European Journal of Nutrition

, Volume 58, Issue 6, pp 2175–2189 | Cite as

Dietary total antioxidant capacity and mortality from all causes, cardiovascular disease and cancer: a systematic review and dose–response meta-analysis of prospective cohort studies

  • Mohammad Parohan
  • Javad Anjom-Shoae
  • Morteza Nasiri
  • Mahmoud Khodadost
  • Seyed Reza Khatibi
  • Omid SadeghiEmail author



No conclusive information is available about the association between dietary total antioxidant capacity (DTAC) and risk of mortality. Current meta-analysis of prospective cohort studies was done to summarize available findings on the association between DTAC and risk of death from all-cause, cancer and cardiovascular diseases (CVDs).


Online databases were searched to detect relevant publications up to January 2018, using relevant keywords. To pool data, either fixed-effects or random-effects model was used. Furthermore, linear and non-linear dose–response analyses were also done.


In total, five prospective studies were included in the current systematic review and meta-analysis. In a follow-up period of 4.3–16.5 years, there were 38,449 deaths from all-cause, 4470 from cancer and 2841 from CVDs among 226,297 individuals. A significant inverse association was found between DTAC and all-cause mortality (combined effect size: 0.62, 95% CI 0.60–0.64). Such finding was also seen for cancer (combined effect size: 0.81, 95% CI 0.75–0.88) and CVD (combined effect size: 0.71, 95% CI 0.63–0.82) mortality. Findings from linear dose–response meta-analysis revealed that a 5 mmol/day increment in DTAC based on ferric reducing antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC) was associated with 7% and 15% lower risk of all-cause mortality, respectively. Based on findings from non-linear dose–response meta-analysis, a significant reduction in risk of all-cause mortality was seen when increasing FRAP from 2 to 12 mmol/day (P-nonlinearity = 0.002) and ORAC from 5 to 11 mmol/day (P-nonlinearity < 0.001).


Adherence to diet with high total antioxidant capacity was associated with decreased risk of death from all-cause, cancer and CVDs.


Antioxidants Mortality Meta-analysis Dose–response Cancer Cardiovascular 



Dietary total antioxidant capacity


Ferric reducing antioxidant power


Total radical trapping antioxidant parameter


Trolox equivalence antioxidant capacity


Oxygen radical absorbance capacity


Odds ratio


Relative risk


Hazard ratio


Food frequency questionnaire


Cardiovascular disease



This study was supported jointly by Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran, and Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.

Author contributions

MN, JAS, MP, SRK and MK contributed to conception, design, statistical analyses, data interpretation and manuscript drafting. OS and MP contributed to data analysis, data interpretation and manuscript drafting. All authors approved the final manuscript for submission.

Compliance with ethical standards

Conflict of interest

The author declares that there is no conflict of interest.

Supplementary material

394_2019_1922_MOESM1_ESM.docx (693 kb)
Supplementary material 1 (DOCX 693 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Mohammad Parohan
    • 1
  • Javad Anjom-Shoae
    • 1
  • Morteza Nasiri
    • 2
    • 3
  • Mahmoud Khodadost
    • 4
    • 5
  • Seyed Reza Khatibi
    • 6
  • Omid Sadeghi
    • 7
    • 8
    Email author
  1. 1.School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
  2. 2.Department of Operating Room Technology, School of ParamedicineQom University of Medical SciencesQomIran
  3. 3.Department of Surgical Technology, School of Nursing and MidwiferyShiraz University of Medical SciencesShirazIran
  4. 4.Department of Epidemiology, School of Public HealthShahid Beheshti University of Medical SciencesTehranIran
  5. 5.Department of Epidemiology, School of Public HealthIran University of Medical SciencesTehranIran
  6. 6.Torbat Heydariyeh University of Medical SciencesTorbat HeydariyehIran
  7. 7.Gerash University of Medical SciencesGerashIran
  8. 8.Students’ Scientific Research CenterTehran University of Medical SciencesTehranIran

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