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Topical Area: Nutritional Epidemiology

Nutritional Epidemiology (I) (Poster Session)

(P19-010-23) The Total Nutrient Index Is Predictive of All-Cause Mortality Among U.S. Adults

Sunday, July 23, 2023
12:45 PM – 1:45 PM ET
Location: Poster Board 107

    Presenting Author(s)

  • AC

    Alexandra E. Cowan, PhD, MS

    Postdoctoral Research Fellow
    Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Research
    Cary, North Carolina, United States

    • Co-Author(s)

  • Janet A. Tooze, PhD, MPH

    Professor of Biostatistics and Data Science
    Wake Forest University School of Medicine
    Winston-Salem, North Carolina, United States

  • Regan L. Bailey, PhD, MPH, RD (she/her/hers)

    Associate Director, Institute for Advancing Health through Agriculture
    Texas A&M University System
    Department of Nutrition Science
    College Station, Texas, United States

Disclosure(s):
Alexandra E. Cowan, PhD, MS: No relevant financial relationship(s) with ineligible companies to disclose.
Regan L. Bailey, PhD, MPH, RD: No relevant financial relationship(s) with ineligible companies to disclose.


Objectives: To assess the ability of the Total Nutrient Index (TNI), a micronutrient-based score that assesses total nutrient exposures from foods/beverages and dietary supplements (DS), to predict the risk of all-cause mortality among U.S. adults (≥40y).

Methods: Dietary (2 24-hr recalls and a DS and Prescription Medicine Questionnaire) and demographic data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES), were used to estimate TNI scores for six available TNI components: calcium, magnesium, potassium, and vitamins A, C, and E, via a simple algorithm method. Average daily intake was expressed as a percentage of the respective Recommended Dietary Allowance (RDA) or Adequate Intake (AI) and truncated at 100 to compute component scores. The average of the component scores yielded the total TNI score (range 0-100), where higher scores indicate greater adherence to the RDA/AI. Using linked mortality data from the 2019 National Death Index, multivariate Cox regression models, with adjustment for the NHANES complex survey design and stepwise covariates (e.g., sex, race/Hispanic origin, education, body mass index, alcohol use, and smoking status), were employed to estimate the risk of all-cause mortality among U.S. adults by quartile of TNI score (≤60, >60-80, >80-94, >94), overall and stratified by sex. Participant age (at study initiation and event time) was used as the time-axis scale, and all analyses were adjusted for baseline birth cohorts.

Results: In general, higher scores on the TNI were inversely associated with risk of all-cause mortality among U.S. adults. In the fully adjusted model, the HR of mortality was 1.28 (95% CI: 1.11, 1.48; p < 0.001) when comparing the lowest (TNI≤60) with the highest (i.e., referent group; TNI >94) quartile of the TNI score. Evidence of a decreasing linear trend was also observed across all TNI quartiles, regardless of the model fit (all p≤0.018). When stratified by sex, similar findings were apparent among women (fully adjusted model: 1.60 (95% CI: 1.19, 2.15; p < 0.03)), but not among men.

Conclusions: These findings suggest that a diet with improved micronutrient quality (i.e., a higher TNI score) is associated with a reduced risk of all-cause mortality among U.S. adults. A stronger association between micronutrient quality and risk of mortality was observed among women, when compared with men.

Funding Sources: N/A