The association of minerals intake in three meals with cancer and all-cause mortality: the U.S. National Health and Nutrition Examination Survey, 2003–2014

Xu et al. BMC Cancer (2021) 21:912 https://doi.org/10.1186/s12885-021-08643-5 RESEARCH ARTICLE Open Access The association of minerals intake in three meals with cancer and all-cause mortality: the U.S. National Health and Nutrition Examination Survey, 2003–2014 Xiaoqing Xu1†, Wei Wei1†, Jiaxu Xu1†, Jiaxin Huang2, Li Li1, Tianshu Han1,3, Jiayue Qi1, Changhao Sun1, Ying Li1* and Wenbo Jiang1* Abstract Background: Intake time of diet has recently been demonstrated to be associated with the internal clock and circadian pattern. However, whether and how the intake time of minerals would influence the natural course of cancer was largely unknown. Methods: This study aimed to assess the association of mineral intake at different periods with cancer and all-cause mortality. A total of 27,455 participants aged 18–85 years old in the National Health and Nutrition Examination Survey were recruited. The main exposures were the mineral intakes in the morning, afternoon and evening, which were categorized into quintiles, respectively. The main outcomes were mortality of cancer and all causes. Results: During the 178,182 person-years of follow-up, 2680 deaths, including 601 deaths due to cancer, were documented. After adjusting for potential confounders, compared to the participants who were in the lowest quintile(quintile-1) of mineral intakes at dinner, the participants in the highest quintile intake(quintile-5) of dietary potassium, calcium and magnesium had lower mortality risks of cancer (HRpotassium = 0.72, 95% CI:0.55–0.94, P for trend = 0.023; HRcalcium = 0.74, 95% CI:0.57–0.98, P for trend = 0.05; HRmagnesium = 0.75, 95% CI:0.56–0.99, P for trend = 0.037) and all-cause (HRpotassium = 0.83, 95% CI:0.73–0.94, P for trend = 0.012; HRcalcium = 0.87, 95% CI: 0.76–0.99, P for trend = 0.025; HRmagnesium = 0.85, 95% CI:0.74–0.97, P for trend = 0.011; HRcopper = 0.80, 95%CI: 0.68–0.94, P for trend = 0.012). Further, equivalently replacing 10% of dietary potassium, calcium and magnesium consumed in the morning with those in the evening were associated with lower mortality risk of cancer (HRpotassium = 0.94, 95%CI:0.91–0.97; HRcalcium = 0.95, 95%CI:0.92–0.98; HRmagnesium = 0.95, 95%CI: 0.92–0.98). Conclusions: This study demonstrated that the optimal intake time of potassium, calcium and magnesium for reducing the risk of cancer and all-cause mortality was in the evening. Keywords: Chrono-nutrition, Minerals, Cancer mortality, NHANES * Correspondence: ; † Xiaoqing Xu, Wei Wei and Jiaxu Xu contributed equally to this work and should be considered co-first authors. 1 Department of Nutrition and Food Hygiene, the National Key Discipline, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, People’s Republic of China 150081 Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Xu et al. BMC Cancer (2021) 21:912 Background Nowadays, people are more and more interested in when to eat, besides what to eat. The emerging nutritional research field of chrono-nutrition also emphasized that the content, amount and the intake time of food are equally critical for maintaining health [1], and it has been demonstrated that eating at the wrong time may lead to circadian desynchronization, which further negatively impacted on their health [2–4]. An increasing amount of rodent and human studies have found that the intake time of energy and macronutrient had an impact on the internal clock and circadian patterns that were related to the development of cancer [5–9]. However, it is largely unknown whether and how the intake time of micronutrients would influence the natural course of cancer. Minerals are essential components of micronutrients for humans [10], which not only can make up human tissues but also maintain normal physiological functions of the human body [11]. A large number of population studies have shown that dietary intake of different minerals may contribute to the development of various cancer. In the Rotterdam Study, dietary zinc and iron intake are associated with reduced lung cancer risk [12]. A case-control study in Taixing showed that increased dietary intake of selenium and zinc may decrease the risk of squamous cell carcinoma of the esophagus in a low-selenium area of China [13]. Other studies have shown that both selenium and magnesium have a protective effect against cancer, and dietary intake of zinc and copper has been linked to a lower risk of lung cancer [14–17]. A high proportion of dietary potassium and sodium had a statistically significant protective effect on colon and rectal cancer in women [18]. Total calcium intake increases the risk of total prostate cancer [19]. Increased dietary intake of calcium, magnesium, and potassium may help reduce the risk of colorectal cancer, while increased dietary iron intake may increase the risk of colorectal cancer [20]. Total dietary iron intake may be associated with an increased risk of breast cancer, in particular through lipid peroxidation [21]. Besides, numerous animal studies have shown that minerals were identified as involved in many homeostatic mechanisms related to cancer, such as oxidative stress, inflammation response, specific immunity, carcinogenesis and malignant cell proliferation [22–28]. Recently, rodent researchers also found that some minerals were components of the mammalian biological clock and were identified as regulators of circadian rhythmdependent metabolism [29–33]. Based on these pieces of evidence, we therefore hypothesized that the right and regular mineral intake time is essential for regulating the body’s metabolism and preventing the process of cancer. Accordingly, this study prospectively examined the association between the mineral intake time and cancer and Page 2 of 14 all-cause mortality using the representative sample of the non-institutionalized civilian population in the U.S. (...truncated)