Association of Vitamin E Intake with All-Cause Mortality Among Individuals with Rheumatoid Arthritis: A Cohort Study from the NHANES 1999-2018.

BACKGROUND: The relationship between dietary vitamin E intake and mortality rates among rheumatoid arthritis (RA) patients remains a relatively uncharted territory in nutritional epidemiology, underscoring an important gap in research. OBJECTIVES: This study is to explore the potential association between dietary vitamin E intake and all-cause mortality in the RA patient population. METHODS: This longitudinal cohort study analyzed 2,906 RA patients aged 20 years or older who participated in the National Health and Nutrition Examination Survey from 1999 to 2018. Comprehensive data on mortality, dietary vitamin E intake, and pertinent confounding variables were systematically collected and analyzed using Cox regression and spline curve fitting to analyze the potential association. RESULTS: Following the adjustment for confounding factors, a significant inverse relationship was identified between dietary vitamin E intake and the risk of all-cause mortality in patients with RA. The adjusted hazard ratios (HRs) for the second (Q2), third (Q3), and fourth (Q4) quartiles of vitamin E intake were 0.85, 0.60, and 0.68, respectively. Non-linear modeling indicated a threshold effect characterized by a curve that associated dietary vitamin E intake with mortality risk (p = 0.016). An intake threshold of 7.097 mg/day was identified, below which each unit increment in vitamin E intake was associated with a 11.1% decrease in all-cause mortality risk (HR = 0.889). Conversely, for intakes surpassing this threshold, no significant relationship with mortality risk was detected (HR = 1.0038). CONCLUSION: The findings of this study indicate a beneficial relationship between elevated dietary vitamin E intake and a reduced risk of all-cause mortality in RA patients. The dose-response relationship exhibits a non-linear pattern, featuring a critical inflection point at an intake of approximately 7.097 mg/day.

Vitamin E Intake and Prevalence Rates of Thyroid Dysfunction and Autoimmune Thyroiditis: A Cross-Sectional Analysis of NHANES Data.

Background: Thyroid disorders are associated with various dietary factors and nutritional elements. The aim of this study was to investigate the relationships between dietary vitamin E intake and the prevalence of thyroid dysfunction and thyroid antibody positivity using data from the National Health and Nutrition Examination Survey (NHANES) database. Methods: Data from the NHANES database collected between 2007 and 2012 were analyzed. A total of 7,773 nonpregnant adults without preexisting thyroid diseases and possessing complete thyroid and vitamin E data were included in the study. The participants were categorized into tertiles based on their dietary vitamin E intake: the lowest group (T1: ≤4.53 mg), the intermediate group (T2: 4.54-8.10 mg), and the highest group (T3: ≥8.11 mg). We used a complex multistage probability sampling design in conjunction with R software. We compared thyroid indices, the prevalence of overt and subclinical hyperthyroidism or hypothyroidism, and the occurrence of thyroid antibody positivity among the three groups based on vitamin E intake. Weighted multinomial logistic regression was used to assess the association between dietary vitamin E intake and thyroid disorders. Restricted cubic splines (RCSs) were used to explore potential nonlinear associations. Results: The prevalence rates of subclinical hypothyroidism (SCH) were 3.63%, 3.07%, and 1.85% in T1, T2, and T3, respectively, indicating a decreasing trend (P-trend = 0.013). In the general population, high vitamin E intake (T3) was significantly associated with a lower prevalence of SCH (OR = 0.28, CI = 0.15-0.54, p < 0.001). Subgroup analysis revealed a more pronounced protective effect in males, with both moderate (T2, OR = 0.45, CI = 0.23-0.87, p = 0.020) and high (T3, OR = 0.19, CI = 0.09-0.39, p < 0.001) dietary vitamin E intake being associated with a lower prevalence of SCH. In addition, moderate (T2, OR = 0.59, CI = 0.37-0.93, p = 0.024) and high (T3, OR = 0.52, CI = 0.36-0.75, p < 0.001) dietary vitamin E intake was associated with a lower prevalence of autoimmune thyroiditis (AIT) in males. However, no significant association was observed among females. Conclusion: The findings of this study suggest that a higher intake of vitamin E is associated with lower prevalence rates of SCH and autoimmune thyroiditis among males.

Association between dietary vitamin E intake and cognitive decline among old American: National Health and Nutrition Examination Survey.

PURPOSE: Numerous studies have reported that vitamin E plays a key role in nervous system development and neurotransmitter production. This study aimed to investigate changes in vitamin E intake in older adults with low cognitive performance using NHANES. METHODS: In this cross-sectional study, we examined a sample of 2255 American adults aged 60 and over between 2011 and 2014. We collected dietary data by averaging two recalls for dietary use to determine vitamin E intake. We assessed cognitive function using five tests and analyzed the association between these variables using a multivariate logistic regression model. RESULTS: A total of 2255 participants aged ≥ 60 years from the National Health and Nutrition Examination Survey (NHANES) for the 2011-2014 cycle were included in the analysis. Vitamin E intake was negatively associated with cognitive function. In the Z test, with each 1 mg/day increase in dietary intake of vitamin E, there was a 6% decrease in the correlation with cognitive impairment (OR = 0.94, 95% CI 0.91-0.97) in the fully fitted model (OR = 0.94, 95% CI 0.91-0.97). These findings remained consistent when analyzing the exposure as a categorical variable. In comparison to Q1, Q4 showed a 53% reduction in the incidence of cognitive impairment in the Z test (OR = 0.47, 95% CI 0.33-0.67).No significant statistical interaction between the variables was found. CONCLUSION: An increased dietary intake of vitamin E has been associated with decreased cognitive impairment in individuals over 60 years old. The dose-response curve showed an L-shaped association between dietary vitamin E intake and cognitive decline in US adults, with an inflection point of approximately 9.296 mg/day.

Dietary vitamin E intake and new-onset hypertension.

The association between dietary vitamin E intake and the risk of new-onset hypertension remains unknown. We aimed to evaluate the prospective relationship of dietary vitamin E intake with new-onset hypertension in the general Chinese population. A total of 12,177 adults without hypertension at baseline were enrolled from the China Health and Nutrition Survey. Dietary intake was measured by 3 consecutive 24 h dietary recalls at the individual level in combination with a weighing inventory taken over the same 3 days at the household level. The study outcome was new-onset hypertension, defined as a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, a diagnosis by a physician, or the use of antihypertensive treatment during follow-up. During a median follow-up duration of 6.1 years, 4269 participants developed new-onset hypertension. Overall, the association between dietary vitamin E intake and new-onset hypertension followed a reverse J-shaped curve (P for nonlinearity <0.001). Accordingly, when dietary vitamin E intake was assessed by quintiles, significantly higher risks of new-onset hypertension were found among participants in the first quintile (<18.75 mg/d: adjusted HR, 1.40; 95% CI, 1.29-1.52) and the fifth quintile (≥40.53 mg/d: adjusted HR, 1.18; 95% CI, 1.09-1.29) compared with those in the second-fourth quintiles (18.75 to <40.53 mg/d). Further adjustments for vitamin A, riboflavin, niacin, vitamin C, zinc, copper, and selenium intake or the intake of vegetables, fruits, legumes, grains, nuts, and vegetable oils did not substantially change the results. In conclusion, there was a reverse J-shaped association between dietary vitamin E intake and new-onset hypertension in general Chinese adults.

Dietary vitamin E intake and risk of Parkinson's disease: a cross-sectional study.

Objective: Current evidence on the association between dietary vitamin E intake and the risk of Parkinson's disease (PD) is limited. The aim of the study was to explore the association of dietary vitamin E intake with PD in the United States among adults over 40 years. Methods: We conducted a cross-sectional study with data collected from National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018. A total of the sample of 13,340 participants were included. To identify the different characteristics of the participants, we utilized propensity score matching (PSM) to reduce the effects of selection bias and confounding variables. Weighted univariate and multivariable logistic regression were used to examine the association between dietary vitamin E intake and PD before and after matching. Then, restricted cubic spline (RCS) was used to visually describe the possible non-linear relationships. Finally, we employed the subgroup analysis to further investigate the relationship between dietary vitamin E intake and PD. Results: According to the weighted univariate and multivariable logistic regression analysis, vitamin E intake was inversely associated with the risk of PD before and after matching. The results of RCS analysis revealed no non-linear inverse relationship between vitamin E intake and PD before and after matching. The subgroup analysis showed that age may influence the negative association between vitamin E and PD (P < 0.05 for interaction). Conclusion: Among participants over 40 years of age, vitamin E intake was negatively associated with the risk of PD. Our data may support the supplementation of vitamin E to be used as an intervention strategy for the occurrence of PD.

Dietary vitamin E and tocopherol isoforms and incident chronic kidney disease: A 30-y follow-up study from young adulthood to midlife.

BACKGROUND: The relationship of dietary vitamin E intake with incident chronic kidney disease (CKD) was not clear as yet. We aimed to examine the associations of dietary total vitamin E and tocopherol isoforms intakes with incident CKD in a 30-year follow-up study from young adulthood to midlife. METHODS: A total of 4038 American adults aged 18-30 years and without reduced estimated glomerular filtration rate (eGFR) were enrolled from Coronary Artery Risk Development in Young Adults study. Diet was evaluated by a validated dietary-history questionnaire at baseline, and after 7 and 20 years later. The study outcome was incident CKD, defined as an eGFR<60 mL/min/1.73 m2 or a urinary albumin to creatinine ratio ≥30 mg/g. RESULTS: During a 30-year follow-up, 642 (15.9%) participants developed incident CKD. Overall, there was a L-shaped relationship between dietary total vitamin E intake and incident CKD (P for non-linearity<0.001). When total vitamin E intake was assessed as quartiles, compared with those in the first quartile (<4.35 mg α-TE/1000 kcal), the adjusted HRs (95%CI) of incident CKD for participants in the fourth quartile (≥9.61 mg α-TE/1000 kcal) was 0.55 (0.40, 0.75). Moreover, higher intakes of beta-tocopherol and gamma-tocopherol were significantly associated with a lower incident CKD. Higher intake of delta-tocopherol was significantly related to a higher incident CKD. And there was no obvious association of alpha-tocopherol intake with incident CKD. CONCLUSIONS: There were inverse associations of total vitamin E, beta-tocopherol and gamma-tocopherol intakes, a positive association of delta-tocopherol intake, and no obvious association of alpha-tocopherol intake, with incident CKD among American adults.

Associations of 24 h urinary excretions of α- and γ-carboxyethyl hydroxychroman with plasma α- and γ-tocopherol and dietary vitamin E intake in older adults: the Lifelines-MINUTHE Study.

BACKGROUND: Urinary metabolites of vitamin E, i.e., α- and γ-carboxyethyl hydroxychroman (α- and γ-CEHC), have gained increasing attention and have been proposed as novel biomarkers of vitamin E intake and status. However, there are insufficient data on the relationship of plasma α-tocopherol and γ-tocopherol and dietary vitamin E intake with 24 h urinary excretions of α- and γ-CEHC. OBJECTIVES: We aimed to (1) investigate the associations of urinary α- and γ-CEHC/creatinine ratios and 24 h urinary excretions of α- and γ-CEHC with plasma α- and γ-tocopherol, respectively; (2) investigate the associations of urinary α- and γ-CEHC/creatinine ratios and 24 h urinary excretions of α- and γ-CEHC with dietary vitamin E intake, and we hypothesize that 24 h urinary excretions of α- and γ-CEHC will better correlate with vitamin E intake than urinary α- and γ-CEHC/creatinine ratios. DESIGN: 24 h Urine and plasma samples were collected from 1519 participants (60-75 years, male: 50%) included in the Lifelines-MINUTHE Study for the assessments of urinary α- and γ-CEHC/creatinine ratios and 24 h urinary excretions of α- and γ-CEHC, and plasma α- and γ-tocopherol. Among those participants, dietary vitamin E intake data from 387 participants were available from an externally validated Flower-Food Frequency Questionnaire (FFQ). The associations of plasma α- and γ-tocopherol, dietary vitamin E intake, with urinary α- and γ-CEHC were assessed using multivariate linear regressions. RESULTS: 24 h Urinary excretion of α-CEHC (median (IQR): 0.9 (0.3-2.4) µmol) was less than that of γ-CEHC (median (IQR): 1.5 (0.5-3.5) µmol). After adjustment for covariates, we found that 24 h urinary α-CEHC excretion and urinary α-CEHC/creatinine ratio were both positively associated with plasma α-tocopherol (std.beta: 0.06, p = 0.02; std.beta: 0.06, p = 0.01, respectively). Furthermore, the sum of 24 h urinary α- and γ-CEHC excretions was positively associated with dietary vitamin E intake (std.beta: 0.08; p = 0.03), whereas there was no relation between urinary α- and γ-CEHC/creatinine ratios and vitamin E intake. No association was observed neither between plasma α- and γ-tocopherol and dietary vitamin E intake, nor between urinary γ-CEHC and plasma γ-tocopherol. CONCLUSION: Our study confirmed our hypothesis that 24 h urinary α- and γ-CEHC excretions would be a better marker for dietary vitamin E intake than urinary α- and γ-CEHC/creatinine ratios. Considering that both 24 h urinary α- and γ-CEHC excretions and α- and γ-CEHC/creatinine ratios were also associated with plasma α-tocopherol status, we suggest that 24 h urinary α- and γ-CEHC excretions could be used to assess overall vitamin E status.

Dietary Vitamin E Intake Was Inversely Associated with Hyperuricemia in US Adults: NHANES 2009-2014.

INTRODUCTION: Current evidence on the association between dietary vitamin E intake and hyperuricemia risk is limited and conflicting. OBJECTIVE: The aim of the study was to assess the association of dietary vitamin E intake with hyperuricemia in US adults. METHODS: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey, 2009-2014. Dietary vitamin E intake was evaluated through two 24-h dietary recall interviews. Logistic regression and restricted cubic spline models were used to examine the association between dietary vitamin E intake and hyperuricemia. RESULTS: Overall, 12,869 participants were included. The prevalence of hyperuricemia was 19.35%. After adjustment for age, gender, BMI, race, educational level, smoking status, alcohol consumption, physical activity, total daily energy intake, total cholesterol, protein intake, glomerular filtration rate, serum Cr, use of uric acid drugs, and drug abuse, the odds ratio (95% confidence interval) of hyperuricemia for the highest tertile of dietary vitamin E intake was 0.77 (0.63-0.96) compared with that of the lowest tertile. In men, dietary vitamin E intake and hyperuricemia were negatively correlated. In stratified analyses by age (20-39, 40-59, and ≥60 years), dietary vitamin E intake was inversely associated with hyperuricemia only among participants aged ≥60 years. Dose-response analyses showed that dietary vitamin E intake was inversely associated with hyperuricemia in a nonlinear manner. CONCLUSION: Dietary vitamin E intake was negatively correlated with hyperuricemia in US adults, especially among males and participants aged ≥60 years.

An exaggerated blood pressure response to exercise is associated with the dietary sodium, potassium, and antioxidant vitamin intake in normotensive subjects.

AIM: This study was designed to examine the associations between an exaggerated systolic blood pressure (SBP) response to exercise and the nutrient intake in normotensive subjects. METHODS: The subjects consisted of 302 normotensive subjects (64 males and 238 females; age, 48.4 ± 11.3 years) without a history of cardiovascular disease or stroke who were not taking any medications. Each subject performed a multistage graded submaximal exercise stress test using an electric bicycle ergometer, and their blood pressure was measured at rest and during the last minute of each stage. The nutrient intake was assessed using a self-administered food frequency questionnaire. An exaggerated SBP response to exercise was defined according to the criteria of the Framingham Study (peak SBP ≥210 mmHg in males, or ≥190 mmHg in females). RESULTS: An exaggerated SBP response to exercise was observed in 85 subjects. A multiple logistic regression analysis revealed that the dietary sodium-to-potassium (Na/K) ratio (odds ratio [OR]: 5.75, 95% confidence interval [CI]: 2.37-13.75, p = 0.001) and vitamin E intake (OR: 0.67, 95% CI: 0.51-0.93, p = 0.012) were significantly associated with an exaggerated SBP response to exercise. Furthermore, the percent change in SBP during exercise was found to be significantly associated with an increase in the dietary Na/K ratio (p for trend = 0.0005) and a decrease in the vitamin E intake (p for trend = 0.018). CONCLUSIONS: These results suggest that an exaggerated SBP response to exercise was associated with the dietary sodium, potassium, and antioxidant vitamin intake in normotensive subjects.

Vitamin E intake and risk of stroke: a meta-analysis.

Findings from observational studies on the associations between vitamin E intake and stroke risk remain controversial, and the dose-response relationship between vitamin E intake and risk of stroke remains to be determined. We conducted a meta-analysis of prospective studies aiming to clarify the relationships between vitamin E intake and risk of stroke. Relevant studies were identified by searching online databases through to June 2018. We computed summary relative risks (RR) with corresponding 95 % CI. Among 3156 articles retrieved from online databases and relevant bibliographies, nine studies involving 3284 events and 220 371 participants were included in the final analyses. High dietary vitamin E intake was inversely associated with the risk of overall stroke (RR=0·83, 95 % CI 0·73, 0·94), and with the risk of stroke for individuals who were followed-up for <10 (RR=0·84, 95 % CI 0·72, 0·91). There was a non-linear association between dietary vitamin E intake and stroke risk (P=0·0249). Omission of any single study did not alter the summary result. In conclusion, this meta-analysis suggests that there is a significant inverse relationship between dietary vitamin E intake and stroke risk. This meta-analysis provides evidence that a higher dietary vitamin E intake is associated with a lower stroke risk.

Plasma and Salivary Non-Urate Total Antioxidant Capacity Does Not Depend on Dietary Vitamin C, E, or ß-Carotene Intake in Older Subjects.

The native Total Antioxidant Capacity (TAC) of plasma and saliva is generally determined by uric acid (UA). Several studies have assessed the impact of habitual dietary antioxidative vitamin intake on TAC, but it remains unknown whether it influences Non-Urate Total Antioxidant Capacity (Nu-TAC), i.e., TAC after enzymatic UA elimination. The purpose of this study was to assess whether the intake of antioxidative vitamins C, E, and ß-carotene, provided with usual daily food rations, affects plasma and salivary Nu-TAC. The study involved 56 older subjects (aged 66.9 ± 4.3 years), divided into two age- and sex-matched groups: group 1 (n = 28), with lower combined vitamin C, E, and ß-carotene intake, and group 2 (n = 28), with higher intake. A 24 h dietary recall was obtained from each individual. Nu-TAC was assessed simultaneously with two methods in plasma (Ferric Reducing Ability of Plasma­Nu-FRAP, 2.2-diphenyl-1-picryl-hydrazyl­Nu-DPPH) and in saliva (Nu-FRAS and Nu-DPPHS test). No differences were found in the Nu-TAC parameters between the groups, either in plasma (Nu-FRAP, Nu-DPPH) or in saliva (Nu-FRAS, Nu-DPPHS) (p > 0.05). No plasma or salivary Nu-TAC indices correlated with dietary vitamin C, E, or ß-carotene intake or with other nutrients. Habitual, not extra-supplemented dietary intake does not significantly affect plasma or salivary Nu-TAC.

Dietary Vitamin C, E and ß-Carotene Intake Does Not Significantly Affect Plasma or Salivary Antioxidant Indices and Salivary C-Reactive Protein in Older Subjects.

It is not clear whether habitual dietary intake influences the antioxidant or inflammatory status. The aim of the present study was to assess the impact of antioxidative vitamins C, E, and ß-carotene obtained from daily food rations on plasma and salivary Total Antioxidant Capacity (TAC), uric acid and salivary C-reactive protein (CRP). The study involved 80 older subjects (66.9 ± 4.3 years), divided into two groups: group 1 (n = 43) with lower and group 2 (n = 37) with higher combined vitamins C, E and ß-carotene intake. A 24-h dietary recall was obtained from each individual. TAC was assessed simultaneously with two methods in plasma (Ferric Reducing Ability of Plasma-FRAP, 2.2-diphenyl-1-picryl-hydrazyl-DPPH) and in saliva (FRAS and DPPHS test). Lower vitamin C intake corresponded to higher FRAS. There were no other correlations between vitamins C, E or ß-carotene intake and antioxidant indices. Salivary CRP was not related to any antioxidant indices. FRAS was decreased in group 2 (p < 0.01) but no other group differences for salivary or for plasma antioxidant parameters and salivary CRP were found. Habitual, not extra supplemented dietary intake does not significantly affect plasma or salivary TAC and salivary CRP.

Plasma n-3 polyunsaturated fatty status and its relationship with vitamin E intake and plasma level.

PURPOSE: The aim of the study was to investigate habitual vitamin E intake and plasma α-tocopherol concentration and their relationship with plasma fatty acid profile in a healthy adult population. METHODS: Vitamin E and fatty acid intake data were determined from the National Adult Nutrition Survey. Plasma α- and γ-tocopherol concentrations were quantified by high-performance liquid chromatography and the percentage of fatty acids in plasma by gas chromatography coupled with mass spectrometry. Participants (n = 601) were divided into vitamin E intake quartiles and plasma α-tocopherol quartiles, and differences in fatty acid intake and plasma fatty acid profile were analyzed by a general linear model. RESULTS: Dietary intake data showed that as vitamin E intake increased, intakes of total polyunsaturated fatty acid (PUFA) and α-linolenic acid increased significantly (p < 0.001), but eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) did not. After adjusting for fatty acid intake, vitamin E intake was positively related to plasma n-3 PUFA (EPA and DHA) levels and plasma n-3/n-6 PUFA ratio. Plasma α-tocopherol concentration was positively related to the percentage of plasma total PUFA, n-3 PUFA and EPA and inversely related to the percentage of plasma n-6 PUFA. CONCLUSIONS: The study illustrates that there are statistical relationships between plasma fatty acid profile and both vitamin E intake and plasma α-tocopherol concentration. Vitamin E may play a role in the maintenance of plasma n-3 PUFA profile in humans with consequent desirable health effects.

Intakes and Major Food Sources of Vitamins A and E of Korean Adults Living in Seoul and Gyeonggi Province

To determine vitamin A and E intakes and their food sources, dietary intakes were collected by three consecutive 24-hour recalls from 192 adults living in Seoul and Gyeonggi Province, Korea. The mean vitamin A, retinol and beta-carotene intakes were 1240.1 +/- 1101.1 microg retinol equivalent/day (693.3 +/- 563.2 microg retinol activity equivalent/day), 182.6 +/- 149.5 microg/day and 5443.3 +/- 6365.5 microg/day, respectively. Only 9.4% of the subjects consumed less than the Korean Estimated Average Requirement for vitamin A. The mean vitamin E intake was 6.03 +/- 2.54 mg alpha-tocopherol equivalent/day. The alpha-tocopherol and gamma-tocopherol intakes were 4.83 +/- 2.03 and 5.57 +/- 3.41 mg/day, respectively. Most of the subjects (93.8%) consumed less than the Korean Adequate Intake for vitamin E. The major food sources of vitamin A were sweet potato, carrot, red pepper powder, spinach, and citrus fruit, and the top 30 foods provided 91.5% of total Plant foods provided 81.0% and animalderived foods 10.5% of the vitamin A intake from the top 30 foods. The major food sources of vitamin E were soybean oil, red pepper powder, Ramyeon (cup noodles), spinach, and egg. The top 30 foods provided 78.0% of total vitamin E intake. Plant foods provided 61.3% and animal-derived foods 15.9% of the vitamin E intake from the top 30 foods. In conclusion, the vitamin A intake of the Korean adults in this study was ge-nerally adequate, but the vitamin E intake of many subjects was inadequate. Therefore, nutritional education may be of benefit to Korean adults to increase their vitamin E intake.

Vitamin A and Vitamin E Status of Diabetic Patients and Normal Adults in Korea

We evaluated the vitamin A and E status of type 2 diabetic patients and normal adults living in Daegu area. Dietary intakes for two non-consecutive days were measured by 24-hour recall method for 76 diabetic patients and 72 normal adults. Plasma levels of retinol and alpha-tocopherol were measured using HPLC method. Dietary intakes of vitamin A were not significantly different between the diabetic and the normal adults. However, the diabetic patients had significantly lower vitamin E intakes than the normal adults. Major food sources for vitamin A intake were red pepper powder and carrot. Half of the subjects from diabetic as well as normal adults consumed less than estimated average requirement of vitamin A. Plasma levels of retinol and tocopherol were maintained within normal ranges for most of the subjects regardless of diabetic status. Dietary intake of vitamin A was associated with vitamin E intake, however, there was no significant correlations between vitamin E intake and plasma alpha-tocopherol levels. It seems that diabetic patients should try to increase dietary intake of vitamin E, as prolonged lower-level intake of vitamin E could eventually lead to vitamin E depletion. Further studies are needed to identify the magnitude of dietary variance at individual and seasonal levels, and to understand the discrepancies in dietary intake and plasma levels before establishing the dietary reference intake based on Korean dietary pattern.