Riboflavin intake has been shown to be inversely associated with blood pressure.(Reference Tzoulaki, Patel and Okamura1) However, the association between riboflavin intake and cardiovascular mortality is understudied.(Reference McNulty, Strain and Pentieva2–Reference Suwannasom, Kao and Pruss4) No study has examined the interaction between riboflavin intake and folate intake in relation to mortality. We aimed to investigate the association between intakes of riboflavin and all-cause and cardiovascular disease mortality using population data to fill in the research gap. Eligible 10,480 adults aged ≥ 20 years who attended the 2005–2016 National Health and Nutrition Examination Survey (NHANES) were followed up till 2019 for their vital status. Nutrient intake including riboflavin was assessed by two-day 24 hours recall. Death date and cause were obtained from the US mortality registry. Multivariable Cox regression was used to determine the association. During a mean of 8.5 years of follow-up, there were 1214 deaths (373 CVD and 302 cancer). High intake of riboflavin was associated with a lower risk of all-cause mortality, and CVD mortality. In multivariable model adjusted for sociodemographic factors, lifestyle factors and chronic conditions, across the quartiles of riboflavin intake, the hazard ratios (HRs) [95% CI] for CVD mortality were: 1.00, 0.92 [0.63, 1.35], 0.79 [0.49, 1.26], 0.52 [0.30, 0.90] (p trend 0.027), respectively. The corresponding figures for all-cause mortality were: 1.00, 0.69 [0.55, 0.87], 0.74 [0.58, 0.94] and 0.62 [0.48, 0.80], respectively. The protective association between riboflavin intake and CVD mortality was further strengthened among those with a high intake of folate (quartiles 3 and 4) with HRs of 1.00, 0.49 [0.21, 1.12], 0.25 [0.10, 0.63] and 0.19 [0.08, 0.47] across quartiles of riboflavin intake (p for interaction 0.039). In conclusion, riboflavin intake was inversely associated with all-cause mortality, particularly CVD mortality. Riboflavin and folate synergistically decreased the risk of CVD mortality.
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