ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutritional Epidemiology
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1609759
Do Serum Vitamins, Carotenoids, and Retinyl Esters Influence Mortality in Osteoarthritis? Insights from a Nationally Representative Study
Provisionally accepted
Yifan Lu1
Junjie Duan2Rong You2Simin Tang2Xinyu Qi1Boyu Wu3Gonghui Jian1Tao Wang2Jianhui Duan2
Zhuo Yang2*- 1Hunan University of Chinese Medicine, Changsha, Anhui Province, China
- 2Changde First Hospital of Traditional Chinese Medicine, Changde, China
- 3Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong Province, China
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The relationship between serum vitamins, carotenoids, and retinyl estersand mortality risk among individuals with osteoarthritis (OA) remains unclear.This study aimed to investigate these associations.Based on data from NHANES 2001-2018 and the National Death Index (NDI), a total of 3,626 patients with OA were included. Cox proportional hazards models were used to evaluate the associations between serum nutrient levels and allcause, cardiovascular, and cancer mortality. Nonlinear effects were assessed using smooth curve fitting and piecewise regression models. Subgroup analyses, sensitivity analyses, and validation in non-OA populations were conducted. Additionally, interactions between vitamin levels and OA status were examined.Results: Higher levels of vitamin D, retinyl palmitate, and stearic acid were associated with a reduced risk of all-cause mortality in patients with OA, with consistent results in sensitivity analyses. A nonlinear inverse association was observed between vitamin D and all-cause mortality in women, with a threshold at 30.5 nmol/L. Vitamin C was associated with cardiovascular mortality, while retinyl palmitate and stearic acid were linked to a reduced risk of cancer-related death. The protective effect of vitamin D was stronger among individuals with lower educational levels. In the non-OA population, only vitamin D was associated with mortality. Interaction analysis indicated that high vitamin levels may attenuate the adverse impact of OA on mortality risk.Conclusions: Elevated serum levels of vitamin D, retinyl palmitate, and stearic acid may be associated with reduced all-cause and cause-specific mortality among individuals with OA, highlighting their potential role in the management of OA.
Keywords: Osteoarthritis, Serum vitamins, Carotenoids, Mortality, NHANES
Received: 10 Apr 2025; Accepted: 28 May 2025.
Copyright: © 2025 Lu, Duan, You, Tang, Qi, Wu, Jian, Wang, Duan and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhuo Yang, Changde First Hospital of Traditional Chinese Medicine, Changde, China
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