Association between dietary antioxidant intake and overweight/obesity risk among children and adolescents: a cross-sectional analysis from NHANES 2011-2016.

Objective: Overweight and obesity among children and adolescents has emerged as a critical global public health issue. Oxidative stress, a key factor in obesity-related inflammation and metabolic dysregulation, underscore the importance of dietary antioxidants. The composite dietary antioxidant index (CDAI), which integrates vitamins A, C, E, carotenoids, selenium, and zinc, provide a comprehensive measure of overall dietary antioxidant intake. However, the relationship between CDAI and overweight/obesity in children and adolescents remains insufficient explored. Methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 2011 and 2016, including 17,919 participants aged 6-19 years. The CDAI were calculated based on dietary intake data from 24-hour dietary recalls. To account for total energy intake, two widely recognized adjustment methods were used: the standard regression model and the nutrient density model. In the nutrient density model, an energy-standardized CDAI (E-CDAI) was computed. Logistic regression models were conducted to examine associations between CDAI, E-CDAI, mCDAI, mE-CDAI, and overweight/obesity risk, adjusting for potential confounders such as age, gender, race, physical activity, and socioeconomic status. Results: The analysis showed a significant negative association between CDAI and overweight/obesity risk among adolescents aged 12-19 years. However, no significant association was observed in children aged 6-11 years. In contrast, E-CDAI showed no significant association with overweight/obesity risk in adolescents (OR = 0.87; 95% CI: 0.71-1.07). Notably, selenium exhibited a negative association with overweight/obesity in the standard regression model but a positive association in the nutrient density model. After excluding the selenium from the original 6 antioxidants included in the CDAI, the modified CDAI (mCDAI) demonstrated a significant negative association with overweight/obesity in both the standard regression model (OR = 0.74; 95% CI: 0.63-0.86) and nutrients density model (OR = 0.78; 95% CI: 0.69-0.89). Conclusion: This study developed a modified CDAI, comprising of vitamins A, C, E, carotenoids, and zinc, and identified a consistent negative association between mCDAI and overweight/obesity risk, irrespective of energy adjustment method. These findings suggest that a diet rich in antioxidants may play a protective role in preventing obesity in adolescent aged 12-19 years.