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The demographics, lifestyle characteristics, and selected fluorosis risk factors of the cases and controls are presented in Table 1. There were 196 case-control pairs, including 105 female pairs and 91 male pairs. The median age was 49.0 years in the skeletal fluorosis cases and 51.0 years in the controls. Compared with the controls, the cases with skeletal fluorosis were more likely to have lower levels of education and proportion of improved stove use, but higher levels of urinary fluoride and mixed coal use. Furthermore, cases with skeletal fluorosis had a lower intake of α-carotene, β-carotene, lutein/zeaxanthin, lycopene and total carotenoids (P for trend range < 0.005 to 0.001); only for β-cryptoxanthin were these results not significant (P= 0.373). The genotype frequency distribution of rs 11968525 in control and case groups was consistent with HardyWeinberg equilibrium (χ2 = 0.601, P= 0.438; χ2 = 2.397, P= 0.122) and No significant differences were observed in genotype frequencies of rs11968525 between case and control groups (P = 0.591).
Variables Median (P25, P75) P-value Case (n= 196) Control (n= 196) Age, years 49.0 (44.0, 60.0) 51.0 (43.2, 60.0) 0.703 Total energy, kcal/d 2676.4 (2002.0, 3487.7) 2587.7 (1998.0, 3213.7) 0.219 Calcium intake, mg/d 457.9 (326.3, 706.6) 482.5 (344.0, 723.6) 0.274 Roasted chili consumption, g/d 6.03 (2.43, 17.2) 5.79 (2.41, 12.5) 0.271 Urinary fluoride, mg/L 1.58 (1.21, 2.31) 1.23 (0.85, 1.73) < 0.001 Carotenoids, μg/d α-carotene 223.5 (112.5, 413.0) 295.5 (136.8, 636.9) 0.001 β-carotene 2478.1 (1388.6, 3783.8) 3186.2 (1999.4, 5051.1) < 0.001 β-cryptoxanthin 241.0 (103.5, 596.2) 210.1 (118.6, 449.3) 0.373 lycopene 296.5 (116.4, 761.6) 559.2 (246.0, 1112.0) < 0.001 Lutein/zeaxanthin 1887.3 (1109.1, 3264.1) 2817.3 (1749.5, 4319.2) < 0.001 Total carotenoids† 5408.5 (3269.2, 9234.4) 7531.6 (4854.5, 11825.7) < 0.001 Marital status, n (%) 0.541 married or cohabitation 161 (82.1) 169 (86.2) divorce or widowed 27 (13.8) 21 (10.7) unmarried 8 (4.1) 6 (3.1) Education level, n (%) < 0.001 primary school or below 177 (90.3) 144 (73.5) secondary school 17 (8.7) 40 (20.4) high school or above 2 (1.0) 12 (6.1) Fuel type, n (%) 0.008 raw coal 104 (53.1) 114 (58.2) mixed coal 56 (28.6) 31 (15.8) firewood 5 (2.6) 14 (7.1) electricity 31 (15.8) 37 (18.9) Smoker‡, n (%) 79 (40.3) 77 (39.3) 0.880 Alcohol drinker§, n (%) 61 (31.1) 65 (33.2) 0.665 Tea drinker||, n (%) 72 (36.7) 74 (37.8) 0.834 Roasting food, n (%) 109 (55.6) 95 (48.5) 0.142 Improved stove use , n (%) 143 (73.0) 169 (86.2) 0.002 Vitamin supplement, n (%) 3 (1.5) 6 (3.1) 0.312 SOD rs11968525, n (%) 0.591 GG 114 (65.1) 108 (67.9) AG+AA 61 (34.9) 51 (32.1) Note. *Continuous and categorical variables were described by means median (P25, P75) or numbers and percentages, and evaluated by the Wilcoxon signed-rank or McNemar's test, respectively, to compare the categorical and continuous variables of case and control group. †Total carotenoids indicate the sum of α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein/zeaxanthin. ‡Smokers were defined as having smoked at least one cigarette daily for at least six consecutive months. §Alcohol drinking was defined as having had wine (beer, white wine, and red wine) at least once per week for at least six consecutive months. ||Tea drinkers were defined having drank tea at least twice weekly. Improving the kitchen stove to exclude the fluoride out of the room to decrease the pollution of the air indoors. Table 1. Characteristics of the Case and Control in Coal-burning Fluorosis Area in Guizhou, China, in 2015*
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The univariate logistic regression analyses showed that α-carotene, β-carotene, lutein/zeaxanthin, lycopene, and total carotenoids were inversely associated with skeletal fluorosis (P for trend range < 0.001 to 0.002) (Table 2). These associations were attenuated after adjusting for socio-demographic characteristics and potential confounding factors related to coal-burning fluorosis (Model 2). With further adjustments made for calcium intake, rs11968525 genotype and urinary fluoride level (Model 3), great intakes of β-carotene, lutein/zeaxanthin, lycopene, and total carotenoids were inversely associated with the risk of skeletal fluorosis (P-trend = 0.002-0.018), whereas α-carotene intakes were not found to be related to skeletal fluorosis (P-trend = 0.769). Comparisons of the first-quartile ORs (95% CIs) of skeletal fluorosis with the fourth quartiles of β-carotene, lutein/ zeaxanthin, lycopene, and total carotenoids were 0.30 (0.10, 0.86), 0.33 (0.13, 0.84), 0.26 (0.10, 0.75), 0.23 (0.08, 0.66), and 0.34 (0.14, 0.74), respectively (Table 2). No associations between the skeletal fluorosis and the intake of β-cryptoxanthin (P-trend = 0.407) were observed (Table 2).
Items Quartiles of Dietary Carotenoids Intake P-trend Quartile 1§ Quartile 2 Quartile 3 Quartile 4 α-carotene Median, μg/d 68.1 211.0 404.6 1035.3 Case/control 61/ 49 61/49 50/49 24/49 Model 1# 1 0.96 (0.54, 1.72) 0.69 (0.40, 1.21) 0.31 (0.15, 0.63)** 0.002 Model 2‡ 1 0.94 (0.50, 1.79) 0.82 (0.45, 1.49) 0.33 (0.17, 0.71)** 0.011 Model 3‖ 1 0.75 (0.32, 1.77) 0.89 (0.41, 1.94) 0.83 (0.30, 2.28) 0.769 β-carotene Median, μg/d 1287.1 2535.5 3788.2 7535.5 Case/control 77/ 49 50/49 43/49 26/49 Model 1# 1 0.59 (0.33, 1.06) 0.45 (0.25, 0.81)** 0.26 (0.13, 0.52)** < 0.001 Model 2‡ 1 0.47 (0.25, 0.90)* 0.44 (0.23, 0.85)* 0.25 (0.12, 0.53)** 0.001 Model 3‖ 1 0.50 (0.20, 1.24) 0.47 (0.19, 1.12) 0.30 (0.10, 0.86)* 0.018 β-cryptoxanthin Median, μg/d 76.2 158.9 313.9 834.1 Case/control 56/49 35/49 36/49 69/49 Model 1# 1 0.58 (0.33, 1.04) 0.63 (0.34, 1.13) 1.19 (0.69, 2.06) 0.430 Model 2‡ 1 0.63 (0.34, 1.18) 0.56 (0.29, 1.09) 1.25 (0.69, 2.29) 0.474 Model 3‖ 1 0.97 (0.40, 2.47) 0.42 (0.16, 1.09) 0.84 (0.36, 1.95) 0.407 Lutein/zeaxanthin Median, μg/d 1103.1 2170.3 3379.2 6420.3 Case/control 88/49 44/49 35/49 29/49 Model 1# 1 0.43 (0.23, 0.78)** 0.30 (0.16, 0.59)** 0.23 (0.11, 0.47)** < 0.001 Model 2‡ 1 0.34 (0.17, 0.67)** 0.25 (0.12, 0.53)** 0.28 (0.13, 0.60)** < 0.001 Model 3‖ 1 0.25 (0.10, 0.65)** 0.18 (0.06, 0.54)** 0.26 (0.10, 0.75)** 0.002 Lycopene Median, μg/d 113.1 379.8 790.3 1962.9 Case/control 85/49 43/49 40/49 28/49 Model 1# 1 0.43 (0.24, 0.78)** 0.33 (0.17, 0.63)** 0.24 (0.12, 0.48)** < 0.001 Model 2‡ 1 0.42 (0.21, 0.85)* 0.33 (0.16, 0.67)** 0.30 (0.14, 0.67)** < 0.001 Model 3‖ 1 0.37 (0.42, 1.09) 0.35 (0.14, 0.94)* 0.23 (0.08, 0.66)** 0.006 Total carotenoids Median, μg/d 3067.3 6175.7 9421.1 16613.3 Case/control 86/48 43/49 36/49 30/48 Model 1# 1 0.46 (0.24, 0.88)* 0.36 (0.19, 0.67)** 0.24 (0.12, 0.48)** < 0.001 Model 2‡ 1 0.47 (0.24, 0.93)* 0.35 (0.18, 0.70)* 0.36 (0.19, 0.68)** 0.001 Model 3‖ 1 0.43 (0.17, 1.04) 0.23 (0.10, 0.53)* 0.34 (0.14, 0.74)* 0.002 Note. Abbreviations: OR, odds ratio; CI, confidence interval. §Quartile 1 was the reference quartile. †Total carotenoids indicate the sum of α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein/zeaxanthin. #Model 1, crude adjusted ORs were obtained without further adjustment of covariates. ‡Model 2, adjusted for energy intake, marital status, education level, smoking, alcohol drinking, tea drinking, fuel type, improved stove use, roasting food, roasted chilli consumption, ‖Model 3, further adjusted calcium intake, rs11968525 genotype, and urinary fluoride level. *P < 0.05, **P < 0.01. Table 2. Odds Ratios (95% CIs) of Skeletal Fluorosis for Quartiles of Dietary Carotenoids Intake in Adults of Coal-burning Fluorosis Area in Guizhou, China, in 2015
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The results of the above calculations show whether the potential risk factors modified the association between carotenoids and skeletal fluorosis (Table 3). Stratified analyses showed that there were inverse associations of total carotenoids and lutein/zeaxanthin with skeletal fluorosis significant in subjects with the SOD2 (rs11968525) AG+AA genotype (P-trend < 0.05), but this association was not significant in subjects with GG genotypes (P-trend > 0.05). There were significant interactions between dietary intake of total carotenoids and lutein/zeaxanthin and rs11968525 polymorphisms (P-interactions < 0.05), and marginal interactions between dietary intake of β-carotene and rs11968525 polymorphisms (P-interactions = 0.075). Stratified and interaction analyses demonstrated no significant interaction between the factors of gender, smoking, education, use of mixed coal and use of improved stoves, and dietary carotenoids in relation to the risk of skeletal fluorosis (P for trend range 0.101 to 0.963). (Supplementary Tables S1 to S6, available in www.besjournal.com).
Items Quartiles of Dietary Energy-adjusted Carotenoids Intake Pa Pb Quartile 1§ Quartile 2 Quartile 3 Quartile 4 α-carotene 0.402 GG 1 0.82 (0.36, 1.83) 0.94 (0.40, 2.21) 0.69 (0.26, 1.87) 0.580 AG+AA 1 1.14 (0.34, 3.85) 1.02 (0.30, 3.38) 0.50 (0.14, 1.79) 0.302 β-carotene 0.075 GG 1 0.53 (0.23, 1.20) 0.92 (0.39, 2.16) 0.45 (0.17, 1.17) 0.229 AG+AA 1 1.05 (030, 3.68) 0.30 (0.09, 0.98) 0.31 (0.08, 1.13) 0.010 lutein/zeaxanthin 0.029 GG 1 0.48 (0.16, 1.09) 0.61 (0.26, 1.42) 0.51 (0.20, 1.29) 0.179 AG+AA 1 0.51 (0.15, 1.73) 0.18 (0.05, 0.65) 0.16 (0.05, 0.52) 0.002 β-cryptoxanthin 0.686 GG 1 0.76 (0.31, 1.85) 0.56 (0.20, 1.05) 1.18 (0.52, 2.71) 0.998 AG+AA 1 0.70 (0.19, 2.60) 0.89 (0.24, 3.31) 1.88 (0.27, 2.97) 0.978 Lycopene 0.289 GG 1 0.49 (0.21, 1.14) 0.41 (0.17, 0.95) 0.44 (0.18, 1.09) 0.043 AG+AA 1 0.49 (0.15, 1.62) 0.34 (0.10, 1.14) 0.20 (0.05, 0.74) 0.004 Total carotenoids† 0.028 GG 1 0.46 (0.20, 1.06) 0.82 (0.35, 1.94) 0.53 (0.21 1.35) 0.313 AG+AA 1 0.72 (0.20, 2.67) 0.16 (0.05, 0.54) 0.19 (0.06, 0.68) 0.002 Note. Abbreviations: OR, odds ratio; CI, confidence interval. Unconditional logistic regression analyses to ORs and 95% CIs. Covariates adjusted for age, gender, marital status, education level, smoking, alcohol drinking, tea drinking, total energy, calcium intake, roasted chili consumption, fuel type, roasting food, use of an improved oven, rs11968525 genotype and urinary fluoride level. §Quartile 1 was the reference quartile. †Total carotenoids indicate the sum of α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein/zeaxanthin. aP value for linear trend, bP value for interaction. Table 3. Multivariate-adjusted OR (95% CIs) of the Skeletal Fluorosis for Each Quartile of Dietary Carotenoids Intake by Subgroups of rs11968525 Genotype in Adults of Coal-burning Fluorosis Area in Guizhou, China, in 2015
Variables Quartiles of Dietary Carotenoids Intake Pa Pb Quartile 1§ Quartile 2 Quartile 3 Quartile 4 α-carotene 0.922 woman 1 0.75 (0.31, 1.81) 0.52 (0.20, 1.34) 0.74 (0.25, 2.17) 0.347 man 1 1.12 (0.41, 3.05) 1.95 (0.69, 5.55) 0.38 (0.12, 1.23) 0.416 β-carotene 0.238 woman 1 0.60 (0.25, 1.45) 0.70 (0.28, 1.78) 0.66 (0.24, 1.82) 0.380 man 1 0.96 (0.33, 2.82) 0.65 (0.23, 1.83) 0.25 (0.08, 0.84) 0.023 Lutein/zeaxanthin 0.232 woman 1 0.61 (0.24, 1.53) 0.49 (0.20, 1.22) 0.58 (0.21, 1.59) 0.148 man 1 0.20 (0.07, 0.60 0.40 (0.13, 1.26) 0.14 (0.04, 0.45) 0.006 β-cryptoxanthin 0.541 woman 1 0.52 (0.20, 1.37) 0.77 (0.29, 2.05) 0.73 (0.29, 1.83) 0.690 man 1 1.40 (0.43, 4.56) 0.76 (0.34, 1.27) 1.60 (0.59, 4.32) 0.480 Lycopene 0.419 woman 1 0.33 (0.13, 0.83) 0.35 (0.14, 0.89) 0.29 (0.11, 0.82) 0.006 man 1 0.93 (0.32, 2.71) 0.54 (0.19, 1.55) 0.46 (0.16, 1.37) 0.102 Total carotenoids† 0.312 woman 1 0.41 (0.16, 1.04) 0.58 (0.24, 1.44) 0.56 (0.20, 1.55) 0.316 man 1 0.70 (0.24, 2.05) 0.54 (0.19, 1.57) 0.28 (0.09, 0.88) 0.027 Note. Abbreviations: OR, odds ratio; CI, confidence interval. Unconditional logistic regression analyses to ORs and 95% CIs. Covariates adjusted for age, gender, marital status, education level, smoking, alcohol drinking, tea drinking, total energy, calcium intake, roasted chili consumption, fuel type, roasting food, use of an improved oven rs11968525 genotype and urinary fluoride level; §Quartile 1 was the reference quartile. †Total carotenoids indicate the sum of α-carotene, β-carotene, β-cryptoxanthin, lycopene and lutein/zeaxanthin. aP value for linear trend, bP value for interaction. Table Supplemental Table S1. Multivariate-adjusted OR (95% CIs) of the Skeletal Fluorosis for Each Quartile of Dietary Carotenoids Intake by Subgroups of Gender in Adults of coal-burning Fluorosis Area in Guizhou, China, in 2015
Variable Quartiles of Dietary Carotenoids Intake Pa Pb Quartile 1§ Quartile 2 Quartile 3 Quartile 4 α-carotene 0.763 No 1 0.56 (0.25, 1.29) 0.48 (0.20, 1.30) 0.48 (0.20, 1.69) 0.193 Yes 1 1.84 (0.59, 5.71) 1.68 (0.54, 5.21) 0.43 (0.13, 1.50) 0.276 β-carotene 0.709 No 1 0.96 (0.42, 2.18) 0.79 (0.33, 1.89) 0.43 (0.16, 1.16) 0.116 Yes 1 0.53 (0.17, 1.66) 0.64 (0.21, 1.93) 0.31 (0.09, 1.05) 0. 099 Lutein/zeaxanthin, 0.813 No 1 0.71 (0.31, 1.67) 0.45 (0.19, 1.08) 0.38 (0.15, 0.98) 0.011 Yes 1 0.19 (0.06, 0.64) 0.55 (0.16, 1.85) 0.19 (0.06, 0.66) 0.689 β-cryptoxanthin 0.146 No 1 0.47 (0.18, 1.20) 0.58 (0.23, 1.42) 0.63 (0.26, 1.52) 0.391 Yes 1 1.33 (0.38, 4.66) 0.76 (0.42, 1.26) 1.94 (0.66, 5.71) 0.385 Lycopene 0.807 No 1 0.39 (0.16, 0.91) 0.42 (0.18, 0.99) 0.32 (0.12, 0.84) 0.006 Yes 1 0.96 (0.30, 3.05) 0.37 (0.12, 1.16) 0.39 (0.12, 1.28) 0.015 Total carotenoids † 0.765 No 1 0.74 (0.32, 1.73) 0.57 (0.24, 1.32) 0.41 (0.15, 1.08) 0.029 Yes 1 0.39 (0.20, 1.24) 0.55 (0.18, 1.72) 0.29 (0.22, 0.96) 0.076 Note. Abbreviations: OR, odds ratio; CI, confidence interval. Unconditional logistic regression analyses to ORs and 95% CIs. Covariates adjusted for age, gender, marital status, education level, smoking, alcohol drinking, tea drinking, total energy, calcium intake, roasted chili consumption, fuel type, roasting food, use of an improved oven rs11968525 genotype and urinary fluoride level §Quartile 1 was the reference quartile. †Total carotenoids indicate the sum of α-carotene, β-carotene, β-cryptoxanthin, lycopene and lutein/zeaxanthin. aP value for linear trend, bP value for interaction. Table Supplemental Table 2. Multivariate-adjusted OR (95% CIs) of Skeletal Fluorosis for Each Quartiles of Dietary Carotenoids Intake by Subgroup of Smoking‡ in Adults of Coal-burning Fluorosis Area in Guizhou, China, in 2015
Variables Quartiles of Dietary Energy-adjusted Carotenoids Intake Pa Pb Quartile 1§ Quartile 2 Quartile 3 Quartile 4 α-carotene 0.691 ≤ 6 years 1 1.83 (0.68, 4.92) 0.85 (0.29, 2.49) 0.75 (0.22, 2.62) 0.472 > 6 years 1 0.49 (0.17, 1.48) 1.53 (0.55, 4.24) 0.38 (0.13, 1.18) 0.445 β-carotene 0.192 ≤ 6 years 1 1.95 (0.73, 5.19) 0.79 (0.26, 2.46) 0.82 (0.25, 2.63) 0.587 > 6 years 1 1.25 (0.44, 3.58) 0.64 (0.22, 1.81) 0.44 (0.15, 1.28) 0.052 lutein/zeaxanthin 0.241 ≤ 6 years 1 0.48 (0.17, 1.34) 0.66 (0.22, 2.11) 0.28 (0.08, 0.93) 0.043 > 6 years 1 0.62 (0.22, 1.74) 0.41 (0.15, 1.13) 0.18 (0.06, 0.58) 0.003 β-cryptoxanthin 0.282 ≤ 6 years 1 1.38 (0.42, 4.58) 1.23 (0.42, 3.62) 1.48 (0.52, 4.21) 0.515 > 6 years 1 0.58 (0.19, 1.73) 0.25 (0.08, 0.75) 0.69 (0.27, 1.82) 0.360 Lycopene 0.634 ≤ 6 years 1 0.25 (0.08, 0.73) 0.07 (0.02, 0.27) 0.33 (0.09, 1.22) 0.010 > 6 years 1 0.65 (0.22, 1.94) 0.19 (0.07, 0.58) 0.26 (0.09, 0.75) 0.003 Total carotenoids† 0.222 ≤ 6 years 1 0.71 (0.27, 1.89) 0.68 (0.23, 2.07) 0.49 (0.15, 1.58) 0.227 > 6 years 1 0.85 (0.29, 2.46) 0.42 (0.15, 1.21) 0.27 (0.09, 0.81) 0.007 Note. Abbreviations: OR, odds ratio; CI, confidence interval. Unconditional logistic regression analyses to ORs and 95% CIs. Covariates adjusted for age, gender, marital status, education level, smoking, alcohol drinking, tea drinking, total energy, calcium intake, roasted chili consumption, fuel type, roasting food, use of an improved oven, rs11968525 genotype and urinary fluoride level §Quartile 1 was the reference quartile. †Total carotenoids indicate the sum of α-carotene, β-carotene, β-cryptoxanthin, lycopene and lutein/zeaxanthin. aP value for linear trend, bP value for interaction. Table Supplemental Table 3. Multivariate-adjusted OR (95% CIs) of the Skeletal Fluorosis for Each Quartile of Dietary Carotenoids Intake by Subgroups of Education Level in Adults of Coal-burning Fluorosis Area in Guizhou, China, in 2015
Quartiles of dietary energy-adjusted carotenoids intake Pa Pb Quartile 1 Quartile 2 Quartile 3 Quartile 4 α-carotene 0.963 Yes 1 1.07 (0.49, 2.33) 1.06 (0.48, 2.35) 0.62 (0.25, 1.56) 0.406 No 1 0.71 (0.12, 4.13) 0.61 (0.49, 5.14) 0.35 (0.06, 1.87) 0.382 β-carotene 0.951 Yes 1 1.16 (0.54, 2.45) 0.59 (0.25, 1.35) 0.63 (0.28, 1.45) 0.141 No 1 1.99 (0.37, 5.77) 2.67 (0.41, 7.44) 0.65 (0.12, 3.45) 0.603 lutein/zeaxanthin 0.641 Yes 1 0.37 (0.16, 0.82) 0.34 (0.15, 0.79) 0.20 (0.08, 0.51) 0.001 No 1 1.45 (0.25, 8.40) 1.06 (0.18, 6.29) 0.31 (0.05, 1.90) 0.166 β-cryptoxanthin 0.101 Yes 1 1.01 (0.43, 2.38) 0.52 (0.23, 1.19) 0.79 (0.36, 1.76) 0.333 No 1 0.32 (0.04, 2.37) 0.63 (0.09, 4.02) 1.48 (0.35, 6.26) 0.434 Lycopene 0.600 Yes 1 0.23 (0.10, 0.55) 0.13 (0.05, 0.33) 0.21 (0.10, 0.48) < 0.001 No 1 1.30 (0.18, 3.04) 0.19 (0.04, 0.97) 0.49 (0.09, 2.65) 0.142 Total carotenoids† 0.869 Yes 1 0.51 (0.24, 1.11) 0.45 (0.19, 1.02) 0.32 (0.14, 0.77) 0.009 No 1 3.81 (0.47, 9.65) 0.91 (0.18, 4.58) 0.77 (0.15, 4.01) 0.394 Note: Abbreviations:OR, odds ratio; CI, confidence interval. Unconditional logistic regression analyses to ORs and 95% CIs. Covariates adjusted for age, gender, marital status, education level, smoking, alcohol drinking, tea drinking, total energy, calcium intake, roasted chili consumption, fuel type, roasting food, use of an improved oven, rs11968525 genotype and urinary fluoride level; § Quartile 1 was the reference quartile. †Total carotenoids indicate the sum of α-carotene, β-carotene, β-cryptoxanthin, lycopene and lutein/zeaxanthin. a P value for linear trend, b P value for interaction. Table Supplemental Table 4. Multivariate-adjusted OR (95% CIs) of the skeletal fluorosis for each quartile of dietary carotenoids intake by subgroups of use of improved stove in adults of coal-burning fluorosis area in Guizhou, China, in 2015
Quartiles of dietary energy-adjusted carotenoids intake Pa Pb Quartile 1 Quartile 2 Quartile 3 Quartile 4 α-carotene 0.911 Yes 1 0.94 (0.38, 2.28) 1.37 (0.54, 3.50) 0.58 (0.20, 1.64) 0.581 No 1 1.80 (0.46, 7.08) 1.96 (0.49, 7.74) 0.94 (0.22, 3.95) 0.855 β-carotene 0.390 Yes 1 1.43 (0.58, 3.52) 0.68 (0.27, 1.75) 0.49 (0.18, 1.34) 0.075 No 1 2.27 (0.61, 8.43) 1.17 (0.32, 4.34) 1.03 (0.26, 3.97) 0.792 lutein/zeaxanthin 0.241 Yes 1 0.45 (0.19, 1.09) 0.41 (0.16, 1.02) 0.19 (0.07, 0.56) 0.002 No 1 2.83 (0.69, 8.55) 1.14 (0.32, 4.04) 0.63 (0.14, 2.82) 0.310 β-cryptoxanthin 0.633 Yes 1 0.91 (0.34, 2.41) 0.54 (0.21, 1.39) 0.92 (0.39, 2.19) 0.658 No 1 0.26 (0.06, 1.19) 0.30 (0.07, 1.26) 0.72 (0.19, 2.69) 0.978 Lycopene 0.231 Yes 1 0.32 (0.13, 0.80) 0.11 (0.06, 0.35) 0.27 (0.10, 0.69) < 0.001 No 1 0.52 (0.13, 2.09) 0.36 (0.09, 1.34) 0.36 (0.09, 1.45) 0.118 Total carotenoids† 0.473 Yes 1 0.57 (0.24, 1.37) 0.52 (0.21, 1.28) 0.28 (0.10, 0.78) 0.016 No 1 2.88 (0.72, 8.45) 0.78 (0.21, 0.97) 0.90 (0.22, 3.65) 0.376 Note: Abbreviations:OR, odds ratio; CI, confidence interval. Unconditional logistic regression analyses to ORs and 95% CIs. Covariates adjusted for age, gender, marital status, education level, smoking, alcohol drinking, tea drinking, total energy, calcium intake, roasted chili consumption, fuel type, roasting food, use of an improved oven, rs11968525 genotype and urinary fluoride level; § Quartile 1 was the reference quartile. †Total carotenoids indicate the sum of α-carotene, β-carotene, β-cryptoxanthin, lycopene and lutein/zeaxanthin. a P value for linear trend, b P value for interaction. Table Supplemental Table 5. Multivariate-adjusted OR (95% CIs) of the skeletal fluorosis for each quartile of dietary carotenoids intake by subgroups of use of mixed coal in adults of coal-burning fluorosis area in Guizhou, China, in 2015
Carotenoids Model 1# Model 2‡ Model 3 α-carotene 267.612 241.433 108.233 β-carotene 261.822 236.977 106.685 lutein/zeaxanthin 244.658 223.626 95.991 β-cryptoxanthin 270.189 247.410 110.904 Lycopene 234.228 212.849 93.815 Total carotenoids 246.642 223.282 96.968 #Model 1 Crude adjusted ORs were obtained without further adjustment of covariates; ‡Model 2 adjusted for energy intake, marital status, education level, smoking, alcohol drinking, tea drinking, fuel type, improved stove use, roasting food, roasted chilli consumption; Model 3 further adjusted calcium intake, rs11968525 genotype and urinary fluoride level. Table Supplemental Table 6. Akaike criteria of three models in present study