Longitudinal Study of Dietary Intake and Risk of Persistent Tinnitus in Two Large Independent Cohorts of Women

Sharon G Curhan; Oana A Zeleznik; Meir J Stampfer; Gary C Curhan

doi:10.1093/aje/kwaf277

. Author manuscript; available in PMC: 2026 Jan 31.

Published in final edited form as: Am J Epidemiol. 2026 Jul 8;195(7):1906–1921. doi: 10.1093/aje/kwaf277

Longitudinal Study of Dietary Intake and Risk of Persistent Tinnitus in Two Large Independent Cohorts of Women

Sharon G Curhan ^1,², Oana A Zeleznik ^1,², Meir J Stampfer ^1,^2,³, Gary C Curhan ^1,^2,^3,⁴

PMCID: PMC12857320 NIHMSID: NIHMS2125717 PMID: 41404663

Abstract

Persistent tinnitus is common, often disabling, and challenging to treat. Greater adherence to healthy diet patterns was associated with 30% lower risk of hearing loss. Dietary factors have also been implicated in tinnitus, but findings are not consistent and longitudinal studies are scarce. We examined the longitudinal associations of healthy diet patterns, specific food groups, individual foods and risk of developing persistent tinnitus in two independent cohorts of 113,554 women, the Nurses' Health Study (NHS)(1984-2022;n=42,504) and NHS2 (1991-2021;n= 71,050). Validated food frequency questionnaires assessed diet every 4 years. We used multivariable-adjusted Cox proportional hazards regression to examine independent associations in cohort-specific and pooled analyses. After 2,643,510 person-years of follow-up, 22,879 cases of incident tinnitus were reported. While greater adherence to overall healthy diet patterns did not consistently reduce risk, in both cohorts we observed higher fruit intake was associated with reduced risk, and higher intakes of whole grains, legumes and sugar-sweetened beverages (SSBs) were associated with greater risk of incident tinnitus. Comparing highest to lowest quintiles of intake, the pooled MVHRs were: 0.81 (0.77,0.85)(p-trend<0.0001) for fruit; 1.26 (1.20,1.32)(p-trend<0.0001) for whole grains; 1.13 (1.08,1.18)(p-trend<0.0001) for legumes; and 1.12 (1.07,1.17)(p-trend<0.0001) for SSBs. Diet composition appears to alter the risk of developing tinnitus.

Keywords: Tinnitus, Diet, DASH, Auditory, Longitudinal study, Neurodegeneration

Introduction

Tinnitus is characterized by the perception of sound when no external source is present.¹ Tinnitus that is persistent can adversely impact health and quality of life.² Among the approximately 50 million adults in the US with tinnitus, 3 million individuals report they are severely disabled by it.³ The substantial healthcare costs and economic burden of tinnitus have been documented.^4,5 There is no cure for tinnitus and there are no reliably effective treatments.⁶ While the cause of persistent tinnitus is often unknown, dietary intake has been implicated as a potential contributor.⁷

Findings from cross-sectional studies of diet and prevalent tinnitus are inconsistent and longitudinal data are scarce.^8-10 One UK Biobank cross-sectional study that used a validated dietary intake assessment found a diet high in protein was associated with 10% lower odds of tinnitus experienced “at least some of the time”.⁷ Another cross-sectional study in the UK Biobank that used a non-validated assessment found higher fruit, vegetable, bread, fish and egg intake were each associated with higher odds of persistent tinnitus, while higher dairy and caffeinated coffee intakes were associated with lower odds.⁸ In contrast, a cross-sectional NHANES study showed a higher Healthy Eating Index (HEI) score, indicating higher intake of fruit, vegetables and whole grains, was associated with 33% lower odds of tinnitus experienced at least monthly.⁹ Findings from a relatively small longitudinal study in Australia suggest that lower intakes of fruit fiber and cereal fiber were associated with a 65% and 54% higher 10-year risk of developing tinnitus, but the analyses did not adjust for other dietary or potential confounding factors factors and power was limited.¹¹

Previous longitudinal studies demonstrate that greater adherence to healthy diet patterns is associated with ~30% lower risk of hearing loss,^12-14 but few published longitudinal studies have used detailed, well-validated dietary intake assessments to examine the relation of overall diet and risk of incident tinnitus. While tinnitus is highly correlated with hearing loss, evidence shows tinnitus has a distinct genetic architecture and pathoetiology.¹⁵ Further, among those with hearing loss, most do not experience persistent tinnitus.^16,17 We previously found that higher caffeine intake¹⁸ and regular seafood consumption¹⁹ were associated with lower risk of incident tinnitus, suggesting that dietary intake contributes to tinnitus susceptibility. Therefore, to better understand the relation of overall diet, intake of specific food groups and foods, and the risk of developing persistent tinnitus, we conducted a longitudinal investigation among two large ongoing cohorts of 113,554 women with detailed information on diet, health-related and lifestyle factors, and over 30 years of follow-up.

Methods

Study Population

The Conservation of Hearing Study (CHEARS) is a large ongoing investigation of risk factors for hearing loss and tinnitus among participants in several cohort studies, including the Nurses’ Health Study (NHS) and NHS2. The methods of the NHS and NHS2 were described previously.²⁰ Briefly, in 1976 NHS started when 121,700 female nurses ages 30 through 55 enrolled. In 1989, NHS2 started when 116,408 female registered nurses ages 25 through 42 enrolled. Questionnaires ask about demographic, health, diet, and lifestyle factors and are completed every 2 years (https://www.nurseshealthstudy.org/participants/questionnaires). The follow-up rate exceeds 90% of eligible person-time.²⁰ For this study, we excluded individuals with tinnitus at baseline (1984 in NHS and 1991 in NHS2), allowing us to examine the longitudinal association of dietary intake and subsequent development of incident tinnitus. Other exclusions included reported cancer (other than non-melanoma skin cancer) to avoid including tinnitus potential due to ototoxic chemotherapy, stroke, had missing information on tinnitus, reported implausible energy intake (<600 or >3,500 kilocalories/day) or missing baseline diet.^21-23 In our primary analysis, 42,504 NHS and 71,050 NHS2 participants were included in the analytic sample (Supplemental Figure 1). The MassGeneral Brigham Human Research Committee approved the study protocol . Participants provided implied consent by returning their questionnaires, which is accepted by the MGB HRC as informed consent.

Ascertainment of Dietary Intake

The validated semi-quantitative food frequency questionnaire (SFFQ) used to assess dietary intake included more than 130 items and was administered every 4 years, beginning in 1984 (NHS) and 1991 (NHS2).^21-23 Participants reported their average intake over the preceding year for a specified serving size of each item. Nine response options were provided, ranging from “never, or less than once/month” to “6 or more/day.” The SFFQ has been used extensively in global research to examine relations between diet and a broad range of health outcomes.^24-26 Each SFFQ was used to calculate scores that measure adherence to the DASH diet, a commonly recommended healthful dietary pattern that has been demonstrated to lower blood pressure^27-29 and is associated with a lower risk of cardiovascular disease (CVD),^28,30 diabetes,³¹ cognitive decline,³² and hearing loss.^12,13 To categorize how closely participants’ diets resembled the DASH diet, we used a previously derived DASH dietary pattern score based on individual dietary components that are emphasized or minimized in the DASH diet,^30,33 focusing a priori on its key food or nutrient groups: higher intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains, and lower intake of sodium, sugar-sweetened beverages (SSB), and red and processed meats.³⁴

For each component, participants were classified into quintiles (Q) according to their intake ranking. The quintile rankings were assigned as the component score for each of the healthy food groups (fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains), with Q1 assigned 1 point and Q5 assigned 5 points. Lower intakes are desired for sodium, SSBs, and red and processed meats, thus Q1 was assigned 5 points and Q5 assigned 1 point. Component scores were summed for each participant for an overall DASH score, ranging from 8 to 40.^12,30,34 In our cohort, this DASH score has been successfully used in studies of hearing loss^12,13,35 and other health outcomes.^30,33 In additional analyses, we also calculated and examined the Alternate Mediterranean diet (AMED) with methods used previously.^12,13

Ascertainment of Tinnitus

Information on tinnitus was collected on questionnaires beginning in 2008(NHS)/2009(NHS2). Participants were asked, “In the past 12 months, have you had ringing, roaring, or buzzing in your ears or head?” Information was also collected on how often the symptoms occur (ranging from never to every day), how long symptoms last (“a few seconds,” “less than 5 minutes,” “5 minutes to an hour,” “several hours,” or “all the time”), and the age at which the symptoms first began. Consistent with methods used previously in this and other cohorts,^19,36-38 persistent tinnitus was defined as tinnitus occurring several days per week or daily to evaluate associations among those with the most severe tinnitus. An alternative definition, tinnitus occurring every day, was used in additional analyses.

Assessment of Covariates

Updated covariates potentially associated with dietary intake and with tinnitus, were adjusted for in the multivariable models. Factors included were age, major ancestry (self-identified), body mass index, waist circumference, physical activity, smoking, hypertension, diabetes mellitus, depression, anxiety (phobic anxiety scale of the Crown-Crisp Experiential Index (CCI)),³⁹ aspirin, ibuprofen and acetaminophen use, caffeine intake, alcohol intake, total energy intake, and self-reported hearing status. Many of these covariates have been validated.^20,40-43 Information on dietary intake and other time-varying covariates was updated at the beginning of each time period based on information obtained from the most recent available questionnaire.

Although information on lifetime noise exposure was not available for all participants, we administered an online Supplementary Questionnaire to collect more detailed information related to auditory health to a subcohort of participants (n~32,000). The supplementary questionnaire obtained detailed information on lifetime, leisure time, occupational and impulse (e.g. gunfire) noise exposure. To examine whether adjustment for higher exposure to occupational, leisure time or impulse (e.g. gunfire) noise influenced the association between dietary intake and risk of incident tinnitus, we conducted additional analyses among the subcohort of participants for whom noise exposure information was available.

Statistical Methods

Baseline participant characteristics were examined by quintiles of DASH adherence score. All analyses were prospective, using information on dietary intake that was collected before tinnitus onset. Person-time of follow-up was computed from study baseline to the reported date of tinnitus, cancer (other than nonmelanoma skin cancer), or end of follow-up. In our primary analyses, DASH scores were divided into quintiles,^12,13 with those with the lowest DASH scores (indicating diets that least resembled the DASH dietary pattern) in Q1 as the referent group. To examine the individual components of the DASH score, fruit, vegetable, whole grain, legume, nut, meat, sodium, low-fat dairy and sugar sweetened beverage intakes were also categorized into quintiles, with those with the lowest intake in Q1 as the referent group. Although the DASH adherence score aggregates legume and nut intake as one component, we a priori examined legumes and nuts separately to evaluate the individual associations with tinnitus risk. In additional analyses, intakes of specific food items from the components were divided into prespecified categories of intake (e.g. servings/week), with the lowest category as the referent group (never or rarely), consistent with methods used previously in these and similar cohorts.^44-46To better represent long-term dietary intake and reduce measurement error, we calculated the cumulative average intake from all available SFFQs up to the start of each follow-up interval, optimizing the use of repeated SFFQs.⁴⁷

Cox proportional hazards regression models were used to estimate the multivariable-adjusted hazard ratios (MVHR) and 95% confidence intervals (95% CI) for persistent tinnitus according to quintile (DASH scores, diet components) or category of intake (individual foods), with the lowest category serving as the referent. Testing of the proportional hazards assumption was shown to be valid (P > 0.5 for all tests). We conducted analyses separately in the NHS and NHS2 cohorts, and we also conducted pooled analyses to calculate summary estimates.⁴⁸ Test for linear trend was modeled using category medians as continuous. We used the Anderson-Gill data structure to handle time-varying covariates efficiently, with a new data record created for each questionnaire cycle in which the participant was at risk, with covariates set to represent the value from the most recent questionnaire. All models were stratified by age and calendar time . Missingness was handled by the missing-indicator method for covariates.⁴⁹ All p-values are 2-tailed. Statistical tests were performed with SAS statistical software, version 9.4 (SAS Institute Inc., Cary, NC).

Results

Baseline characteristics according DASH score are shown in Tables 1A and 1B. In both cohorts, participants in the highest DASH score quintile were slightly leaner, more physically active, consumed less caffeine and slightly more calories per day, and were less likely to be current smokers. In NHS, women in the higher quintiles were slightly older. There were no large differences in baseline characteristics among women who did and did not develop tinnitus during follow-up (Tables S1A and S1B).

Table 1A:

Age-Standardized Baseline (1984) Characteristics^a of Participants in the Nurses’ Health Study (NHS), According to Quintile of DASH Diet Score^b

Characteristic	DASH Score
	Q1	Q2	Q3	Q4	Q5
	N=8291	N=8107	N=6138	N=8317	N=8848
DASH score	15.9 (2.0)	20.1 (0.8)	22.5 (0.5)	24.9 (0.8)	29.2 (2.0)
Age, years^c	46.1 (5.9)	47.2 (6.3)	48.3 (6.5)	49.0 (6.6)	50.4 (6.7)
Body mass index, kg/m²	24.8 (4.8)	24.7 (4.3)	24.6 (4.3)	24.6 (4.2)	24.3 (4.1)
Waist circumference,^d cm	78.5 (11.0)	77.6 (10.6)	77.4 (10.2)	77.3 (10.2)	76.5 (10.0)
Major ancestry,^e
White, %	94.7	94.8	95.2	95.0	94.5
Black, %	1.0	1.0	0.7	0.8	1.0
Hispanic, %	0.1	0.1	0.2	0.1	0.1
Asian, %	0.7	0.7	0.6	0.5	0.5
Mixed/other,⁵ %	3.6	3.5	3.4	3.6	3.8
Physical activity, METS/wk^f	10.2 (16.7)	12.3 (17.2)	14.2 (20.5)	15.3 (19.8)	20.6 (27.8)
Total energy intake, cal/day	1760 (521)	1629 (542)	1733 (533)	1765 (530)	1803 (498)
Alcohol intake, g/day	7.0 (11.7)	7.0 (11.0)	7.0 (10.6)	6.6 (9.9)	6.0 (9.0)
Caffeine intake, mg/day	345.6	334.7	321.1	310.8	276.1
Alcohol intake, g/day	2.2 (5.2)	2.4 (5.5)	3.3 (6.1)	3.6 (6.4)	4.1 (7.1)
Never smoker, %	44.0	47.6	47.5	47.7	48.8
Past smoker, %	25.7	29.9	33.3	35.9	39.7
Current smoker, %	30.1	22.3	19.0	16.2	11.3
Hypertension, %	16.6	16.8	16.9	17.5	17.7
Diabetes, %	1.2	1.5	1.9	2.0	2.1
Depression, %	8.0	7.3	7.9	7.8	8.3
Anxiety, CCI score^g	6.0 (1.8)	5.8 (1.8)	5.8 (1.7)	5.7 (1.7)	5.7 (1.7)
Aspirin use^h
None, %	54.7	53.8	51.9	52.5	53.7
1 day/wk, %	23.8	25.0	25.8	25.6	23.6
≥2 days/wk, %	20.9	21.3	22.3	22.0	22.7
Acetaminophen use^h
None, %	54.8	55.3	56.2	58.0	60.3
1 day/wk, %	29.9	30.6	29.6	29.4	27.1
≥2 days/wk, %	15.3	14.2	14.2	12.6	12.6
Ibuprofen use^h
None, %	62.2	61.0	61.2	62.4	64.1
1 day/wk, %	20.2	20.6	20.7	20.1	18.8
≥2 days/wk, %	17.6	18.4	17.7	17.5	17.1
No hearing loss,ⁱ %	96.7	96.9	96.4	96.4	96.4
Mild hearing loss,ⁱ %	1.0	0.9	1.1	0.7	0.9
Moderate or worse,ⁱ %	2.4	2.3	2.5	2.9	2.7

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MET: Metabolic equivalent of task; NSAID: Nonsteroidal anti-inflammatory drug

Values are means (SD) or medians for continuous variables; percentages or N’s or both for categorical variables, and are standardized to the age distribution of the study population. Table does not include the 2803 women who were skipped at baseline and entered the analysis during follow-up.

Values of polytomous variables may not sum to 100% due to rounding.

DASH: Dietary Appproaches to Stop Hypertension dietary adherence pattern

Value is not age-adjusted

Waist circumference assessed in 1986 (NHS)

Participants responded to a question about their major ancestry. The response options provided were: Southern European/ Mediterranean; Scandinavian; Other Caucasian; African-American; Hispanic; Asian; Other. Participants could mark more than one response.

Metabolic equivalents from recreational and leisure-time activities

Phobic anxiety score of the Crown-Crisp Index (CCI) assessed in NHS in 1988 (NHS) and 1993 (NHS2)

Assessed in 1990

ⁱ

Hearing status was self-reported on biennial questionnaire

Table 1B:

Age-Standardized Baseline (1991) Characteristics^a of Participants in the Nurses’ Health Study 2 (NHS2), According to Quintile of DASH^b Diet Score

Characteristic	DASH Score
	Quintile 1	Quintile 2	Quintile 3	Quintile 4	Quintile 5
	N=13,485	N=12,767	N=14,083	N=11,970	N=11,315
DASH score	16.9 (1.9)	21.1 (0.8)	24.0 (0.8)	26.9 (0.8)	31.0 (1.9)
Age, years^c	36.1 (4.7)	36.3 (4.7)	36.3 (4.7)	36.4 (4.6)	36.5 (4.5)
Body mass index, kg/m²	25.1 (5.8)	24.6 (5.3)	24.5 (5.1)	24.2 (4.9)	23.8 (4.6)
Waist circumference,^d cm	79.4 (13.5)	78.4 (12.6)	77.9 (12.3)	77.5 (12.2)	76.3 (11.7)
Major ancestry,^e
White, %	94.3	94.0	94.1	94.6	94.0
Black, %	1.2	1.3	1.1	0.9	0.7
Hispanic, %	0.9	1.0	0.9	1.0	1.2
Asian, %	1.1	1.2	1.4	1.0	1.3
Mixed/other,⁵ %	2.5	2.6	2.6	2.5	2.8
Physical activity, METS/wk^f	14.4 (20.1)	17.3 (22.7)	20.2 (24.3)	23.5 (28.4)	30.2 (34.1)
Total energy intake, cal/day	1552 (497)	1661 (507)	1790 (520)	1923 (522)	2067 (508)
Alcohol intake, g/day	2.8 (6.1)	3.2 (6.5)	3.2 (5.9)	3.3 (6.0)	3.4 (5.9)
Caffeine intake, mg/day	238.1	243.9	242.9	240.8	243.7
Alcohol intake, g/day	2.2 (5.2)	2.4 (5.5)	3.3 (6.1)	3.6 (6.4)	4.1 (7.1)
Never smoker, %	62.9	66.9	67.5	68.9	67.5
Past smoker, %	18.8	20.6	22.7	23.5	26.2
Current smoker, %	18.2	12.4	9.6	7.5	6.1
Hypertension, %	7.1	6.3	6.0	6.0	5.2
Diabetes, %	0.8	0.9	1.1	1.0	1.0
Depression, %	12.8	12.2	12.3	12.6	12.7
Anxiety, CCI score^g	2.4 (2.0)	2.3 (1.9)	2.2 (1.8)	2.1 (1.8)	2.0 (1.8)
Aspirin use^h
None, %	84.0	84.6	85.2	85.6	85.6
1 day/wk, %	2.3	2.4	2.3	2.4	2.4
≥2 days/wk, %	6.4	6.2	6.0	6.1	6.0
Acetaminophen use^h
None, %	41.2	42.1	42.9	44.9	46.9
1 day/wk, %	39.6	40.8	41.0	39.6	39.5
≥2 days/wk, %	6.4	6.2	6.0	6.1	6.0
Ibuprofen use^h
None, %	32.9	32.9	31.7	32.4	34.1
1 day/wk, %	37.5	38.6	40.5	39.8	40.6
≥2 days/wk, %	25.7	25.1	24.3	24.8	22.3
No hearing loss,ⁱ %	97.3	97.4	97.4	97.3	97.5
Mild hearing loss,ⁱ %	1.6	1.7	1.7	1.8	1.6
Moderate or worse,ⁱ %	1.0	0.9	1.0	0.9	0.9

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MET: Metabolic equivalent of task; NSAID: Nonsteroidal anti-inflammatory drug

Values are means (SD) or medians for continuous variables; percentages or N’s or both for categorical variables, and are standardized to the age distribution of the study population. Table does not include the 7430 women who were skipped at baseline and entered the analysis during follow-up. Values of polytomous variables may not sum to 100% due to rounding.

DASH: Dietary Approaches to Stop Hypertension

Value is not age-adjusted

Waist circumference assessed in 1993 (NHS2)

Metabolic equivalents from recreational and leisure-time activities

Phobic anxiety score of the Crown-Crisp Index (CCI) assessed in NHS in 1988 (NHS) and 1993 (NHS2)

Assessed in 1995

ⁱ

Hearing status was self-reported on biennial questionnaire

DASH Score

After 2,643,510 (NHS: 1,146,353 and NHS2: 1,497,157) person-years of follow-up, 22,879 (NHS: 8,690 and NHS2: 14,189) cases of incident persistent tinnitus were reported. In both cohorts, >65% of those with frequent tinnitus experienced tinnitus daily. After adjustment for potential confounders, higher cumulative average DASH score was not consistently associated with risk of tinnitus (Table 2). In the pooled analysis, compared with women in Q1, the MVHR for tinnitus among women in Q5 was 1.03 (95% CI: 0.98,1.08)(P-trend=0.32); however, the findings were not consistent in the two cohorts. Compared with women in Q1, the MVHR in Q5 was 0.92 (0.86,0.99)(p-trend=0.005) in NHS and 1.09 (1.03,1.15)(p-trend=0.002) in NHS2.

TABLE 2:

DASH Adherence Score and Risk of Incident Tinnitus in Women in the NHS (1984-2022) and NHS2 (1991-2021)

DASH Adherence Score	Quintile 1	Quintile 2	Quintile 3	Quintile 4	Quintile 5	P-trend
NHS
No. Cases	1862	1779	1708	1661	1680
Person-Years	233034	224825	226600	231134	230760
Age-adjusted HR (95% CI)	1.00 (ref)	0.99 (0.92, 1.05)	0.95 (0.89, 1.02)	0.93 (0.87, 0.99)	0.93 (0.87, 1.00)	0.01
MVHR^a (95% CI)	1.00 (ref)	0.98 (0.91, 1.04)	0.94 (0.88, 1.00)	0.91 (0.85, 0.98)	0.92 (0.86, 0.99)	0.005
NHS2
No. Cases	2723	2753	2852	2923	2938
Person-Years	304880	294891	305342	299139	292905
Age-adjusted HR (95% CI)	1.00 (ref)	1.02 (0.97, 1.08)	1.03 (0.98, 1.09)	1.06 (1.01, 1.12)	1.06 (1.01, 1.12)	0.007
MVHR^a (95% CI)	1.00 (ref)	1.03 (0.97, 1.08)	1.04 (0.98, 1.10)	1.07 (1.01, 1.13)	1.09 (1.03, 1.15)	0.002
Pooled MVHR^a (95% CI)	1.00 (ref)	1.01 (0.97, 1.05)	1.00 (0.96, 1.05)	1.01 (0.97, 1.06)	1.03 (0.98, 1.08)	0.32

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DASH: Dietary Approaches to Stop Hypertension; NHS: Nurses’ Health Study; NHS2: Nurses’ Health Study 2; HR: Hazard ratio; CI: Confidence interval

MVHR: Multivariable-adjusted for age (years, continuous), major ancestry (self-identified categories), body mass index (<21, 21-22, 23-24, 25-29, 30-31, ≥32 kg/m²), waist circumference (<70, 70-79, 80-88, >88 cm), physical activity (quintiles, metabolic equivalents from recreational and leisure-time activities), smoking (never, past, current), hypertension (yes/no), diabetes mellitus (yes/no), depression (yes/no), anxiety (using the phobic anxiety scale of the Crown-Crisp Experiential Index (CCI)), aspirin, ibuprofen and acetaminophen use (number of days per week), caffeine intake (<150, 150-299, 300-449, 450-599, ≥600 mg per day), alcohol intake (<1, 1-4.9, 5-14.9, 15-29.9, 30-34.9, 35-39.9, 40-44.9, ≥45 grams/week), total energy intake (calories/day) and self-reported hearing status (no hearing loss, mild, moderate or worse hearing loss).

DASH Score Components

In analyses that examined the individual components of the DASH score, higher intakes of whole grains, legumes and SSBs were associated with higher risk of tinnitus in both cohorts (Table 3). Compared with women in Q1, the pooled MVHRs among those in Q5 were 1.26 (1.20,1.32)(p-trend<0.0001) for whole grains; 1.13 (1.08,1.18)(p-trend<0.0001) for legumes; and 1.12 (1.07,1.17)(p-trend <0.0001) for SSBs.

Table 3:

Dietary Components of the DASH Score and Risk of Incident Tinnitus in Women in the NHS (1984-2022) and NHS2 (1991-2021)

Dietary Score Components	Quintile 1	Quintile 2	Quintile 3	Quintile 4	Quintile 5	p-trend
Fruit
NHS
No. cases	1899	1751	1773	1750	1517
Person-years	240554	225530	221625	239369	219276
MVHR^a (95% CI)	1.00 (ref)	0.95 (0.89, 1.02)	0.94 (0.88, 1.01)	0.87 (0.81, 0.94)	0.80(0.73, 0.87)	<0.001
NHS2
No. cases	2682	2993	2819	2965	2730
Person-years	289050	306562	291660	312727	297158
MVHR¹ (95% CI)	1.00 (ref)	0.95 (0.90, 1.00)	0.91 (0.86, 0.96)	0.88 (0.83,0.94)	0.84 (0.78, 0.90)	<0.0001
Pooled MVHR ¹	1.00 (ref)	0.95 (0.91, 0.99)	0.92 (0.88, 0.96)	0.87 (0.83, 0.91)	0.81 (0.77, 0.85)	<0.0001
Vegetables
NHS
No. cases	1763	1709	1740	1818	1660
Person-years	229691	229822	224250	234398	228192
MVHR^a (95% CI)	1.00 (ref)	0.96 (0.90, 1.03)	0.98 (0.91, 1.05)	1.00 (0.92, 1.07)	0.93 (0.86, 1.01)	0.35
NHS2
No. cases	2691	2769	2891	2865	2973
Person-years	298092	299482	297192	303674	298717
MVHR^a (95% CI)	1.00 (ref)	1.00 (0.95, 1.06)	0.99 (0.94, 1.05)	1.00 (0.94, 1.06)	1.03 (0.97, 1.10)	0.46
Pooled MVHR ¹	1.00 (ref)	0.98 (0.94, 1.02)	0.98 (0.93, 1.02)	0.99 (0.94, 1.03)	0.98 (0.93, 1.03)	0.81
Whole Grains
NHS
No. cases	1660	1618	17987	1842	1773
Person-years	229576	231120	229767	235916	219975
MVHR^a (95% CI)	1.00 (ref)	0.99 (0.92, 1.06)	1.09 (1.01, 1.16)	1.13 (1.05, 1.22)	1.19 (1.10, 1.29)	<0.001
NHS2
No. cases	2414	2744	2929	3063	3039
Person-years	295723	297973	297618	314816	291027
MVHR^a (95% CI)	1.00 (ref)	1.14 (1.08, 1.21)	1.18 (1.12, 1.25)	1.22 (1.15, 1.30)	1.30 (1.22, 1.39)	<0.0001
Pooled MVHR ^a	1.00 (ref)	1.08 (1.03, 1.13)	1.15 (1.10, 1.20)	1.19 (1.13, 1.24)	1.26 (1.20, 1.32)	<0.0001
Legumes
NHS
No. cases	1722	1673	1635	1620	2040
Person-years	254636	213241	189087	297373	192016
MVHR^a (95% CI)	1.00 (ref)	1.02 (0.95, 1.09)	1.06 (0.99, 1.14)	1.07 (0.99, 1.15)	1.10 (1.02, 1.18)	0.01
NHS2
No. cases	2600	2504	2636	3787	2662
Person-years	329312	245548	199855	569894	152548
MVHR^a (95% CI)	1.00 (ref)	1.06 (1.00, 1.12)	1.11 (1.05, 1.17)	1.16 (1.10, 1.22)	1.15 (1.08, 1.22)	<0.001
Pooled MVHR ^a	1.00 (ref)	1.04 (1.00, 1.09)	1.09 (1.04, 1.14)	1.13 (1.08, 1.18)	1.13 (1.08, 1.18)	<0.0001
Nuts
NHS
No. cases	1742	1449	1750	1773	1976
Person-years	232884	206933	216184	253108	237245
MVHR^a (95% CI)	1.00 (ref)	0.94 (0.87, 1.01)	1.00 (0.93, 1.07)	1.00 (0.93, 1.07)	1.00 (0.93, 1.08)	0.42
NHS2
No. cases	2674	2478	2846	3171	3020
Person-years	345287	190718	290694	422492	247966
MVHR¹ (95% CI)	1.00 (ref)	0.99 (0.94, 1.05)	1.00 (0.95, 1.06)	1.02 (0.96, 1.07)	1.03 (0.97, 1.09)	0.40
Pooled MVHR ^a	1.00 (ref)	0.97 (0.93, 1.01)	1.00 (0.96, 1.04)	1.01 (0.97, 1.06)	1.02 (0.97, 1.06)	0.22
Meat
NHS
No. cases	1757	1923	1775	1729	1506
Person-years	220907	240010	223093	240303	222040
MVHR^a (95% CI)	1.00 (ref)	1.04 (0.97, 1.12)	1.07 (0.99, 1.15)	1.05 (0.97, 1.13)	1.01 (0.92, 1.10)	0.54
NHS2
No. cases	3059	2892	2827	2716	2695
Person-years	293677	306448	295986	303007	298040
MVHR^a (95% CI)	1.00 (ref)	0.99 (0.94, 1.05)	0.99 (0.94,1.05)	1.03 (0.97, 1.10)	1.02 (0.95, 1.09)	0.29
Pooled MVHR ^a	1.00 (ref)	1.02 (0.98, 1.06)	1.03 (0.98, 1.07)	1.05 (1.00, 1.10)	1.02 (0.97, 1.08)	0.23
Sodium
NHS
No. cases	1833	1879	1701	1725	1552
Person-years	225097	240047	216581	243623	221004
MVHR^a (95% CI)	1.00 (ref)	0.99 (0.92, 1.06)	0.99 (0.91, 1.07)	0.98 (0.89, 1.08)	0.97 (0.86,1.09)	0.77
NHS2
No. cases	2815	2792	2969	2838	2775
Person-years	296600	303764	294860	314758	287177
MVHR^a (95% CI)	1.00 (ref)	0.96 (0.91, 1.01)	0.98 (0.93, 1.03)	0.92 (0.87, 0.98)	0.90 (0.84, 0.95)	<0.0001
Pooled MVHR ^a	1.00 (ref)	0.96 (0.92, 1.00)	0.97 (0.93, 1.01)	0.93 (0.89, 0.97)	0.90 (0.86, 0.95)	<0.0001
Low Fat Dairy
NHS
No. cases	1718	1739	1768	1781	1684
Person-years	225861	232477	225504	233763	228749
MVHR^a (95% CI)	1.00 (ref)	0.95 (0.88, 1.01)	0.98 (0.91, 1.05)	0.95 (0.89, 1.02)	0.90 (0.83, 0.97)	0.04
NHS2
No. cases	2754	2845	2946	2862	2782
Person-years	296381	295270	300427	310405	294674
MVHR^a (95% CI)	1.00 (ref)	1.03 (0.98, 1.09)	1.01 (0.96, 1.07)	0.99 (0.93,1.04)	0.99 (0.93,1.05)	0.25
Pooled MVHR ¹	1.00 (ref)	1.00 (0.96, 1.04)	1.00 (0.95, 1.04)	0.97 (0.93,1.01)	0.94 (0.90,0.99)	0.01
Sugar Sweetened Beverages
NHS
No. cases	1844	1863	1764	1426	1793
Person-years	226532	243850	222427	176798	276746
MVHR^a (95% CI)	1.00 (ref)	1.01 (0.94, 1.08)	1.10 (1.03, 1.17)	1.09 (1.01, 1.16)	1.12 (1.04, 1.20)	0.002
NHS2
No. cases	2967	2986	2601	2999	2636
Person-years	297806	336142	247433	286116	329661
MVHR^a (95% CI)	1.00 (ref)	1.06 (1.00, 1.11)	1.04 (0.99, 1.10)	1.05 (1.00, 1.11)	1.12 (1.06, 1.19)	<0.001
Pooled MVHR ^a	1.00 (ref)	1.04 (1.00, 1.09)	1.07 (1.02, 1.11)	1.07 (1.03, 1.12)	1.12 (1.07, 1.17)	<0.0001

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DASH: Dietary Approaches to Stop Hypertension; NHS: Nurses’ Health Study; NHS2: Nurses’ Health Study 2; HR: Hazard ratio; CI: Confidence interval

MVHR: Multivariable-adjusted for age (years, continuous), major ancestry (self-identified categories), body mass index (<21, 21-22, 23-24, 25-29, 30-31, ≥32 kg/m²), waist circumference (<70, 70-79, 80-88, >88 cm), physical activity (quintiles, metabolic equivalents from recreational and leisure-time activities), smoking (never, past, current), hypertension (yes/no), diabetes mellitus (yes/no), depression (yes/no), anxiety (using the phobic anxiety scale of the Crown-Crisp Experiential Index (CCI)), aspirin, ibuprofen and acetaminophen use (number of days per week), caffeine intake (<150, 150-299, 300-449, 450-599, ⩾600 mg per day), alcohol intake (<1, 1-4.9, 5-14.9, 15-29.9, 30-34.9, 35-39.9, 40-44.9, ⩾45 grams/week), total energy intake (calories/day) and self-reported hearing status (no hearing loss, mild, moderate or worse hearing loss), and intakes of the other diet components.

Quintile 1: Lowest intake

Quintile 5: Highest intake

Higher fruit intake was associated with lower risk; compared with those in Q1, the pooled MVHR for those in Q5 was 0.81 (0.77, 0.85)(p-trend<0.0001). Higher intake of low-fat dairy was modestly associated with lower risk; compared with those in Q1, the pooled MVHR for those in Q5 was 0.94 (0.90,0.99)(p-trend=0.01). In the NHS2, higher sodium intake was associated with lower risk [MVHR: 0.90 (0.84,0.95)(p-trend<0.0001)], but there was no association observed in the NHS cohort [MVHR: 0.97 (0.86,1.09)(p-trend=0.77). No significant associations were observed for vegetable, meat or nut intakes (Table 3).

Individual foods

We also examined the relation between consumption of individual foods that comprised the DASH component scores that were significantly associated with risk of incident tinnitus. Some notable findings are highlighted here and full results are shown in (Tables 4A-4D). Among the whole grains, compared with never or infrequent consumption, consumption of 2 or more servings/week of whole grain cereal [NHS: MVHR 1.12 (1.05,1.18)(p-trend<0.0001); NHS2: 1.06 (1.01,1.10)(p-trend=0.01)] and oats [NHS: MVHR 1.08 (1.02,1.15)(p-trend=0.002); NHS2: 1.11 (1.05,1.16)(p-trend=0.002)] were associated with higher risk. In NHS2, more frequent consumption of other cooked cereals, dark bread and popcorn were also associated with higher risk (Table 4A).

Table 4A:

Whole Grains and Rice Intake and Risk of Incident Tinnitus in Women in the NHS (1984-2022) and NHS2 (1991-2021)

	Servings
Grain Intake	Never or rarely	1/month to 1/week	2+/week	p-trend
Whole Grain Cereal
NHS
No. cases	1780	1609	5301
Person-years	303823	216469	625871
MVHR^a (95% CI)	1.00 (ref)	1.00 (0.93, 1.07)	1.12 (1.05, 1.18)	<0.0001
NHS2
No. cases	6064	3234	4890
Person-years	745998	239694	510860
MVHR^a (95% CI)	1.00 (ref)	1.05 (1.00, 1.10)	1.06 (1.01, 1.10)	0.01
Oats
NHS
No. cases	3039	3210	2440
Person-years	482043	403129	260726
MVHR^a (95% CI)	1.00 (ref)	1.04 (0.98, 1.09)	1.08 (1.02, 1.15)	0.002
NHS2
No. cases	4071	5764	4352
Person-years	571816	598166	326247
MVHR^a (95% CI)	1.00 (ref)	1.11 (1.06, 1.15)	1.11 (1.05, 1.16)	0.002
Other Cooked Cereal
NHS
No. cases	6546	1756	373
Person-years	877263	213696	52781
MVHR^a (95% CI)	1.00 (ref)	1.04 (0.98,1.09)	0.89 (0.80,0.99)	0.18
NHS2
No. cases	10274	3219	682
Person-years	1111064	316441	65191
MVHR^a (95% CI)	1.00 (ref)	1.04 (0.99, 1.08)	1.09 (1.01, 1.18)	0.01
Dark Bread
NHS
No. cases	426	964	7296
Person-years	71080	156220	917135
MVHR^a (95% CI)	1.00 (ref)	0.96 (0.86,1.08)	0.97 (0.87,1.07)	0.94
NHS2
No. cases	604	1734	11844
Person-years	124898	250796	1118256
MVHR^a (95% CI)	1.00 (ref)	1.11 (1.01, 1.22)	1.21 (1.11, 1.32)	<0.0001
Brown Rice
NHS
No. cases	5159	2964	564
Person-years	716183	361987	67410
MVHR^a (95% CI)	1.00 (ref)	1.04 (0.99, 1.09)	1.06 (0.96, 1.16)	0.05
NHS2
No. cases	5955	6448	1783
Person-years	718698	627095	149681
MVHR^a (95% CI)	1.00 (ref)	1.01 (0.97, 1.05)	1.04 (0.98, 1.11)	0.16
Popcorn
NHS
No. cases	2068	3939	2681
Person-years	313344	523828	308786
MVHR^a (95% CI)	1.00 (ref)	1.02 (0.97, 1.08)	1.04 (0.98, 1.11)	0.37
NHS2
No. cases	1773	6877	5538
Person-years	197655	767219	531752
MVHR^a (95% CI)	1.00 (ref)	1.06 (1.01, 1.12)	1.07 (1.01, 1.14)	0.08

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NHS: Nurses’ Health Study; NHS2: Nurses’ Health Study 2; HR: Hazard ratio; CI: Confidence interval

Table 4D:

Fruit Intake and Risk of Incident Tinnitus in Women in the NHS (1984-2022) and NHS2 (1991-2021)

	Servings
Fruit intake	Never or rarely	1-3/week	>3 to <6/week	6+/week	p-trend
Citrus Fruit
NHS
No. cases	2043	4412	1810	425
Person-years	267782	544209	258255	76004
MVHR^a (95% CI)	1.00 (ref)	0.97 (0.92, 1.03)	0.90 (0.84, 0.98)	0.89 (0.79, 0.99)	0.002
NHS2
No. cases	5250	7005	1661	272
Person-years	590957	685600	181135	39158
MVHR^a (95% CI)	1.00 (ref)	0.93 (0.89, 0.97)	0.87 (0.81, 0.92)	0.88 (0.77, 1.00)	<0.001
Berries
NHS
No. cases	3210	4817	587	76
Person-years	446103	611717	77594	10888
MVHR^a (95% CI)	1.00 (ref)	0.93 (0.89, 0.98)	0.81 (0.74, 0.89)	0.88 (0.70, 1.11)	<0.001
NHS2
No. cases	4177	7747	1970	295
Person-years	564310	757657	147906	26881
MVHR^a (95% CI)	1.00 (ref)	0.99 (0.95, 1.03)	0.99 (0.93, 1.05)	0.95 (0.84, 1.08)	0.65
Apples and Pears
NHS
No. cases	1490	4505	2297	390
Person-years	208604	548748	325350	62286
MVHR^a (95% CI)	1.00 (ref)	0.96 (0.90, 1.02)	0.89 (0.83, 0.96)	0.91 (0.81, 1.03)	0.02
NHS2
No. cases	3237	7157	3373	412
Person-years	391295	652184	389664	61886
MVHR^a (95% CI)	1.00 (ref)	0.95 (0.91, 0.99)	0.91 (0.86, 0.97)	0.83 (0.75, 0.93)	0.0003
Other Fruits
NHS
No. cases	178	1830	3751	2931
Person-years	31099	260534	474594	380127
MVHR^a (95% CI)	1.00 (ref)	0.96 (0.82, 1.13)	0.97 (0.83, 1.14)	0.99 (0.84, 1.17)	0.68
NHS2
No. cases	424	4006	6034	3725
Person-years	66634	489056	592413	348999
MVHR^a (95% CI)	1.00 (ref)	0.98 (0.89, 1.09)	0.97 (0.87, 1.08)	0.97 (0.87, 1.09)	0.70

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NHS: Nurses’ Health Study; NHS2: Nurses’ Health Study 2; HR: Hazard ratio; CI: Confidence interval

Among the legumes, consumption of 2 or more servings/week of beans and lentils [NHS: MVHR 1.10 (1.02,1.19)(p-trend=0.01); NHS2: 1.18 (1.11,1.25)(p-trend<0.0001)], and of soy milk [NHS: 1.18 (1.06,1.30)(p-trend=0.005); NHS2: 1.15 (1.08,1.22)(p-trend<0.0001)] were associated with higher risk (Table 4B). More frequent intake of tree nuts (other than walnuts) was associated with higher risk in NHS2 [1.17 (1.09,1.25)(p-trend<0.0001)(Table 4C).

Table 4B:

Legume Intake and Risk of Incident Tinnitus in Women in the NHS (1984-2022) and NHS2 (1991-2021)

	Servings
Legume Intake	Never or rarely	1/month to 1/week	2+/week	p-trend
Peas
NHS
No. cases	891	5305	2493
Person-years	134141	724823	287037
MVHR^a (95% CI)	1.00 (ref)	1.08 (1.00, 1.16)	1.12 (1.03, 1.22)	0.03
NHS2
No. cases	2946	7864	3376
Person-years	340544	850663	304882
MVHR^a (95% CI)	1.00 (ref)	1.01 (0.97, 1.06)	1.03 (0.98, 1.09)	0.59
Beans and Lentils
NHS
No. cases	1771	5475	1442
Person-years	281508	712871	151513
MVHR^a (95% CI)	1.00 (ref)	1.07 (1.01, 1.13)	1.10 (1.02, 1.19)	0.01
NHS2
No. cases	2078	7433	4670
Person-years	334425	830216	330841
MVHR^a (95% CI)	1.00 (ref)	1.12 (1.06, 1.17)	1.18 (1.11, 1.25)	<0.0001
Tofu/Soybeans
NHS
No. cases	7719	722	243
Person-years	1031503	88482	25647
MVHR^a (95% CI)	1.00 (ref)	1.01 (0.94, 1.10)	1.08 (0.94, 1.24)	0.35
NHS2
No. cases	11367	1939	876
Person-years	1268415	163986	63031
MVHR^a (95% CI)	1.00 (ref)	1.04 (0.99, 1.10)	1.06 (0.98, 1.15)	0.06
Soy Milk
NHS
No. cases	5253	205	464
Person-years	490574	15613	33945
MVHR^a (95% CI)	1.00 (ref)	1.15 (1.00, 1.32)	1.18 (1.06, 1.30)	0.005
NHS2
No. cases	9864	753	1402
Person-years	748173	44253	76676
MVHR^a (95% CI)	1.00 (ref)	1.11 (1.03, 1.20)	1.15 (1.08, 1.22)	<0.0001

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NHS: Nurses’ Health Study; NHS2: Nurses’ Health Study 2; HR: Hazard ratio; CI: Confidence interval

Table 4C:

Peanut and Nut Intake and Risk of Incident Tinnitus in Women in the NHS (1984-2022) and NHS2 (1991-2021)

	Servings
Peanut and Nut Intake	Never or rarely	< 1 /week	1/week	2+/week	p-trend
Peanuts and Peanut Butter
NHS
No. cases	454	3398	2189	2648
Person-years	96569	487134	257487	304719
MVHR^a (95% CI)	1.00 (ref)	0.99 (0.89, 1.09)	0.99 (0.89, 1.11)	1.05 (0.94, 1.16)	0.05
NHS2
No. cases	725	5171	3886	4407
Person-years	145873	613361	368338	369410
MVHR^a (95% CI)	1.00 (ref)	0.97 (0.89, 1.05)	0.96 (0.88, 1.04)	0.98 (0.90, 1.07)	0.51
Tree Nuts (except walnuts)
NHS
No. cases	1602	4885	1291	911
Person-years	256321	629276	150122	110179
MVHR^a (95% CI)	1.00 (ref)	0.97 (0.91, 1.02)	1.01 (0.94, 1.10)	1.02 (0.93, 1.12)	0.11
NHS2
No. cases	3310	6454	2282	2139
Person-years	649141	594828	141229	110902
MVHR^a (95% CI)	1.00 (ref)	1.03 (0.98, 1.08)	1.09 (1.03, 1.16)	1.17 (1.09, 1.25)	<0.0001
Walnuts
NHS
No. cases	2960	2347	552	535
Person-years	295348	212458	48091	43359
MVHR^a (95% CI)	1.00 (ref)	0.94 (0.89, 1.00)	0.94 (0.85, 1.04)	0.98 (0.88, 1.08)	0.71
NHS2
No. cases	5081	4960	1260	1270
Person-years	515583	313241	65236	60670
MVHR^a (95% CI)	1.00 (ref)	1.00 (0.96, 1.04)	1.03 (0.97, 1.11)	1.05 (0.97, 1.12)	0.17

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NHS: Nurses’ Health Study; NHS2: Nurses’ Health Study 2; HR: Hazard ratio; CI: Confidence interval

Several individual fruits were consistently inversely associated with risk, particularly citrus fruit [MVHRs: 0.90 (0.84,0.98)(NHS), 0.87 (0.81,0.92)(NHS2) for >3 and <6 servings/week; 0.89 (0.79,0.99)(NHS), 0.88 (0.77,1.00)(NHS2) for 6+ servings/week][p-trend=0.002 (NHS), <0.001 (NHS2)]; and apples and pears [0.89 (0.83, 0.96)(NHS), 0.91 (0.86, 0.97)(NHS2) for >3 and <6 servings/week; 0.91(0.81,1.03)(NHS), 0.83 (0.75,0.93)(NHS2) for 6+ servings/week][p-trend=0.02 (NHS), 0.0003 (NHS2)](Table 4D).

Additional analyses

In multivariable models that did and did not adjust for hearing status, the findings were not materially different. In an analysis of AMED scores and risk of tinnitus, the pooled results were similar to those for DASH (Table S2). We conducted sensitivity analyses that evaluated DASH scores and risk of daily tinnitus, a more stringent definition, and the findings were similar (Table S3). Regarding the individual components of the DASH score and risk of daily tinnitus, the magnitude of the associations were slightly greater for whole grains, legumes and fruit; the MVHRs among those in the highest quintile were 1.26 (1.14,1.39)(NHS) and 1.37 (1.26,1.48)(NHS2) for whole grains; 1.11 (1.01,1.22)(NHS) and 1.14 (1.05,1.23)(NHS2) for legumes; and 0.75 (0.67,0.83)(NHS) and 0.80 (0.73,0.87)(NHS2) for fruit (Table S4). In additional analyses among the subcohort of NHS2 women for whom we had detailed information on self-reported lifetime noise exposure and did not have tinnitus at baseline (n=29,805), the findings for the DASH adherence score and for the dietary components of the DASH score were similar to those among the full cohort and in multivariable-adjusted models that did and did not adjust for noise (Tables S5 and S6).

Discussion

In this large longitudinal study, we observed no consistent association between the overall DASH score and risk of incident tinnitus, yet a number of significant associations between dietary intake of specific food groups and foods and the risk of developing persistent tinnitus were seen. In particular, higher intakes of whole grains, legumes and SSBs were each independently associated with higher risk, while higher fruit intake was associated with lower risk. There was a suggestion of higher risk with intake of some tree nuts and of a modest inverse association with low-fat dairy intake. These longitudinal findings provide evidence that diet is important in the pathogenesis of tinnitus and highlight specific modifiable dietary factors.

There are several mechanisms by which dietary factors may increase or protect against vulnerability to developing tinnitus, including the impact on vascular health, inflammation, neural function and neurodegeneration.^50,51 The role of the central nervous system in tinnitus pathophysiology is complex,^17,52,53 and tinnitus persistence may involve dysfunction of the central noise canceling system.^54-56 Dietary intake may influence neuroprotection against aging-related neurodegeneration and increase vulnerability to tinnitus persistence. Presumably, eating an overall heart-healthy and anti-inflammatory diet, such as DASH, would have been anticipated to reduce the risk for tinnitus. Thus, our findings that greater adherence to these recommended dietary patterns was not protective, and possibly may increase risk, were unexpected. Therefore, we examined the individual components and specific foods to investigate whether there were certain contributors to risk and to disentangle those components that may increase risk from those that may be protective. We identified several food groups that were associated with higher risk, including whole grains, legumes, and SSBs, while higher intakes of fruit and possibly low-fat dairy were protective.

Although anecdotal reports suggest specific foods or nutrients may exacerbate or alleviate tinnitus symptoms, longitudinal evidence is limited.⁷ Most population-based studies have been cross-sectional and the findings have been conflicting. A cross-sectional study using NHANES found that higher HEI scores, indicating a better diet quality, were associated with 33% lower odds of tinnitus experienced monthly or more.⁹ A cross-sectional UK Biobank study using a non-validated questionnaire found greater consumption of fruit, vegetables, whole meal/whole grain or ‘other’ type of bread (as compared with white bread), and dairy avoidance were associated with higher odds of tinnitus “present at least a lot of the time.”⁸ Another cross-sectional UK Biobank study using a validated food frequency questionnaire found higher calcium, iron and fat intakes were associated with higher odds of prevalent tinnitus while a higher protein diet and vitamin B12 intakes were associated with lower odds.⁷

This is the first large longitudinal investigation to comprehensively examine overall diet, encompassing patterns of overall dietary intake and a wide range of food groups and individual foods, and risk of developing incident tinnitus. Our previous longitudinal investigations demonstrated that regular seafood consumption¹⁹ and higher caffeine intake¹⁸ are associated with lower risk, and our published metabolomics study suggests that metabolic dysregulation can contribute to persistent tinnitus.³⁸ This study expands on those findings and provides additional and broader evidence about the role of diet. Notably, the impact of diet on plasma metabolite profiles related to the development of other neurodegenerative diseases and CVD has been demonstrated.^57,58

The finding that higher intake of whole grains is associated with higher risk of tinnitus was unexpected. The benefits to health associated with consumption of whole grains are widely recognized and may be due to their fiber, antioxidants and phytochemicals.⁵⁹ Diets high in whole grains improve lipid profiles, reduce systemic inflammation, reduce body fat mass and increase insulin sensitivity.⁶⁰ However, foods that are categorized as whole grains may differ in their composition, how they are processed and their influence on health.^61-63 Whole grains contain phytic acid, an antinutrient that chelates minerals, such as iron and zinc, and impairs their absorption.^64-66 In the UK Biobank, a cross-sectional study reported greater intake of “whole meal/wholegrain or other” type of bread, compared with white bread, was associated with higher odds of tinnitus “present at least a lot of the time.”⁸ A study in Australia found that lower intakes of iron and of zinc were significantly associated with a 35% higher and 44% higher 10-year risk of incident tinnitus, respectively.⁶⁷

We also observed a consistently higher risk of tinnitus among those with higher intakes of legumes. Legumes are generally considered to provide health benefits, are a source of potassium, magnesium, phosphorus, iron, B vitamins and vitamin C, and are higher in protein than other vegetables, but they also contain intestinal enzyme inhibitors and potentially toxic metabolites, such as saponins, lectins, hemoagglutonins, trypsin inhibitors and phytic acid.⁶⁸ Soy contains a high concentration of isoflavones, a plant phytoestrogen that functions similarly to human estrogen but with weaker effects. The content of major isoflavones in various soy sources can differ widely among different soybean products and may vary by type of processing.⁶⁹ Soy isoflavones may exert estrogenic action, have antiestrogenactivity,⁷⁰ and may also exert non-estrogen related effects,⁷¹ but the influence of soy isoflavones on neurodegenerative disease is unclear.^72-74

We also found that higher intake of SSBs, a major source of added sugar (39%) in the US diet,⁷⁵ may increase the risk of tinnitus. Our results are consistent with a cross-sectional study among adolescents in Serbia,⁷⁶ but sugar intake was not associated with prevalent tinnitus in the UK Biobank.⁷ Some but not all studies have reported higher carbohydrate and sugar intakes and high-glycemic load diets are associated with greater risk of hearing loss.^7,77,78 SSB consumption contributes to inflammation, accumulation of visceral adioposity, and lipogenesis,^79,80 and is associated with higher risk of neurodegenerative disorders.^80-82

Our study showed that higher fruit intake may protect against the development of persistent tinnitus. A cross-sectional UK Biobank study and a small study in Italy did not observe significant associations of fruit intake with tinnitus.^7,83 An Australian longitudinal study of fiber intake found that fruit fiber was associated with lower risk of incident tinnitus.¹¹ The health benefits of fruit are well-documented,⁶⁸ including lower risk of CVD,⁸⁴ hypertension,⁸⁵ type 2 diabetes and metabolic syndrome,^86-88 neurodegenerative disease and depression.^89-91 Fruits provide micronutrients, including vitamin C, potassium, magnesium, folic acid, carotenoids, phytochemicals, including polyphenols, and dietary fiber.⁶⁸ A large UK Biobank study found higher intake of fresh fruit was associated with larger volumes in grey matter in certain brain regions,⁹² including those previously implicated in tinnitus.^93,94 The anti-oxidative, anti-inflammatory, cardioprotective and neuroprotective benefits that fruits provide may help protect against persistent tinnitus.^95-99 Notably, our observation that higher fruit, but not vegetable, intake may protect against tinnitus are similar to those previously shown for depression and other neurodegenerative disorders.^92,100

Consistent protective associations with higher intakes of citrus, including orange juice, and of apple and pears were observed in both cohorts. Citrus fruits contain heptamethoxy flavone, a flavonoid that is associated with greater expression of brain-derived neurotrophic factor (BDNF);¹⁰¹ alterations in BDNF regulation and activity have been implicated in chronic tinnitus.¹⁰² Citrus-derived secondary metabolites may provide anti-oxidative, anti-inflammatory, cardiovascular and neuroprotective benefits.⁶⁸ Citrus fruits are also rich in the carotenoid beta-cryptoxanthin; we previously demonstrated that higher dietary intake of beta-cryptoxanthin was associated with lower risk of incident hearing loss,¹⁰³ but there are no published studies for tinnitus.

There was a suggestion of an inverse association between low-fat dairy intake and risk of tinnitus, however the findings were not consistent in the two cohorts. Low-fat dairy products may providecalcium, vitamin D and potassium, which may have benefits for vascular and neuronal function.^104-107 One cross-sectional UK Biobank study found that dairy avoidance was associated with higher odds of prevalent tinnitus,⁸ while another found higher calcium intake was associated with higher odds,⁷ but did not specifically examine dairy intake.⁷

The magnitude of the associations between dietary intake and tinnitus was not altered after further adjustment for hearing status, indicating that the influence of diet on the development of tinnitus may be independent of hearing loss.This is consistent with findings in the UK Biobank⁷ and in our previous study of fish intake and tinnitus.¹⁹ Notably, most people living with hearing loss do not experience persistent tinnitus,^16,17 and GWAS findings show that tinnitus demonstrates a distinct genetic architecture characterized by greater polygenicity and a high proportion of genetic variants that are different from those shown to be associated with hearing loss.¹⁵ Although information on lifetime noise exposure was not available in the full cohort, we conducted analyses among participants in the subcohort for whom data on lifetime noise exposure were available and the results did not differ after adjusting for lifetime noise exposure.

This study provides compelling evidence that dietary intake can influence the development of persistent tinnitus. As certain foods that were identified in this study as contributors to increased risk are typically recommended as part of an overall healthy diet, at this point we do not recommend avoidance of these foods. Future studies should build on the novel insights from these findings and investigate whether specific changes in dietary intake may mitigate or eliminate tinnitus symptoms among those with persistent tinnitus.

Strengths of our study include its large size, long duration of follow-up, and prospective collection of regularly updated detailed dietary information. This allowed us to investigate a broad range of diet intakes and tinnitus. We evaluated cumulative average intake, which allowed us to account for dietary intakes over the long-term as well as changes in the participants’ intakes over time. Our study also had limitations. Subjective tinnitus is a sensory perception that is experienced only by the individual with tinnitus. For this reason, tinnitus diagnosis relies on self-report.¹⁰⁸ In previous epidemiologic studies of tinnitus, the methods used to define tinnitus have varied widely.¹⁰⁹ Nevertheless, our findings were similar when we examined alternative definitions of tinnitus. Although information on diagnosed causes of tinnitus was not available in the full cohort, we collected this informationin a subcohort of ~32,000 participants who completed hearing and tinnitus supplemental questionnaires³⁷ and very few participants reported a diagnosed cause of their tinnitus (e.g., the frequency of Meniere’s disease was 0.9%, the frequency of vestibular schwannoma was <0.1%, and the frequency of otosclerosis <0.1%). Analyses were carefully adjusted for potentially confounding variables and simulataneously adjusted for the other dietary factors, but residual confounding cannot be ruled out. In the full cohort, we did not have information on noise exposure. Nonethethess, the findings were similar in analyses in the subcohort of women for whom lifetime noise exposure information was available. Consistent with previous studies of dietary intake and risk of various health outcomes in these and similar cohorts,^44,110-113 in our exploratory analyses of the individual foods that may influence tinnitus risk, we elected to be inclusive in our approach and chose not adjust for multiple comparisons. As false positive findings may be possible, we focused on associations that were consistent between the two independent cohorts. This study does not address whether modifying dietary intake can reduce tinnitus symptoms among individuals with tinnitus. The NHS and NHS2 study populations are comprised predominantly of white females who are health care professionals. This enhances the validity of the health-related information that is collected and reduces the variability in factors such as socioeconomic status and education, but further research in additional populations could be informative.

Conclusion

Higher consumption of whole grains, legumes and sugar sweetened beverages is associated with higher risk of developing persistent tinnitus in women while higher fruit intake is associated with lower risk. This study supports diet as a contributor to tinnitus development. Further studies to evaluate whether specific dietary modifications may help alleviate tinnitus among those who suffer from this disabling disorder are needed.

Supplementary Material

Supplemental tables and figure

NIHMS2125717-supplement-Supplemental_tables_and_figure.docx^{(119.2KB, docx)}

Acknowledgments:

We would like to thank Elaine Coughlan-Gifford for her computer programming support on this project.

Sources of Support:

This research was supported by grants UM1 CA186107, UO1 CA176726 and R21 DC020777 from the National Institutes of Health. The supporting source had no involvement in the study design; collection, analysis, or interpretation of data; writing of the manuscript; or restrictions regarding publication.

Abbreviations

AMED: Alternate Mediterranean diet
BWH: Brigham and Women’s Hospital
CCI: Crown-Crisp Experiential Index
CHEARS: Conservation of Hearing Study
CI: Confidence interval
DASH: Dietary Approaches to Stop Hypertension
GWAS: Genome-wide association study
HR: Hazard ratio
MVHR: Multivariable-adjusted hazard ratio
MET: Metabolic equivalent of task
NHS: Nurses’ Health Study
NHS2: Nurses’ Health Study 2
SFFQ: Semi-quantitative food frequency questionnaire

Footnotes

Conflicts of Interest

Dr. S. Curhan received an investigator-initiated grant from GlaxoSmithKline Biologicals SA. Dr. G. Curhan serves as a consultant to Atom Bioscience and receives royalties from UpToDate for being an author and Section Editor. The other author declares no conflicts of interest. All authors had access to the data and participated in the preparation of the manuscript.

Data Sharing Plan:

The data described in this manuscript will be made available from the corresponding author upon reasonable request.

References

1.Baguley D, McFerran D, Hall D. Tinnitus. Lancet. Nov 9 2013;382(9904):1600–7. doi: 10.1016/S0140-6736(13)60142-7 [DOI] [PubMed] [Google Scholar]
2.Nondahl DM, Cruickshanks KJ, Dalton DS, et al. The impact of tinnitus on quality of life in older adults. J Am Acad Audiol. Mar 2007;18(3):257–66. [DOI] [PubMed] [Google Scholar]
3.Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med. Aug 2010;123(8):711–8. doi:S0002-9343(10)00344-X [pii] 10.1016/j.amjmed.2010.02.015 [DOI] [PubMed] [Google Scholar]
4.Goldstein E, Ho CX, Hanna R, et al. Cost of care for subjective tinnitus in relation to patient satisfaction. Otolaryngol Head Neck Surg. Mar 2015;152(3):518–23. doi: 10.1177/0194599814566179 [DOI] [PubMed] [Google Scholar]
5.Stockdale D, McFerran D, Brazier P, et al. An economic evaluation of the healthcare cost of tinnitus management in the UK. BMC Health Serv Res. Aug 22 2017;17(1):577. doi: 10.1186/s12913-017-2527-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
6.Hoare DJ, Kowalkowski VL, Kang S, Hall DA. Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. Laryngoscope. Jul 2011;121(7):1555–64. doi: 10.1002/lary.21825 [DOI] [PMC free article] [PubMed] [Google Scholar]
7.Dawes P, Cruickshanks KJ, Marsden A, Moore DR, Munro KJ. Relationship Between Diet, Tinnitus, and Hearing Difficulties. Ear Hear. Mar/Apr 2020;41(2):289–299. doi: 10.1097/AUD.0000000000000765 [DOI] [PMC free article] [PubMed] [Google Scholar]
8.McCormack A, Edmondson-Jones M, Mellor D, et al. Association of dietary factors with presence and severity of tinnitus in a middle-aged UK population. PLoS One. 2014;9(12):e114711. doi: 10.1371/journal.pone.0114711 [DOI] [PMC free article] [PubMed] [Google Scholar]
9.Spankovich C, Bishop C, Johnson MF, et al. Relationship between dietary quality, tinnitus and hearing level: data from the national health and nutrition examination survey, 1999-2002. Int J Audiol. Oct 2017;56(10):716–722. doi: 10.1080/14992027.2017.1331049 [DOI] [PubMed] [Google Scholar]
10.Lee DY, Kim YH. Relationship Between Diet and Tinnitus: Korea National Health and Nutrition Examination Survey. Clin Exp Otorhinolaryngol. Sep 2018;11(3):158–165. doi: 10.21053/ceo.2017.01221 [DOI] [PMC free article] [PubMed] [Google Scholar]
11.Tang D, Tran Y, Shekhawat GS, Burlutsky G, Mitchell P, Gopinath B. Dietary Fibre Intake and the 10-Year Incidence of Tinnitus in Older Adults. Nutrients. Nov 17 2021;13(11)doi: 10.3390/nu13114126 [DOI] [Google Scholar]
12.Curhan SG, Wang M, Eavey RD, Stampfer MJ, Curhan GC. Adherence to Healthful Dietary Patterns Is Associated with Lower Risk of Hearing Loss in Women. J Nutr. Jun 1 2018;148(6):944–951. doi: 10.1093/jn/nxy058 [DOI] [PMC free article] [PubMed] [Google Scholar]
13.Curhan SG, Halpin C, Wang M, Eavey RD, Curhan GC. Prospective Study of Dietary Patterns and Hearing Threshold Decline. Am J Epidemiol. Oct 14 2019;doi: 10.1093/aje/kwz223 [DOI] [Google Scholar]
14.Jin Y, Tanaka T, Reed NS, Tucker KL, Ferrucci L, Talegawkar SA. Associations between dietary indices and hearing status among middle-older aged adults - results from the Baltimore Longitudinal Study of Aging. Am J Clin Nutr. May 2024;119(5):1338–1345. doi: 10.1016/j.ajcnut.2024.03.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
15.Clifford RE, Maihofer AX, Chatzinakos C, et al. Genetic architecture distinguishes tinnitus from hearing loss. Nat Commun. Jan 19 2024;15(1):614. doi: 10.1038/s41467-024-44842-x [DOI] [PMC free article] [PubMed] [Google Scholar]
16.Tan CM, Lecluyse W, McFerran D, Meddis R. Tinnitus and patterns of hearing loss. J Assoc Res Otolaryngol. Apr 2013;14(2):275–82. doi: 10.1007/s10162-013-0371-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
17.Lockwood AH, Salvi RJ, Burkard RF. Tinnitus. N Engl J Med. Sep 19 2002;347(12):904–10. doi: 10.1056/NEJMra013395 [DOI] [PubMed] [Google Scholar]
18.Glicksman JT, Curhan SG, Curhan GC. A prospective study of caffeine intake and risk of incident tinnitus. Am J Med. Aug 2014;127(8):739–43. doi: 10.1016/j.amjmed.2014.02.033 [DOI] [PMC free article] [PubMed] [Google Scholar]
19.Curhan SG, Zeleznik OA, Curhan GC. Longitudinal study of seafood and fish oil supplement intake and risk of persistent tinnitus. Am J Clin Nutr. Dec 2024;120(6):1409–1418. doi: 10.1016/j.ajcnut.2024.09.028 [DOI] [PMC free article] [PubMed] [Google Scholar]
20.Bao Y, Bertoia ML, Lenart EB, et al. Origin, Methods, and Evolution of the Three Nurses' Health Studies. Am J Public Health. Sep 2016;106(9):1573–81. doi: 10.2105/AJPH.2016.303338 [DOI] [PMC free article] [PubMed] [Google Scholar]
21.Willett WC. Nutritional Epidemiology. 2nd ed. Oxford University Press; 1998:528. [Google Scholar]
22.London SJ, Sacks FM, Caesar J, Stampfer MJ, Siguel E, Willett WC. Fatty acid composition of subcutaneous adipose tissue and diet in postmenopausal US women. Am J Clin Nutr. Aug 1991;54(2):340–5. [DOI] [PubMed] [Google Scholar]
23.Feskanich D, Rimm EB, Giovannucci EL, et al. Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire. J Am Diet Assoc. Jul 1993;93(7):790–6. doi:0002-8223(93)91754-E [pii] [DOI] [PubMed] [Google Scholar]
24.Willett WC, Sampson L, Stampfer MJ, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. Jul 1985;122(1):51–65. [DOI] [PubMed] [Google Scholar]
25.Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB, Willett WC. Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol. May 15 1992;135(10):1114–26; discussion 1127-36. [DOI] [PubMed] [Google Scholar]
26.Willett WC, Sampson L, Browne ML, et al. The use of a self-administered questionnaire to assess diet four years in the past. Research Support, U.S. Gov't, P.H.S. American journal of epidemiology. Jan 1988;127(1):188–99. [DOI] [PubMed] [Google Scholar]
27.Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. Jan 4 2001;344(1):3–10. doi: 10.1056/NEJM200101043440101 [DOI] [PubMed] [Google Scholar]
28.Appel LJ, Brands MW, Daniels SR, et al. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. Feb 2006;47(2):296–308. doi: 10.1161/01.HYP.0000202568.01167.B6 [DOI] [PubMed] [Google Scholar]
29.Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. Apr 17 1997;336(16):1117–24. doi: 10.1056/NEJM199704173361601 [DOI] [PubMed] [Google Scholar]
30.Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med. Apr 14 2008;168(7):713–20. doi: 10.1001/archinte.168.7.713 [DOI] [PubMed] [Google Scholar]
31.Ard JD, Grambow SC, Liu D, et al. The effect of the PREMIER interventions on insulin sensitivity. Diabetes Care. Feb 2004;27(2):340–7. [DOI] [PubMed] [Google Scholar]
32.Wengreen H, Munger RG, Cutler A, et al. Prospective study of Dietary Approaches to Stop Hypertension- and Mediterranean-style dietary patterns and age-related cognitive change: the Cache County Study on Memory, Health and Aging. Am J Clin Nutr. Nov 2013;98(5):1263–71. doi: 10.3945/ajcn.112.051276 [DOI] [PMC free article] [PubMed] [Google Scholar]
33.Taylor EN, Fung TT, Curhan GC. DASH-style diet associates with reduced risk for kidney stones. J Am Soc Nephrol. Oct 2009;20(10):2253–9. doi: 10.1681/ASN.2009030276 [DOI] [PMC free article] [PubMed] [Google Scholar]
34.Karanja NM, Obarzanek E, Lin PH, et al. Descriptive characteristics of the dietary patterns used in the Dietary Approaches to Stop Hypertension Trial. DASH Collaborative Research Group. J Am Diet Assoc. Aug 1999;99(8 Suppl):S19–27. [DOI] [PubMed] [Google Scholar]
35.Chen C, Zhang N, Curhan GC, Curhan SG, Wang M. Both-Ear Method for the Analysis of Audiometric Data. Ear Hear. Sep-Oct 01 2022;43(5):1447–1455.doi: 10.1097/AUD.0000000000001216 [DOI] [PMC free article] [PubMed] [Google Scholar]
36.Curhan SG, Glicksman J, Wang M, Eavey RD, Curhan GC. Longitudinal Study of Analgesic Use and Risk of Incident Persistent Tinnitus. J Gen Intern Med. Nov 2022;37(14):3653–3662. doi: 10.1007/s11606-021-07349-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
37.Curhan SG, Halpin C, Wang M, Eavey RD, Curhan GC. Tinnitus and 3-Year Change in Audiometric Hearing Thresholds. Ear Hear. Jul-Aug 01 2021;42(4):886–895. doi: 10.1097/AUD.0000000000000990 [DOI] [PMC free article] [PubMed] [Google Scholar]
38.Zeleznik OA, Welling DB, Stankovic K, et al. Association of Plasma Metabolomic Biomarkers With Persistent Tinnitus: A Population-Based Case-Control Study. JAMA Otolaryngol Head Neck Surg. May 1 2023;149(5):404–415. doi: 10.1001/jamaoto.2023.0052 [DOI] [PMC free article] [PubMed] [Google Scholar]
39.Burgess PM, Mazzocco L, Campbell IM. Discriminant validity of the Crown-Crisp Experiential Index. Br J Med Psychol. Mar 1987;60 ( Pt 1):61–9. [PubMed] [Google Scholar]
40.Salvini S, Hunter DJ, Sampson L, et al. Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. Int J Epidemiol. Dec 1989;18(4):858–67. [DOI] [PubMed] [Google Scholar]
41.Wolf AM, Hunter DJ, Colditz GA, et al. Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol. Oct 1994;23(5):991–9. [DOI] [PubMed] [Google Scholar]
42.Colditz GA, Martin P, Stampfer MJ, et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol. May 1986;123(5):894–900. [DOI] [PubMed] [Google Scholar]
43.Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin LB, Willett WC. Validity of self-reported waist and hip circumferences in men and women. Epidemiology. Nov 1990;1(6):466–73. [DOI] [PubMed] [Google Scholar]
44.Wang DD, Li Y, Bhupathiraju SN, et al. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. Apr 27 2021;143(17):1642–1654. doi: 10.1161/CIRCULATIONAHA.120.048996 [DOI] [PMC free article] [PubMed] [Google Scholar]
45.Fang Z, Wu Y, Li Y, et al. Association of nut consumption with risk of total cancer and 5 specific cancers: evidence from 3 large prospective cohort studies. Am J Clin Nutr. Dec 1 2021;114(6):1925–1935. doi: 10.1093/ajcn/nqab295 [DOI] [PMC free article] [PubMed] [Google Scholar]
46.Hu FB, Satija A, Rimm EB, et al. Diet Assessment Methods in the Nurses' Health Studies and Contribution to Evidence-Based Nutritional Policies and Guidelines. Am J Public Health. Sep 2016;106(9):1567–72. doi: 10.2105/AJPH.2016.303348 [DOI] [PMC free article] [PubMed] [Google Scholar]
47.Hu FB, Stampfer MJ, Rimm E, et al. Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol. Mar 15 1999;149(6):531–40. [DOI] [PubMed] [Google Scholar]
48.Friedenreich CM. Methods for pooled analyses of epidemiologic studies. Epidemiology. Jul 1993;4(4):295–302. doi: 10.1097/00001648-199307000-00004 [DOI] [PubMed] [Google Scholar]
49.Groenwold RH, White IR, Donders AR, Carpenter JR, Altman DG, Moons KG. Missing covariate data in clinical research: when and when not to use the missing-indicator method for analysis. CMAJ. Aug 7 2012;184(11):1265–9. doi: 10.1503/cmaj.110977 [DOI] [PMC free article] [PubMed] [Google Scholar]
50.Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health. Jun 24 2014;14:643. doi: 10.1186/1471-2458-14-643 [DOI] [PMC free article] [PubMed] [Google Scholar]
51.American Heart Association Nutrition C, Lichtenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. Jul 4 2006;114(1):82–96. doi: 10.1161/CIRCULATIONAHA.106.176158 [DOI] [PubMed] [Google Scholar]
52.Roberts LE, Eggermont JJ, Caspary DM, Shore SE, Melcher JR, Kaltenbach JA. Ringing ears: the neuroscience of tinnitus. J Neurosci. Nov 10 2010;30(45):14972–9. doi:30/45/14972 [pii] 10.1523/JNEUROSCI.4028-10.2010 [DOI] [PMC free article] [PubMed] [Google Scholar]
53.Bartels H, Staal MJ, Albers FW. Tinnitus and neural plasticity of the brain. Otol Neurotol. Feb 2007;28(2):178–84. doi: 10.1097/MAO.0b013e31802b3248 [DOI] [PubMed] [Google Scholar]
54.Rauschecker JP, Leaver AM, Muhlau M. Tuning out the noise: limbic-auditory interactions in tinnitus. Neuron. Jun 24 2010;66(6):819–26. doi:S0896-6273(10)00325-9 [pii] 10.1016/j.neuron.2010.04.032 [DOI] [PMC free article] [PubMed] [Google Scholar]
55.De Ridder D, Vanneste S, Menovsky T, Langguth B. Surgical brain modulation for tinnitus: the past, present and future. J Neurosurg Sci. Dec 2012;56(4):323–40. [PubMed] [Google Scholar]
56.Leaver AM, Turesky TK, Seydell-Greenwald A, Morgan S, Kim HJ, Rauschecker JP. Intrinsic network activity in tinnitus investigated using functional MRI. Hum Brain Mapp. Aug 2016;37(8):2717–35. doi: 10.1002/hbm.23204 [DOI] [PMC free article] [PubMed] [Google Scholar]
57.Mielke MM, Haughey NJ, Bandaru VV, et al. Plasma sphingomyelins are associated with cognitive progression in Alzheimer's disease. J Alzheimers Dis. 2011;27(2):259–69. doi: 10.3233/JAD-2011-110405 [DOI] [PMC free article] [PubMed] [Google Scholar]
58.Dong MX, Wei YD, Hu L. Lipid metabolic dysregulation is involved in Parkinson's disease dementia. Metab Brain Dis. Mar 2021;36(3):463–470. doi: 10.1007/s11011-020-00665-5 [DOI] [PubMed] [Google Scholar]
59.Slavin J. Whole grains and human health. Nutr Res Rev. Jun 2004;17(1):99–110. doi: 10.1079/NRR200374 [DOI] [PubMed] [Google Scholar]
60.Hu Y, Willett WC, Manson JAE, Rosner B, Hu FB, Sun Q. Intake of whole grain foods and risk of coronary heart disease in US men and women. BMC Med. Jun 10 2022;20(1):192. doi: 10.1186/s12916-022-02396-z [DOI] [PMC free article] [PubMed] [Google Scholar]
61.Schlemmer U, Frolich W, Prieto RM, Grases F. Phytate in foods and significance for humans: food sources, intake, processing, bioavailability, protective role and analysis. Mol Nutr Food Res. Sep 2009;53 Suppl 2:S330–75. doi: 10.1002/mnfr.200900099 [DOI] [PubMed] [Google Scholar]
62.Mozaffarian RS, Lee RM, Kennedy MA, Ludwig DS, Mozaffarian D, Gortmaker SL. Identifying whole grain foods: a comparison of different approaches for selecting more healthful whole grain products. Public Health Nutr. Dec 2013;16(12):2255–64. doi: 10.1017/S1368980012005447 [DOI] [PMC free article] [PubMed] [Google Scholar]
63.de Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med. Aug 2007;4(8):e261. doi: 10.1371/journal.pmed.0040261 [DOI] [PMC free article] [PubMed] [Google Scholar]
64.Hallberg L, Brune M, Rossander L. Iron absorption in man: ascorbic acid and dose-dependent inhibition by phytate. Am J Clin Nutr. Jan 1989;49(1):140–4.doi: 10.1093/ajcn/49.1.140 [DOI] [PubMed] [Google Scholar]
65.Reddy MB, Hurrell RF, Juillerat MA, Cook JD. The influence of different protein sources on phytate inhibition of nonheme-iron absorption in humans. Am J Clin Nutr. Feb 1996;63(2):203–7. doi: 10.1093/ajcn/63.2.203 [DOI] [PubMed] [Google Scholar]
66.Bohn T, Davidsson L, Walczyk T, Hurrell RF. Phytic acid added to white-wheat bread inhibits fractional apparent magnesium absorption in humans. Am J Clin Nutr. Mar 2004;79(3):418–23. doi: 10.1093/ajcn/79.3.418 [DOI] [PubMed] [Google Scholar]
67.Tang D, Shekhawat GS, Burlutsky G, Mitchell P, Gopinath B. The Association between Dietary Intakes of Vitamins and Minerals with Tinnitus. Nutrients. Aug 2 2024;16(15) doi: 10.3390/nu16152535 [DOI] [Google Scholar]
68.Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Adv Nutr. Jul 1 2012;3(4):506–16. doi: 10.3945/an.112.002154 [DOI] [PMC free article] [PubMed] [Google Scholar]
69.Erdman JW Jr., Badger TM, Lampe JW, Setchell KD, Messina M. Not all soy products are created equal: caution needed in interpretation of research results. J Nutr. May 2004;134(5):1229S–1233S. doi: 10.1093/jn/134.5.1229S [DOI] [PubMed] [Google Scholar]
70.Cassidy A, Bingham S, Setchell K. Biological effects of isoflavones in young women: importance of the chemical composition of soyabean products. Br J Nutr. Oct 1995;74(4):587–601. doi: 10.1079/bjn19950160 [DOI] [PubMed] [Google Scholar]
71.Barnes S. Soy isoflavones--phytoestrogens and what else? J Nutr. May 2004;134(5):1225S–1228S. doi: 10.1093/jn/134.5.1225S [DOI] [PubMed] [Google Scholar]
72.Henderson VW, St John JA, Hodis HN, et al. Long-term soy isoflavone supplementation and cognition in women: a randomized, controlled trial. Neurology. Jun 5 2012;78(23):1841–8. doi: 10.1212/WNL.0b013e318258f822 [DOI] [PMC free article] [PubMed] [Google Scholar]
73.Cheng PF, Chen JJ, Zhou XY, et al. Do soy isoflavones improve cognitive function in postmenopausal women? A meta-analysis. Menopause. Feb 2015;22(2):198–206. doi: 10.1097/GME.0000000000000290 [DOI] [PubMed] [Google Scholar]
74.Gleason CE, Fischer BL, Dowling NM, et al. Cognitive Effects of Soy Isoflavones in Patients with Alzheimer's Disease. J Alzheimers Dis. 2015;47(4):1009–19. doi: 10.3233/JAD-142958 [DOI] [PMC free article] [PubMed] [Google Scholar]
75.Romanos-Nanclares A, Collins LC, Hu FB, et al. Sugar-Sweetened Beverages, Artificially Sweetened Beverages, and Breast Cancer Risk: Results From 2 Prospective US Cohorts. J Nutr. Sep 4 2021;151(9):2768–2779. doi: 10.1093/jn/nxab172 [DOI] [PMC free article] [PubMed] [Google Scholar]
76.Tomanic M, Belojevic G, Jovanovic A, Vasiljevic N, Davidovic D, Maksimovic K. Dietary Factors and Tinnitus among Adolescents. Nutrients. Oct 27 2020;12(11)doi: 10.3390/nu12113291 [DOI] [Google Scholar]
77.Gopinath B, Flood VM, McMahon CM, Burlutsky G, Brand-Miller J, Mitchell P. Dietary glycemic load is a predictor of age-related hearing loss in older adults. J Nutr. Dec 2010;140(12):2207–12. doi:jn.110.128462 [pii] 10.3945/jn.110.128462 [DOI] [PubMed] [Google Scholar]
78.Dillard LK, Nelson-Bakkum E, Schultz A, Merten N, Malecki K. Associations of Dietary Intake With Self-Reported Hearing Loss: Findings From the Survey of the Health of Wisconsin. J Speech Lang Hear Res. Jul 12 2023;66(7):2478–2489. doi: 10.1044/2023_JSLHR-22-00473 [DOI] [PubMed] [Google Scholar]
79.Malik VS, Popkin BM, Bray GA, Despres JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. Mar 23 2010;121(11):1356–64. doi: 10.1161/CIRCULATIONAHA.109.876185 [DOI] [PMC free article] [PubMed] [Google Scholar]
80.Bernstein AM, de Koning L, Flint AJ, Rexrode KM, Willett WC. Soda consumption and the risk of stroke in men and women. Am J Clin Nutr. May 2012;95(5):1190–9. doi: 10.3945/ajcn.111.030205 [DOI] [PMC free article] [PubMed] [Google Scholar]
81.Hu FB, Malik VS. Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav. Apr 26 2010;100(1):47–54. doi: 10.1016/j.physbeh.2010.01.036 [DOI] [PMC free article] [PubMed] [Google Scholar]
82.Pase MP, Himali JJ, Beiser AS, et al. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study. Stroke. May 2017;48(5):1139–1146. doi: 10.1161/STROKEAHA.116.016027 [DOI] [PMC free article] [PubMed] [Google Scholar]
83.Jarach CM, Lugo A, Garavello W, et al. The Role of Diet in Tinnitus Onset: A Hospital-Based Case-Control Study from Italy. Nutrients. Jan 25 2023;15(3)doi: 10.3390/nu15030621 [DOI] [Google Scholar]
84.Zhan J, Liu YJ, Cai LB, Xu FR, Xie T, He QQ. Fruit and vegetable consumption and risk of cardiovascular disease: A meta-analysis of prospective cohort studies. Crit Rev Food Sci Nutr. May 24 2017;57(8):1650–1663. doi: 10.1080/10408398.2015.1008980 [DOI] [PubMed] [Google Scholar]
85.Wu L, Sun D, He Y. Fruit and vegetables consumption and incident hypertension: dose-response meta-analysis of prospective cohort studies. J Hum Hypertens. Oct 2016;30(10):573–80. doi: 10.1038/jhh.2016.44 [DOI] [PubMed] [Google Scholar]
86.Lee M, Lim M, Kim J. Fruit and vegetable consumption and the metabolic syndrome: a systematic review and dose-response meta-analysis. Br J Nutr. Oct 14 2019;122(7):723–733. doi: 10.1017/S000711451900165X [DOI] [PubMed] [Google Scholar]
87.Wedick NM, Pan A, Cassidy A, et al. Dietary flavonoid intakes and risk of type 2 diabetes in US men and women. Am J Clin Nutr. Apr 2012;95(4):925–33. doi: 10.3945/ajcn.111.028894 [DOI] [PMC free article] [PubMed] [Google Scholar]
88.Hung HC, Joshipura KJ, Jiang R, et al. Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst. Nov 3 2004;96(21):1577–84. doi: 10.1093/jnci/djh296 [DOI] [PubMed] [Google Scholar]
89.Liu X, Yan Y, Li F, Zhang D. Fruit and vegetable consumption and the risk of depression: A meta-analysis. Nutrition. Mar 2016;32(3):296–302. doi: 10.1016/j.nut.2015.09.009 [DOI] [PubMed] [Google Scholar]
90.Saghafian F, Malmir H, Saneei P, Milajerdi A, Larijani B, Esmaillzadeh A. Fruit and vegetable consumption and risk of depression: accumulative evidence from an updated systematic review and meta-analysis of epidemiological studies. Br J Nutr. May 2018;119(10):1087–1101. doi: 10.1017/S0007114518000697 [DOI] [PubMed] [Google Scholar]
91.Jiang X, Huang J, Song D, Deng R, Wei J, Zhang Z. Increased Consumption of Fruit and Vegetables Is Related to a Reduced Risk of Cognitive Impairment and Dementia: Meta-Analysis. Front Aging Neurosci. 2017;9:18. doi: 10.3389/fnagi.2017.00018 [DOI] [PMC free article] [PubMed] [Google Scholar]
92.Gaudio S, Rukh G, Di Ciommo V, Berkins S, Wiemerslage L, Schioth HB. Higher fresh fruit intake relates to larger grey matter volumes in areas involved in dementia and depression: A UK Biobank study. Neuroimage. Dec 1 2023;283:120438. doi: 10.1016/j.neuroimage.2023.120438 [DOI] [PubMed] [Google Scholar]
93.Chen YC, Xia W, Chen H, et al. Tinnitus distress is linked to enhanced resting-state functional connectivity from the limbic system to the auditory cortex. Hum Brain Mapp. May 2017;38(5):2384–2397. doi: 10.1002/hbm.23525 [DOI] [PMC free article] [PubMed] [Google Scholar]
94.Ueyama T, Donishi T, Ukai S, et al. Brain regions responsible for tinnitus distress and loudness: a resting-state FMRI study. PLoS One. 2013;8(6):e67778. doi: 10.1371/journal.pone.0067778 [DOI] [PMC free article] [PubMed] [Google Scholar]
95.Orr SK, Bazinet RP. The emerging role of docosahexaenoic acid in neuroinflammation. Curr Opin Investig Drugs. Jul 2008;9(7):735–43. [Google Scholar]
96.Gomez-Pinilla F Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci. Jul 2008;9(7):568–78. doi: 10.1038/nrn2421 [DOI] [PMC free article] [PubMed] [Google Scholar]
97.Berchtold NC, Chinn G, Chou M, Kesslak JP, Cotman CW. Exercise primes a molecular memory for brain-derived neurotrophic factor protein induction in the rat hippocampus. Neuroscience. 2005;133(3):853–61. doi: 10.1016/j.neuroscience.2005.03.026 [DOI] [PubMed] [Google Scholar]
98.Feher A, Juhasz A, Rimanoczy A, Kalman J, Janka Z. Association between BDNF Val66Met polymorphism and Alzheimer disease, dementia with Lewy bodies, and Pick disease. Alzheimer Dis Assoc Disord. Jul-Sep 2009;23(3):224–8. doi: 10.1097/WAD.0b013e318199dd7d [DOI] [PubMed] [Google Scholar]
99.Sinn N, Milte CM, Street SJ, et al. Effects of n-3 fatty acids, EPA v. DHA, on depressive symptoms, quality of life, memory and executive function in older adults with mild cognitive impairment: a 6-month randomised controlled trial. Br J Nutr. Jun 2012;107(11):1682–93. doi: 10.1017/S0007114511004788 [DOI] [PubMed] [Google Scholar]
100.Matison AP, Flood VM, Lam BCP, et al. Associations between fruit and vegetable intakes and incident depression in middle-aged and older adults from 10 diverse international longitudinal cohorts. J Affect Disord. Aug 15 2024;359:373–381. doi: 10.1016/j.jad.2024.05.096 [DOI] [PubMed] [Google Scholar]
101.Sawamoto A, Okuyama S, Yamamoto K, et al. 3,5,6,7,8,3',4'-Heptamethoxyflavone, a Citrus Flavonoid, Ameliorates Corticosterone-Induced Depression-like Behavior and Restores Brain-Derived Neurotrophic Factor Expression, Neurogenesis, and Neuroplasticity in the Hippocampus. Molecules. Apr 23 2016;21(4):541. doi: 10.3390/molecules21040541 [DOI] [PMC free article] [PubMed] [Google Scholar]
102.Yuksel B, Dogan M, Boyacioglu O, Sahin M, Orenay-Boyacioglu S. Association between chronic tinnitus and brain-derived neurotrophic factor antisense RNA polymorphisms linked to the Val66Met polymorphism in BDNF. Gene. Jul 30 2023;875:147507. doi: 10.1016/j.gene.2023.147507 [DOI] [PubMed] [Google Scholar]
103.Curhan SG, Stankovic KM, Eavey RD, Wang M, Stampfer MJ, Curhan GC. Carotenoids, vitamin A, vitamin C, vitamin E, and folate and risk of self-reported hearing loss in women. Am J Clin Nutr. Nov 2015;102(5):1167–75. doi: 10.3945/ajcn.115.109314 [DOI] [PMC free article] [PubMed] [Google Scholar]
104.Wang L, Manson JE, Buring JE, Lee IM, Sesso HD. Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women. Hypertension. Apr 2008;51(4):1073–9. doi: 10.1161/HYPERTENSIONAHA.107.107821 [DOI] [PubMed] [Google Scholar]
105.Bostick RM, Kushi LH, Wu Y, Meyer KA, Sellers TA, Folsom AR. Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol. Jan 15 1999;149(2):151–61. doi: 10.1093/oxfordjournals.aje.a009781 [DOI] [PubMed] [Google Scholar]
106.Sica DA, Struthers AD, Cushman WC, Wood M, Banas JS Jr., Epstein M Importance of potassium in cardiovascular disease. J Clin Hypertens (Greenwich). May-Jun 2002;4(3):198–206. doi: 10.1111/j.1524-6175.2002.01728.x [DOI] [PMC free article] [PubMed] [Google Scholar]
107.Latimer CS, Brewer LD, Searcy JL, et al. Vitamin D prevents cognitive decline and enhances hippocampal synaptic function in aging rats. Proc Natl Acad Sci U S A. Oct 14 2014;111(41):E4359–66. doi: 10.1073/pnas.1404477111 [DOI] [PMC free article] [PubMed] [Google Scholar]
108.Heller AJ. Classification and epidemiology of tinnitus. Otolaryngol Clin North Am. Apr 2003;36(2):239–48. [DOI] [PubMed] [Google Scholar]
109.McCormack A, Edmondson-Jones M, Somerset S, Hall D. A systematic review of the reporting of tinnitus prevalence and severity. Hear Res. Jul 2016;337:70–9. doi: 10.1016/j.heares.2016.05.009 [DOI] [PubMed] [Google Scholar]
110.Tessier AJ, Wang F, Korat AA, et al. Optimal dietary patterns for healthy aging. Nat Med. May 2025;31(5):1644–1652. doi: 10.1038/s41591-025-03570-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
111.Juan J, Liu G, Willett WC, Hu FB, Rexrode KM, Sun Q. Whole Grain Consumption and Risk of Ischemic Stroke: Results From 2 Prospective Cohort Studies. Stroke. Dec 2017;48(12):3203–3209. doi: 10.1161/STROKEAHA.117.018979 [DOI] [PMC free article] [PubMed] [Google Scholar]
112.Bhupathiraju SN, Wedick NM, Pan A, et al. Quantity and variety in fruit and vegetable intake and risk of coronary heart disease. Am J Clin Nutr. Dec 2013;98(6):1514–23. doi: 10.3945/ajcn.113.066381 [DOI] [PMC free article] [PubMed] [Google Scholar]
113.Bertoia ML, Mukamal KJ, Cahill LE, et al. Changes in Intake of Fruits and Vegetables and Weight Change in United States Men and Women Followed for Up to 24 Years: Analysis from Three Prospective Cohort Studies. PLoS Med. Sep 2015;12(9):e1001878. doi: 10.1371/journal.pmed.1001878 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplemental tables and figure

NIHMS2125717-supplement-Supplemental_tables_and_figure.docx^{(119.2KB, docx)}

Data Availability Statement

The data described in this manuscript will be made available from the corresponding author upon reasonable request.

[R1] 1.Baguley D, McFerran D, Hall D. Tinnitus. Lancet. Nov 9 2013;382(9904):1600–7. doi: 10.1016/S0140-6736(13)60142-7 [DOI] [PubMed] [Google Scholar]

[R2] 2.Nondahl DM, Cruickshanks KJ, Dalton DS, et al. The impact of tinnitus on quality of life in older adults. J Am Acad Audiol. Mar 2007;18(3):257–66. [DOI] [PubMed] [Google Scholar]

[R3] 3.Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med. Aug 2010;123(8):711–8. doi:S0002-9343(10)00344-X [pii] 10.1016/j.amjmed.2010.02.015 [DOI] [PubMed] [Google Scholar]

[R4] 4.Goldstein E, Ho CX, Hanna R, et al. Cost of care for subjective tinnitus in relation to patient satisfaction. Otolaryngol Head Neck Surg. Mar 2015;152(3):518–23. doi: 10.1177/0194599814566179 [DOI] [PubMed] [Google Scholar]

[R5] 5.Stockdale D, McFerran D, Brazier P, et al. An economic evaluation of the healthcare cost of tinnitus management in the UK. BMC Health Serv Res. Aug 22 2017;17(1):577. doi: 10.1186/s12913-017-2527-2 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R6] 6.Hoare DJ, Kowalkowski VL, Kang S, Hall DA. Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. Laryngoscope. Jul 2011;121(7):1555–64. doi: 10.1002/lary.21825 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R7] 7.Dawes P, Cruickshanks KJ, Marsden A, Moore DR, Munro KJ. Relationship Between Diet, Tinnitus, and Hearing Difficulties. Ear Hear. Mar/Apr 2020;41(2):289–299. doi: 10.1097/AUD.0000000000000765 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R8] 8.McCormack A, Edmondson-Jones M, Mellor D, et al. Association of dietary factors with presence and severity of tinnitus in a middle-aged UK population. PLoS One. 2014;9(12):e114711. doi: 10.1371/journal.pone.0114711 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R9] 9.Spankovich C, Bishop C, Johnson MF, et al. Relationship between dietary quality, tinnitus and hearing level: data from the national health and nutrition examination survey, 1999-2002. Int J Audiol. Oct 2017;56(10):716–722. doi: 10.1080/14992027.2017.1331049 [DOI] [PubMed] [Google Scholar]

[R10] 10.Lee DY, Kim YH. Relationship Between Diet and Tinnitus: Korea National Health and Nutrition Examination Survey. Clin Exp Otorhinolaryngol. Sep 2018;11(3):158–165. doi: 10.21053/ceo.2017.01221 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R11] 11.Tang D, Tran Y, Shekhawat GS, Burlutsky G, Mitchell P, Gopinath B. Dietary Fibre Intake and the 10-Year Incidence of Tinnitus in Older Adults. Nutrients. Nov 17 2021;13(11)doi: 10.3390/nu13114126 [DOI] [Google Scholar]

[R12] 12.Curhan SG, Wang M, Eavey RD, Stampfer MJ, Curhan GC. Adherence to Healthful Dietary Patterns Is Associated with Lower Risk of Hearing Loss in Women. J Nutr. Jun 1 2018;148(6):944–951. doi: 10.1093/jn/nxy058 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R13] 13.Curhan SG, Halpin C, Wang M, Eavey RD, Curhan GC. Prospective Study of Dietary Patterns and Hearing Threshold Decline. Am J Epidemiol. Oct 14 2019;doi: 10.1093/aje/kwz223 [DOI] [Google Scholar]

[R14] 14.Jin Y, Tanaka T, Reed NS, Tucker KL, Ferrucci L, Talegawkar SA. Associations between dietary indices and hearing status among middle-older aged adults - results from the Baltimore Longitudinal Study of Aging. Am J Clin Nutr. May 2024;119(5):1338–1345. doi: 10.1016/j.ajcnut.2024.03.001 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R15] 15.Clifford RE, Maihofer AX, Chatzinakos C, et al. Genetic architecture distinguishes tinnitus from hearing loss. Nat Commun. Jan 19 2024;15(1):614. doi: 10.1038/s41467-024-44842-x [DOI] [PMC free article] [PubMed] [Google Scholar]

[R16] 16.Tan CM, Lecluyse W, McFerran D, Meddis R. Tinnitus and patterns of hearing loss. J Assoc Res Otolaryngol. Apr 2013;14(2):275–82. doi: 10.1007/s10162-013-0371-6 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R17] 17.Lockwood AH, Salvi RJ, Burkard RF. Tinnitus. N Engl J Med. Sep 19 2002;347(12):904–10. doi: 10.1056/NEJMra013395 [DOI] [PubMed] [Google Scholar]

[R18] 18.Glicksman JT, Curhan SG, Curhan GC. A prospective study of caffeine intake and risk of incident tinnitus. Am J Med. Aug 2014;127(8):739–43. doi: 10.1016/j.amjmed.2014.02.033 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R19] 19.Curhan SG, Zeleznik OA, Curhan GC. Longitudinal study of seafood and fish oil supplement intake and risk of persistent tinnitus. Am J Clin Nutr. Dec 2024;120(6):1409–1418. doi: 10.1016/j.ajcnut.2024.09.028 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R20] 20.Bao Y, Bertoia ML, Lenart EB, et al. Origin, Methods, and Evolution of the Three Nurses' Health Studies. Am J Public Health. Sep 2016;106(9):1573–81. doi: 10.2105/AJPH.2016.303338 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R21] 21.Willett WC. Nutritional Epidemiology. 2nd ed. Oxford University Press; 1998:528. [Google Scholar]

[R22] 22.London SJ, Sacks FM, Caesar J, Stampfer MJ, Siguel E, Willett WC. Fatty acid composition of subcutaneous adipose tissue and diet in postmenopausal US women. Am J Clin Nutr. Aug 1991;54(2):340–5. [DOI] [PubMed] [Google Scholar]

[R23] 23.Feskanich D, Rimm EB, Giovannucci EL, et al. Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire. J Am Diet Assoc. Jul 1993;93(7):790–6. doi:0002-8223(93)91754-E [pii] [DOI] [PubMed] [Google Scholar]

[R24] 24.Willett WC, Sampson L, Stampfer MJ, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. Jul 1985;122(1):51–65. [DOI] [PubMed] [Google Scholar]

[R25] 25.Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB, Willett WC. Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol. May 15 1992;135(10):1114–26; discussion 1127-36. [DOI] [PubMed] [Google Scholar]

[R26] 26.Willett WC, Sampson L, Browne ML, et al. The use of a self-administered questionnaire to assess diet four years in the past. Research Support, U.S. Gov't, P.H.S. American journal of epidemiology. Jan 1988;127(1):188–99. [DOI] [PubMed] [Google Scholar]

[R27] 27.Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. Jan 4 2001;344(1):3–10. doi: 10.1056/NEJM200101043440101 [DOI] [PubMed] [Google Scholar]

[R28] 28.Appel LJ, Brands MW, Daniels SR, et al. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. Feb 2006;47(2):296–308. doi: 10.1161/01.HYP.0000202568.01167.B6 [DOI] [PubMed] [Google Scholar]

[R29] 29.Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. Apr 17 1997;336(16):1117–24. doi: 10.1056/NEJM199704173361601 [DOI] [PubMed] [Google Scholar]

[R30] 30.Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med. Apr 14 2008;168(7):713–20. doi: 10.1001/archinte.168.7.713 [DOI] [PubMed] [Google Scholar]

[R31] 31.Ard JD, Grambow SC, Liu D, et al. The effect of the PREMIER interventions on insulin sensitivity. Diabetes Care. Feb 2004;27(2):340–7. [DOI] [PubMed] [Google Scholar]

[R32] 32.Wengreen H, Munger RG, Cutler A, et al. Prospective study of Dietary Approaches to Stop Hypertension- and Mediterranean-style dietary patterns and age-related cognitive change: the Cache County Study on Memory, Health and Aging. Am J Clin Nutr. Nov 2013;98(5):1263–71. doi: 10.3945/ajcn.112.051276 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R33] 33.Taylor EN, Fung TT, Curhan GC. DASH-style diet associates with reduced risk for kidney stones. J Am Soc Nephrol. Oct 2009;20(10):2253–9. doi: 10.1681/ASN.2009030276 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R34] 34.Karanja NM, Obarzanek E, Lin PH, et al. Descriptive characteristics of the dietary patterns used in the Dietary Approaches to Stop Hypertension Trial. DASH Collaborative Research Group. J Am Diet Assoc. Aug 1999;99(8 Suppl):S19–27. [DOI] [PubMed] [Google Scholar]

[R35] 35.Chen C, Zhang N, Curhan GC, Curhan SG, Wang M. Both-Ear Method for the Analysis of Audiometric Data. Ear Hear. Sep-Oct 01 2022;43(5):1447–1455.doi: 10.1097/AUD.0000000000001216 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R36] 36.Curhan SG, Glicksman J, Wang M, Eavey RD, Curhan GC. Longitudinal Study of Analgesic Use and Risk of Incident Persistent Tinnitus. J Gen Intern Med. Nov 2022;37(14):3653–3662. doi: 10.1007/s11606-021-07349-5 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R37] 37.Curhan SG, Halpin C, Wang M, Eavey RD, Curhan GC. Tinnitus and 3-Year Change in Audiometric Hearing Thresholds. Ear Hear. Jul-Aug 01 2021;42(4):886–895. doi: 10.1097/AUD.0000000000000990 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R38] 38.Zeleznik OA, Welling DB, Stankovic K, et al. Association of Plasma Metabolomic Biomarkers With Persistent Tinnitus: A Population-Based Case-Control Study. JAMA Otolaryngol Head Neck Surg. May 1 2023;149(5):404–415. doi: 10.1001/jamaoto.2023.0052 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R39] 39.Burgess PM, Mazzocco L, Campbell IM. Discriminant validity of the Crown-Crisp Experiential Index. Br J Med Psychol. Mar 1987;60 ( Pt 1):61–9. [PubMed] [Google Scholar]

[R40] 40.Salvini S, Hunter DJ, Sampson L, et al. Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. Int J Epidemiol. Dec 1989;18(4):858–67. [DOI] [PubMed] [Google Scholar]

[R41] 41.Wolf AM, Hunter DJ, Colditz GA, et al. Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol. Oct 1994;23(5):991–9. [DOI] [PubMed] [Google Scholar]

[R42] 42.Colditz GA, Martin P, Stampfer MJ, et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol. May 1986;123(5):894–900. [DOI] [PubMed] [Google Scholar]

[R43] 43.Rimm EB, Stampfer MJ, Colditz GA, Chute CG, Litin LB, Willett WC. Validity of self-reported waist and hip circumferences in men and women. Epidemiology. Nov 1990;1(6):466–73. [DOI] [PubMed] [Google Scholar]

[R44] 44.Wang DD, Li Y, Bhupathiraju SN, et al. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. Apr 27 2021;143(17):1642–1654. doi: 10.1161/CIRCULATIONAHA.120.048996 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R45] 45.Fang Z, Wu Y, Li Y, et al. Association of nut consumption with risk of total cancer and 5 specific cancers: evidence from 3 large prospective cohort studies. Am J Clin Nutr. Dec 1 2021;114(6):1925–1935. doi: 10.1093/ajcn/nqab295 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R46] 46.Hu FB, Satija A, Rimm EB, et al. Diet Assessment Methods in the Nurses' Health Studies and Contribution to Evidence-Based Nutritional Policies and Guidelines. Am J Public Health. Sep 2016;106(9):1567–72. doi: 10.2105/AJPH.2016.303348 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R47] 47.Hu FB, Stampfer MJ, Rimm E, et al. Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol. Mar 15 1999;149(6):531–40. [DOI] [PubMed] [Google Scholar]

[R48] 48.Friedenreich CM. Methods for pooled analyses of epidemiologic studies. Epidemiology. Jul 1993;4(4):295–302. doi: 10.1097/00001648-199307000-00004 [DOI] [PubMed] [Google Scholar]

[R49] 49.Groenwold RH, White IR, Donders AR, Carpenter JR, Altman DG, Moons KG. Missing covariate data in clinical research: when and when not to use the missing-indicator method for analysis. CMAJ. Aug 7 2012;184(11):1265–9. doi: 10.1503/cmaj.110977 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R50] 50.Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health. Jun 24 2014;14:643. doi: 10.1186/1471-2458-14-643 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R51] 51.American Heart Association Nutrition C, Lichtenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. Jul 4 2006;114(1):82–96. doi: 10.1161/CIRCULATIONAHA.106.176158 [DOI] [PubMed] [Google Scholar]

[R52] 52.Roberts LE, Eggermont JJ, Caspary DM, Shore SE, Melcher JR, Kaltenbach JA. Ringing ears: the neuroscience of tinnitus. J Neurosci. Nov 10 2010;30(45):14972–9. doi:30/45/14972 [pii] 10.1523/JNEUROSCI.4028-10.2010 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R53] 53.Bartels H, Staal MJ, Albers FW. Tinnitus and neural plasticity of the brain. Otol Neurotol. Feb 2007;28(2):178–84. doi: 10.1097/MAO.0b013e31802b3248 [DOI] [PubMed] [Google Scholar]

[R54] 54.Rauschecker JP, Leaver AM, Muhlau M. Tuning out the noise: limbic-auditory interactions in tinnitus. Neuron. Jun 24 2010;66(6):819–26. doi:S0896-6273(10)00325-9 [pii] 10.1016/j.neuron.2010.04.032 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R55] 55.De Ridder D, Vanneste S, Menovsky T, Langguth B. Surgical brain modulation for tinnitus: the past, present and future. J Neurosurg Sci. Dec 2012;56(4):323–40. [PubMed] [Google Scholar]

[R56] 56.Leaver AM, Turesky TK, Seydell-Greenwald A, Morgan S, Kim HJ, Rauschecker JP. Intrinsic network activity in tinnitus investigated using functional MRI. Hum Brain Mapp. Aug 2016;37(8):2717–35. doi: 10.1002/hbm.23204 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R57] 57.Mielke MM, Haughey NJ, Bandaru VV, et al. Plasma sphingomyelins are associated with cognitive progression in Alzheimer's disease. J Alzheimers Dis. 2011;27(2):259–69. doi: 10.3233/JAD-2011-110405 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R58] 58.Dong MX, Wei YD, Hu L. Lipid metabolic dysregulation is involved in Parkinson's disease dementia. Metab Brain Dis. Mar 2021;36(3):463–470. doi: 10.1007/s11011-020-00665-5 [DOI] [PubMed] [Google Scholar]

[R59] 59.Slavin J. Whole grains and human health. Nutr Res Rev. Jun 2004;17(1):99–110. doi: 10.1079/NRR200374 [DOI] [PubMed] [Google Scholar]

[R60] 60.Hu Y, Willett WC, Manson JAE, Rosner B, Hu FB, Sun Q. Intake of whole grain foods and risk of coronary heart disease in US men and women. BMC Med. Jun 10 2022;20(1):192. doi: 10.1186/s12916-022-02396-z [DOI] [PMC free article] [PubMed] [Google Scholar]

[R61] 61.Schlemmer U, Frolich W, Prieto RM, Grases F. Phytate in foods and significance for humans: food sources, intake, processing, bioavailability, protective role and analysis. Mol Nutr Food Res. Sep 2009;53 Suppl 2:S330–75. doi: 10.1002/mnfr.200900099 [DOI] [PubMed] [Google Scholar]

[R62] 62.Mozaffarian RS, Lee RM, Kennedy MA, Ludwig DS, Mozaffarian D, Gortmaker SL. Identifying whole grain foods: a comparison of different approaches for selecting more healthful whole grain products. Public Health Nutr. Dec 2013;16(12):2255–64. doi: 10.1017/S1368980012005447 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R63] 63.de Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med. Aug 2007;4(8):e261. doi: 10.1371/journal.pmed.0040261 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R64] 64.Hallberg L, Brune M, Rossander L. Iron absorption in man: ascorbic acid and dose-dependent inhibition by phytate. Am J Clin Nutr. Jan 1989;49(1):140–4.doi: 10.1093/ajcn/49.1.140 [DOI] [PubMed] [Google Scholar]

[R65] 65.Reddy MB, Hurrell RF, Juillerat MA, Cook JD. The influence of different protein sources on phytate inhibition of nonheme-iron absorption in humans. Am J Clin Nutr. Feb 1996;63(2):203–7. doi: 10.1093/ajcn/63.2.203 [DOI] [PubMed] [Google Scholar]

[R66] 66.Bohn T, Davidsson L, Walczyk T, Hurrell RF. Phytic acid added to white-wheat bread inhibits fractional apparent magnesium absorption in humans. Am J Clin Nutr. Mar 2004;79(3):418–23. doi: 10.1093/ajcn/79.3.418 [DOI] [PubMed] [Google Scholar]

[R67] 67.Tang D, Shekhawat GS, Burlutsky G, Mitchell P, Gopinath B. The Association between Dietary Intakes of Vitamins and Minerals with Tinnitus. Nutrients. Aug 2 2024;16(15) doi: 10.3390/nu16152535 [DOI] [Google Scholar]

[R68] 68.Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Adv Nutr. Jul 1 2012;3(4):506–16. doi: 10.3945/an.112.002154 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R69] 69.Erdman JW Jr., Badger TM, Lampe JW, Setchell KD, Messina M. Not all soy products are created equal: caution needed in interpretation of research results. J Nutr. May 2004;134(5):1229S–1233S. doi: 10.1093/jn/134.5.1229S [DOI] [PubMed] [Google Scholar]

[R70] 70.Cassidy A, Bingham S, Setchell K. Biological effects of isoflavones in young women: importance of the chemical composition of soyabean products. Br J Nutr. Oct 1995;74(4):587–601. doi: 10.1079/bjn19950160 [DOI] [PubMed] [Google Scholar]

[R71] 71.Barnes S. Soy isoflavones--phytoestrogens and what else? J Nutr. May 2004;134(5):1225S–1228S. doi: 10.1093/jn/134.5.1225S [DOI] [PubMed] [Google Scholar]

[R72] 72.Henderson VW, St John JA, Hodis HN, et al. Long-term soy isoflavone supplementation and cognition in women: a randomized, controlled trial. Neurology. Jun 5 2012;78(23):1841–8. doi: 10.1212/WNL.0b013e318258f822 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R73] 73.Cheng PF, Chen JJ, Zhou XY, et al. Do soy isoflavones improve cognitive function in postmenopausal women? A meta-analysis. Menopause. Feb 2015;22(2):198–206. doi: 10.1097/GME.0000000000000290 [DOI] [PubMed] [Google Scholar]

[R74] 74.Gleason CE, Fischer BL, Dowling NM, et al. Cognitive Effects of Soy Isoflavones in Patients with Alzheimer's Disease. J Alzheimers Dis. 2015;47(4):1009–19. doi: 10.3233/JAD-142958 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R75] 75.Romanos-Nanclares A, Collins LC, Hu FB, et al. Sugar-Sweetened Beverages, Artificially Sweetened Beverages, and Breast Cancer Risk: Results From 2 Prospective US Cohorts. J Nutr. Sep 4 2021;151(9):2768–2779. doi: 10.1093/jn/nxab172 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R76] 76.Tomanic M, Belojevic G, Jovanovic A, Vasiljevic N, Davidovic D, Maksimovic K. Dietary Factors and Tinnitus among Adolescents. Nutrients. Oct 27 2020;12(11)doi: 10.3390/nu12113291 [DOI] [Google Scholar]

[R77] 77.Gopinath B, Flood VM, McMahon CM, Burlutsky G, Brand-Miller J, Mitchell P. Dietary glycemic load is a predictor of age-related hearing loss in older adults. J Nutr. Dec 2010;140(12):2207–12. doi:jn.110.128462 [pii] 10.3945/jn.110.128462 [DOI] [PubMed] [Google Scholar]

[R78] 78.Dillard LK, Nelson-Bakkum E, Schultz A, Merten N, Malecki K. Associations of Dietary Intake With Self-Reported Hearing Loss: Findings From the Survey of the Health of Wisconsin. J Speech Lang Hear Res. Jul 12 2023;66(7):2478–2489. doi: 10.1044/2023_JSLHR-22-00473 [DOI] [PubMed] [Google Scholar]

[R79] 79.Malik VS, Popkin BM, Bray GA, Despres JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. Mar 23 2010;121(11):1356–64. doi: 10.1161/CIRCULATIONAHA.109.876185 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R80] 80.Bernstein AM, de Koning L, Flint AJ, Rexrode KM, Willett WC. Soda consumption and the risk of stroke in men and women. Am J Clin Nutr. May 2012;95(5):1190–9. doi: 10.3945/ajcn.111.030205 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R81] 81.Hu FB, Malik VS. Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav. Apr 26 2010;100(1):47–54. doi: 10.1016/j.physbeh.2010.01.036 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R82] 82.Pase MP, Himali JJ, Beiser AS, et al. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study. Stroke. May 2017;48(5):1139–1146. doi: 10.1161/STROKEAHA.116.016027 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R83] 83.Jarach CM, Lugo A, Garavello W, et al. The Role of Diet in Tinnitus Onset: A Hospital-Based Case-Control Study from Italy. Nutrients. Jan 25 2023;15(3)doi: 10.3390/nu15030621 [DOI] [Google Scholar]

[R84] 84.Zhan J, Liu YJ, Cai LB, Xu FR, Xie T, He QQ. Fruit and vegetable consumption and risk of cardiovascular disease: A meta-analysis of prospective cohort studies. Crit Rev Food Sci Nutr. May 24 2017;57(8):1650–1663. doi: 10.1080/10408398.2015.1008980 [DOI] [PubMed] [Google Scholar]

[R85] 85.Wu L, Sun D, He Y. Fruit and vegetables consumption and incident hypertension: dose-response meta-analysis of prospective cohort studies. J Hum Hypertens. Oct 2016;30(10):573–80. doi: 10.1038/jhh.2016.44 [DOI] [PubMed] [Google Scholar]

[R86] 86.Lee M, Lim M, Kim J. Fruit and vegetable consumption and the metabolic syndrome: a systematic review and dose-response meta-analysis. Br J Nutr. Oct 14 2019;122(7):723–733. doi: 10.1017/S000711451900165X [DOI] [PubMed] [Google Scholar]

[R87] 87.Wedick NM, Pan A, Cassidy A, et al. Dietary flavonoid intakes and risk of type 2 diabetes in US men and women. Am J Clin Nutr. Apr 2012;95(4):925–33. doi: 10.3945/ajcn.111.028894 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R88] 88.Hung HC, Joshipura KJ, Jiang R, et al. Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst. Nov 3 2004;96(21):1577–84. doi: 10.1093/jnci/djh296 [DOI] [PubMed] [Google Scholar]

[R89] 89.Liu X, Yan Y, Li F, Zhang D. Fruit and vegetable consumption and the risk of depression: A meta-analysis. Nutrition. Mar 2016;32(3):296–302. doi: 10.1016/j.nut.2015.09.009 [DOI] [PubMed] [Google Scholar]

[R90] 90.Saghafian F, Malmir H, Saneei P, Milajerdi A, Larijani B, Esmaillzadeh A. Fruit and vegetable consumption and risk of depression: accumulative evidence from an updated systematic review and meta-analysis of epidemiological studies. Br J Nutr. May 2018;119(10):1087–1101. doi: 10.1017/S0007114518000697 [DOI] [PubMed] [Google Scholar]

[R91] 91.Jiang X, Huang J, Song D, Deng R, Wei J, Zhang Z. Increased Consumption of Fruit and Vegetables Is Related to a Reduced Risk of Cognitive Impairment and Dementia: Meta-Analysis. Front Aging Neurosci. 2017;9:18. doi: 10.3389/fnagi.2017.00018 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R92] 92.Gaudio S, Rukh G, Di Ciommo V, Berkins S, Wiemerslage L, Schioth HB. Higher fresh fruit intake relates to larger grey matter volumes in areas involved in dementia and depression: A UK Biobank study. Neuroimage. Dec 1 2023;283:120438. doi: 10.1016/j.neuroimage.2023.120438 [DOI] [PubMed] [Google Scholar]

[R93] 93.Chen YC, Xia W, Chen H, et al. Tinnitus distress is linked to enhanced resting-state functional connectivity from the limbic system to the auditory cortex. Hum Brain Mapp. May 2017;38(5):2384–2397. doi: 10.1002/hbm.23525 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R94] 94.Ueyama T, Donishi T, Ukai S, et al. Brain regions responsible for tinnitus distress and loudness: a resting-state FMRI study. PLoS One. 2013;8(6):e67778. doi: 10.1371/journal.pone.0067778 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R95] 95.Orr SK, Bazinet RP. The emerging role of docosahexaenoic acid in neuroinflammation. Curr Opin Investig Drugs. Jul 2008;9(7):735–43. [Google Scholar]

[R96] 96.Gomez-Pinilla F Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci. Jul 2008;9(7):568–78. doi: 10.1038/nrn2421 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R97] 97.Berchtold NC, Chinn G, Chou M, Kesslak JP, Cotman CW. Exercise primes a molecular memory for brain-derived neurotrophic factor protein induction in the rat hippocampus. Neuroscience. 2005;133(3):853–61. doi: 10.1016/j.neuroscience.2005.03.026 [DOI] [PubMed] [Google Scholar]

[R98] 98.Feher A, Juhasz A, Rimanoczy A, Kalman J, Janka Z. Association between BDNF Val66Met polymorphism and Alzheimer disease, dementia with Lewy bodies, and Pick disease. Alzheimer Dis Assoc Disord. Jul-Sep 2009;23(3):224–8. doi: 10.1097/WAD.0b013e318199dd7d [DOI] [PubMed] [Google Scholar]

[R99] 99.Sinn N, Milte CM, Street SJ, et al. Effects of n-3 fatty acids, EPA v. DHA, on depressive symptoms, quality of life, memory and executive function in older adults with mild cognitive impairment: a 6-month randomised controlled trial. Br J Nutr. Jun 2012;107(11):1682–93. doi: 10.1017/S0007114511004788 [DOI] [PubMed] [Google Scholar]

[R100] 100.Matison AP, Flood VM, Lam BCP, et al. Associations between fruit and vegetable intakes and incident depression in middle-aged and older adults from 10 diverse international longitudinal cohorts. J Affect Disord. Aug 15 2024;359:373–381. doi: 10.1016/j.jad.2024.05.096 [DOI] [PubMed] [Google Scholar]

[R101] 101.Sawamoto A, Okuyama S, Yamamoto K, et al. 3,5,6,7,8,3',4'-Heptamethoxyflavone, a Citrus Flavonoid, Ameliorates Corticosterone-Induced Depression-like Behavior and Restores Brain-Derived Neurotrophic Factor Expression, Neurogenesis, and Neuroplasticity in the Hippocampus. Molecules. Apr 23 2016;21(4):541. doi: 10.3390/molecules21040541 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R102] 102.Yuksel B, Dogan M, Boyacioglu O, Sahin M, Orenay-Boyacioglu S. Association between chronic tinnitus and brain-derived neurotrophic factor antisense RNA polymorphisms linked to the Val66Met polymorphism in BDNF. Gene. Jul 30 2023;875:147507. doi: 10.1016/j.gene.2023.147507 [DOI] [PubMed] [Google Scholar]

[R103] 103.Curhan SG, Stankovic KM, Eavey RD, Wang M, Stampfer MJ, Curhan GC. Carotenoids, vitamin A, vitamin C, vitamin E, and folate and risk of self-reported hearing loss in women. Am J Clin Nutr. Nov 2015;102(5):1167–75. doi: 10.3945/ajcn.115.109314 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R104] 104.Wang L, Manson JE, Buring JE, Lee IM, Sesso HD. Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women. Hypertension. Apr 2008;51(4):1073–9. doi: 10.1161/HYPERTENSIONAHA.107.107821 [DOI] [PubMed] [Google Scholar]

[R105] 105.Bostick RM, Kushi LH, Wu Y, Meyer KA, Sellers TA, Folsom AR. Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol. Jan 15 1999;149(2):151–61. doi: 10.1093/oxfordjournals.aje.a009781 [DOI] [PubMed] [Google Scholar]

[R106] 106.Sica DA, Struthers AD, Cushman WC, Wood M, Banas JS Jr., Epstein M Importance of potassium in cardiovascular disease. J Clin Hypertens (Greenwich). May-Jun 2002;4(3):198–206. doi: 10.1111/j.1524-6175.2002.01728.x [DOI] [PMC free article] [PubMed] [Google Scholar]

[R107] 107.Latimer CS, Brewer LD, Searcy JL, et al. Vitamin D prevents cognitive decline and enhances hippocampal synaptic function in aging rats. Proc Natl Acad Sci U S A. Oct 14 2014;111(41):E4359–66. doi: 10.1073/pnas.1404477111 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R108] 108.Heller AJ. Classification and epidemiology of tinnitus. Otolaryngol Clin North Am. Apr 2003;36(2):239–48. [DOI] [PubMed] [Google Scholar]

[R109] 109.McCormack A, Edmondson-Jones M, Somerset S, Hall D. A systematic review of the reporting of tinnitus prevalence and severity. Hear Res. Jul 2016;337:70–9. doi: 10.1016/j.heares.2016.05.009 [DOI] [PubMed] [Google Scholar]

[R110] 110.Tessier AJ, Wang F, Korat AA, et al. Optimal dietary patterns for healthy aging. Nat Med. May 2025;31(5):1644–1652. doi: 10.1038/s41591-025-03570-5 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R111] 111.Juan J, Liu G, Willett WC, Hu FB, Rexrode KM, Sun Q. Whole Grain Consumption and Risk of Ischemic Stroke: Results From 2 Prospective Cohort Studies. Stroke. Dec 2017;48(12):3203–3209. doi: 10.1161/STROKEAHA.117.018979 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R112] 112.Bhupathiraju SN, Wedick NM, Pan A, et al. Quantity and variety in fruit and vegetable intake and risk of coronary heart disease. Am J Clin Nutr. Dec 2013;98(6):1514–23. doi: 10.3945/ajcn.113.066381 [DOI] [PMC free article] [PubMed] [Google Scholar]

[R113] 113.Bertoia ML, Mukamal KJ, Cahill LE, et al. Changes in Intake of Fruits and Vegetables and Weight Change in United States Men and Women Followed for Up to 24 Years: Analysis from Three Prospective Cohort Studies. PLoS Med. Sep 2015;12(9):e1001878. doi: 10.1371/journal.pmed.1001878 [DOI] [PMC free article] [PubMed] [Google Scholar]

PERMALINK

Longitudinal Study of Dietary Intake and Risk of Persistent Tinnitus in Two Large Independent Cohorts of Women

Sharon G Curhan, MD, ScM

Oana A Zeleznik, PhD

Meir J Stampfer, MD, DrPH

Gary C Curhan, MD, ScD

Abstract

Introduction

Methods

Study Population

Ascertainment of Dietary Intake

Ascertainment of Tinnitus

Assessment of Covariates

Statistical Methods

Results

Table 1A:

Table 1B:

DASH Score

TABLE 2:

DASH Score Components

Table 3:

Individual foods

Table 4A:

Table 4D:

Table 4B:

Table 4C:

Additional analyses

Discussion

Conclusion

Supplementary Material

Acknowledgments:

Sources of Support:

Abbreviations

Footnotes

Data Sharing Plan:

References

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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