L-Shaped Associations Between Composite Dietary Antioxidant Index and Hearing Loss: A Cross-Sectional Study From the National Health and Nutrition Examination Survey

Background Oxidative stress has been implicated in the pathogenesis of hearing loss (HL). Dietary intake is a modifiable factor that could influence the oxidant and antioxidant capacity. We hypothesized that a higher composite dietary antioxidant index (CDAI) is associated with a reduced odds for HL. Methods Adult participants from the 2001–2012 & 2015–2018 National Health and Nutrition Examination Study were included in this cross-sectional study. The CDAI was calculated from vitamins A, C, E, selenium, zinc, and caretenoid through 24-h dietary recall. Outcomes were HL, speech frequency HL (SFHL), and high frequency HL (HFHL). The associations between CDAI and HL, SFHL, and HFHL were evaluated by weighted multivariable logistic regression. Results CDAI was associated with lower odds of HL (OR = 0.98, 95%CI 0.95–1.00, p = .043) and SFHL (OR = 0.97, 95%CI 0.95–1.00, p = .041), but not HFHL (OR = 0.98, 95%CI 0.96–1.00, p = .118) after adjustment for confounders. The multivariable-adjusted model showed a significant trend toward decreased risk of HL, SFHL, and HFHL with increasing CDAI quartile (all p for trend < 0.05). Restricted cubic spline analysis suggested that the associations between CDAI and HL, SFHL, and HFHL were L-shaped, with inflection points of CDAI at −0.61, 2.33, and 4.32, respectively. Subgroup analysis showed that participants with exposure to loud noise benefited from a higher CDAI for SFHL ( p for interaction = 0.039). Conclusion Higher CDAI is associated with reduced odds of HL and SFHL in the U.S. adult population and serves as a promising intervention target to be further explored in prospective longitudinal studies in the future.