolic blood pressure; DBP: diastolic blood pressure; TC: total cholesterol; HDL: high-density lipoprotein. Values are expressed as the mean (SD) for normally distributed continuous variables or median (IQR) for non-normally distributed continuous variables, or n (%) for categorical variables. Comparisons between groups were carried out using the Student’s t-test, the Mann–Whitney U test for quantitative characteristics, and the chi-square test or the Fisher exact test for qualitative characteristics. P-values <0.05 are shown in bold.

Table 2. Multivariate analysis to evaluate associations between AAC group and diet-derived antioxidants in included participants*.

	Mild–moderate AAC versus no AAC		Severe AAC versus no AAC
Variables	OR (95% CI)	P-value	OR (95% CI)	P-value
Unadjusted
Retinol, per 1 mg/day	1.09 (0.88, 1.36)	0.44	1.12 (0.84,1.50)	0.45
β-carotene, per 1 mg/day	0.99 (0.97, 1.01)	0.33	0.99 (0.96,1.02)	0.35
Vitamin B6, per 1 mg/day	0.96 (0.89, 1.02)	0.19	0.81 (0.72,0.91)	.001
Vitamin C, per 1 mg/day	1.00 (.999, 1.00)	0.44	0.999 (.997,1.00)	0.16
α-tocopherol, per 1 mg/day	1.00 (0.99, 1.02)	0.66	0.97 (0.95,0.99)	.008
Lycopene, per 1 mg/day	1.00 (0.99, 1.01)	0.92	0.98 (0.96,0.99)	0.01
Model 1
Retinol, per 1 mg/day	0.98 (0.76, 1.26)	0.85	0.90 (0.62, 1.29)	0.56
β-carotene, per 1 mg/day	0.99 (0.97, 1.01)	0.38	1.01 (0.97, 1.04)	0.78
Vitamin B6, per 1 mg/day	0.97 (0.88, 1.06)	0.46	0.93 (0.78, 1.11)	0.40
Vitamin C, per 1 mg/day	1.00 (1.00, 1.00)	0.25	1.00 (1.00, 1.00)	0.20
α-tocopherol, per 1 mg/day	1.01 (1.00, 1.03)	0.11	1.00 (0.97, 1.03)	1.00
Lycopene, per 1 mg/day	1.00 (0.97, 1.01)	0.99	0.98 (0.96, 1.00)	0.04
Model 2
Retinol, per 1 mg/day	1.01 (0.77, 1.32)	0.96	0.61 (0.35,1.06)	0.08
β-carotene, per 1 mg/day	0.99 (0.97, 1.02)	0.53	1.00 (0.96, 1.05)	0.99
Vitamin B6, per 1 mg/day	0.96 (0.86, 1.06)	0.38	0.96 (0.79, 1.17)	0.67
Vitamin C, per 1 mg/day	1.00 (1.00, 1.00)	0.39	0.998 (.996, 1.00)	0.17
α-tocopherol, per 1 mg/day	1.01 (.99, 1.03)	0.16	1.01 (0.98, 1.05)	0.46
Lycopene, per 1 mg/day	1.00 (0.99, 1.01)	0.98	0.98 (0.95, 0.99)	0.04

ACC: abdominal aortic calcification; OR: odds ratios; CI: confidence interval. Multivariate logistic regression analysis was used to evaluate the relationship between diet-derived antioxidants and AAC. Only factors with p < 0.05 in the univariable analysis and traditional factors associated with AAC and diet-derived antioxidants were included in the multivariable logistic regression analysis. Significant differences are shown in bold. Model 1: Adjusted for age, sex, race/ethnicity, and other diet-derived antioxidants. Model 2: Adjusted for variables in Model 1 plus marital status, body mass index, diabetes, hypertension, smoking history, eGFR, Haemoglobin A1c, TC/HDL, mean SBP, and mean DBP.

Table 3. Multivariate analysis to evaluate associations between the AAC group and other relevant covariates in included participants*.

	Mild–moderate AAC versus no AAC		Severe AAC versus no AAC
Variables	OR (95% CI)	P value	OR (95% CI)	P value
Age (years old)	1.03 (1.02,1.05)	<0.001	1.12 (1.09,1.14)	<0.001
Female (versus male)	0.95 (0.77,1.18)	0.63	0.88 (0,61,1.27)	0.48
Race/ethnicity
Non-Hispanic White	Reference		Reference
Non-Hispanic Black	0.66 (0.49,0.88)	0.005	0.31 (0.19,0.52)	<0.001
Hispanic	0.76 (0.58,0.99)	0.04	0.47 (0.29,0.77)	0.003
Non-Hispanic Asian	0.89 (0.62,1.27)	0.52	0.72 (0.38,1.36)	0.32
Multiracial/other	0.96 (0.49,1.89)	0.91	0.73 (0.18,2.94)	0.65
Married (yes versus no)	1.01 (0.81,1.25)	0.96	0.79 (0.55,1.12)	0.18
Body mass index (kg/m^2)	0.96 (0.94,0.98)	<0.001	0.93 (0.90,0.97)	<0.001
Smoker (yes versus no)	1.37 (1.05,1.78)	0.02	2.85 (1.78,4.56)	<0.001
Diabetes (yes versus no)	1.21 (0.88,1.66)	0.24	1.94 (1.24,3.06)	0.004
Hypertension (yes versus no)	1.51 (1.19,1.91)	0.001	2.29 (1.45,3.62)	<0.001
CKD group		0.33		0.03
No CKD	Reference		Reference
Stage 1-2	0.88 (0.62,1.26)	0.48	1.18 (0.70,2.00)	0.54
Stage 3-5	1.23 (0.88,1.71)	0.23	1.75 (1.15,2.67)	0.01
Haemoglobin A1c (%)	0.98 (0.88,1.10)	0.79	1.08 (0.92,1.27)	0.33
TC/HDL	1.11 (1.03,1.19)	0.009	1.04 (0.91,1.19)	0.57
Mean SBP (mm Hg)	1.01 (1.00,1.02)	0.01	1.01 (1.00,1.02)	0.03
Mean DBP (mm Hg)	0.99 (0.98,.99)	0.003	0.98 (0.95,0.99)	0.001

ACC: abdominal aortic calcification; GED: general educational development test; eGFR: estimated glomerular filtration rate; SBP: systolic blood pressure; DBP: diastolic blood pressure; TC: total cholesterol; HDL: high-density lipoprotein. Multivariate logistic regression analysis was used to evaluate the relationship between other covariates and AAC. Significant differences are shown in bold. ^*Multinomial logistic regression model includes age, sex, race/ethnicity, marital status, body mass index, diabetes, hypertension, smoking history, CKD group, Haemoglobin A1c, TC/HDL, mean systolic pressure, mean diastolic pressure, and all diet-derived antioxidants.

Data availability statement

The data used in this study are freely available from the following sources: https://www.cdc.gov/nchs/nhanes/index.htm.