Abstract
Observational studies have found a protective effect of vitamin C on cardiovascular health. However, results are inconsistent, and residual confounding by fiber might be present. The aim of this study was to assess the association of vitamin C with the incidence of cardiovascular disease (CVD) and cardiovascular mortality (CVM) while accounting for fiber intake and adherence to the Mediterranean dietary pattern. We followed up 13,421 participants in the Seguimiento Universidad de Navarra (University of Navarra follow-up) (SUN) cohort for a mean time of 11 years. Information was collected at baseline and every two years through mailed questionnaires. Diet was assessed with a validated semi-quantitative food frequency questionnaire. Incident CVD was defined as incident fatal or non-fatal myocardial infarction, fatal or non-fatal stroke, or death due to any cardiovascular cause. CVM was defined as death due to cardiovascular causes. Events were confirmed by physicians in the study team after revision of medical records. Cox proportional hazard models were fitted to assess the associations of (a) energy-adjusted and (b) fiber-adjusted vitamin C intake with CVD and CVM. We found energy-adjusted vitamin C was inversely associated with CVD and CVM after adjusting for several confounding factors, including fiber from foods other than fruits and vegetables, and adherence to the Mediterranean dietary pattern. On the other hand, when vitamin C was adjusted for total fiber intake using the residuals method, we found a significant inverse association with CVM (HR (95% confidence interval (CI)) for the third tertile compared to the first tertile, 0.30 (0.12–0.72), but not with CVD in the fully adjusted model.
Highlights
Vitamin C, known as L-ascorbic acid, is a water-soluble vitamin naturally present in some foods, added to others, and available as dietary supplement
We evaluated the association of tertiles of dietary vitamin C with cardiovascular disease (CVD) and cardiovascular mortality (CVM) fitting a model adjusted for vitamin C supplements intake
We found total vitamin C intake showed a modest correlation with energy intake (r = 0.33), but it was highly correlated with total fiber intake (r = 0.72)
Summary
Vitamin C, known as L-ascorbic acid, is a water-soluble vitamin naturally present in some foods, added to others, and available as dietary supplement. Vitamin C is required for the synthesis of collagen, L-carnitine and some neurotransmitters. Based on vitamin C’s antioxidant capacity, there is growing interest in assessing whether vitamin C intake might help prevent or delay some type of cancer, cardiovascular disease (CVD) or other diseases in which oxidative stress plays an important role. Recommended dietary allowances (RDA) for vitamin C—75 mg/day for women and 90 mg/day for men [1]—are based on its known physiological and antioxidant functions in white blood cells and Nutrients 2017, 9, 954; doi:10.3390/nu9090954 www.mdpi.com/journal/nutrients. Given that vitamin C may relate to cancer, CVD, or other diseases through different mechanisms, whether classical RDAs are optimal to obtain maximum benefits is unclear [2]
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