Nutrient intake and peripheral artery disease in adults: key considerations in cross-sectional studies

Abstract

Background & aims: There are limited studies of nutrient intake and peripheral artery disease (PAD). Some studies have not accounted for the functional consequences of PAD, potentially leading to biased results. To determine the associations between intakes of dietary fiber, folate, vitamins A, C, E, and B6 and PAD.

Methods: Cross-sectional analysis of 6534 adults aged 40 years and older in the U.S. National Health and Nutrition Examination Survey between 1999 and 2004, including measurement of ankle-brachial index (ABI) and nutrient intake by 24-h dietary recall. Weighted multivariable logistic regression models to determine odds ratios and 95% confidence intervals.

Results: The prevalence of PAD (ABI < 0.9) was 5.3% (4.7-5.9). Inverse associations between PAD and intakes of fiber, folate, and vitamins A, B6, C, and E were statistically significant when adjusting for age, sex, hypertension, diabetes and smoking. In models further adjusted for energy intake and physical activity, these odds ratios all became null (p ≥ 0.1).

Conclusions: In this sample, dietary fiber, folate, and vitamins B6, C, and E were not associated with PAD after accounting for energy intake and activity. Adjustment for energy and physical activity are essential to avoid bias due to reverse causation in cross-sectional studies of diet and PAD.

Keywords: Activity; Cross-sectional; Diet; Energy; Nutrients; Peripheral artery disease.