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Associations of dietary folate, vitamin B6 and B12 intake with cardiovascular outcomes in 115664 participants: a large UK population-based cohort

European Journal of Clinical Nutrition volume 77, pages 299–307 (2023)Cite this article

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Abstract

Background/Objectives

The evidence of relationship between dietary intake of folate, vitamin B6 and vitamin B12 and cardiovascular diseases (CVD) in UK populations is limited. We aimed to analyze the association of dietary intake of folate, vitamin B6, and vitamin B12 with CVD events [stroke, myocardial infarction (MI)] and CVD mortality.

Methods

We included 115,664 participants, aged 40–70 years, with no CVD events or cancer at baseline, enrolled between 2006 and 2010 and followed up to the end of 2018. Dietary intake was measured with an online 24-h dietary assessment. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations.

Results

After multivariate adjustment, higher dietary folate intake was inversely associated with CVDs with hazard ratios of 0.99, 0.92, and 0.88 in groups 2–4 compared with group 1 (the lowest group); inversely associated with stroke with hazard ratios of 0.94, 0.90, and 0.86 groups 2–4 compared to group 1 (lowest group); inversely associated with MI with hazard ratios of 1.01, 0.90 and 0.86 groups 2–4 compared to group 1 (lowest group); inversely associated with CVD mortality with hazard ratios of 0.95, 0.80 and 0.74 Groups 2–4 compared to group 1 (lowest group). Each tablespoon/day higher intake of raw vegetable intake, pieces/day higher intake of fresh fruit intake bowls/week higher intake of cereal intake, and g/day higher intake of dietary fiber were associated with higher intakes of folate every 0.02,0.06,0.05, and 0.08 SD, respectively. E-value analysis suggested robustness to unmeasured confounding.

Conclusions

Each increase in folate intakes was related to 5% lower risks of total CVD events and 10% lower risks of CVD mortality. Our findings support that strengthening dietary folate intake as a primary prevention strategy for CVD events and CVD mortality.

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Fig. 1: Association of dietary factors with folate, vitamin B6 and vitamin B12 intakes in the UK Biobank study.
Fig. 2: Associations of dietary intakes of folate with incident CVD events and CVD mortality in the UK Biobank study.
Fig. 3: Association of dietary intake of folate with CVD events stratified by sex.

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Data availability

Data may be obtained from a third party and are not publicly available. We used UK Biobank data to analyse and report the findings. Data access policy can be obtained from https://www.ukbiobank.ac.uk/.

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Acknowledgements

Our research has been conducted using the UK Biobank Resource (application No 52632). Permission to use the UK Biobank Resource was approved by the access subcommittee of the UK Biobank Board(www.ukbiobank.ac.uk/).

Funding

This study is supported by the National Natural Science Foundation of China (82173648), Innovative Talent Support Plan of the Medical and Health Technology Project in Zhejiang Province (2021422878), Internal Fund of Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences (2020YJY0212), Ningbo Clinical Research Center for Digestive System Tumors (Grant No. 2019A21003), and Sanming Project of Medicine in Shenzhen (SZSM201803080).

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Author notes

  1. These authors contributed equally: Boya Zhang, Haoyu Dong.

Authors and Affiliations

  1. School of Public Health, Medical College of Soochow University, Suzhou, China

    Boya Zhang, Haoyu Dong, Ying Xu, Duo Xu & Hongpeng Sun

  2. Department of Global Health, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China

    Liyuan Han

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Contributions

Boya Zhang performed the data analyses and wrote the manuscript; Haoyu Dong contributed significantly to manuscript preparation; Xu Ying and Xu duo contributed significantly to analysis; Hongpeng Sun and Li Yuan Han helped perform the analysis with constructive discussions. All authors reviewed the manuscript.

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Correspondence to Hongpeng Sun or Liyuan Han.

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UK Biobank has received ethics approval from the National Health Service National Research Ethics Service.

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Zhang, B., Dong, H., Xu, Y. et al. Associations of dietary folate, vitamin B6 and B12 intake with cardiovascular outcomes in 115664 participants: a large UK population-based cohort. Eur J Clin Nutr 77, 299–307 (2023). https://doi.org/10.1038/s41430-022-01206-2

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