ArticleFrontiers in nutrition2026
Association between the composite dietary antioxidant index and chronic rhinosinusitis burden: the potential mediating role of insulin resistance.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory sinonasal disease with variable radiologic and symptom burden. Dietary antioxidant capacity and insulin resistance may be related to CRS burden, but their interrelationship remains unclear. This study investigated the association of energy-adjusted composite dietary antioxidant index (CDAI) with CRS burden and explored the potential mediating roles of insulin resistance-related indicators. Methods: In this single-center cross-sectional study, we analyzed baseline data from 340 adult patients with clinically diagnosed CRS who were recruited at Huludao Central Hospital. Dietary intake was assessed using 24-h dietary recalls, and the CDAI was calculated by summing standardized values of six energy-adjusted antioxidant nutrients. CDAI was analyzed as tertiles of the CDAI score and as standardized CDAI per 1-SD increment. HOMA-IR was specified as the primary mediator, and the triglyceride-glucose (TyG) index was considered a pragmatic non-insulin mediator. The primary outcome was Lund-Mackay CT score, and the secondary outcome was SNOT-22 score. Multivariable regression, binary sensitivity analyses, exploratory mediation analyses, and subgroup analyses were performed. Results: Higher CDAI tertiles were associated with lower fasting insulin, HOMA-IR, TyG index, and Lund-Mackay CT score. In fully adjusted models, each 1-SD increment in CDAI was associated with lower Lund-Mackay CT score ( Conclusion: Higher CDAI was associated with lower radiologic CRS burden and modestly lower symptom burden among adults with CRS. Exploratory mediation analyses suggested that insulin resistance may partly account for the association between CDAI and radiologic disease burden, with TyG providing supportive evidence as a pragmatic non-insulin surrogate. These cross-sectional findings highlight a potential diet-metabolism relationship in CRS and support further prospective and interventional studies to clarify temporality, causality, and biological significance.
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