Abstract
Evidence regarding the relationship between dietary or supplemental vitamin C intake and human papillomavirus infection is limited. Therefore, this study aimed to evaluate if dietary and/or supplemental vitamin C intake is independently associated with human papillomavirus (HPV) infection and compare them. The analysis utilized data extracted from the National Health and Nutrition Examination Survey spanning from 2007 to 2016. The study cohort comprised 950 women within the age range of 18 to 59 years. The associations between dietary and supplemental vitamin C intake and cervicovaginal human papillomavirus infection were estimated using weighted logistic regression, interaction analyses, and subgroup analyses based on complex multistage sampling. Adjusted binary logistic regression revealed that supplemental vitamin C intake was negatively associated with the risk of HPV (adjusted odds ratio [AOR] 0.94, 95% confidence interval [CI] 0.89-0.99) and high-risk human papillomavirus infection (AOR = 0.76, 95% CI = 0.55-0.99). However, we did not find an association between dietary vitamin C and human papillomavirus infection (AOR = 1.18, CI = 0.96-1.45). Subgroup analyses indicated that supplemental vitamin C was only negatively associated with human papillomavirus infection in women older than 25 years (P = .03) and was more strongly associated with HPV infection in those who did not receive HPV vaccination (Pinteraction = 0.03). The results from a nationally representative sample from the United States supported that the protective effect of vitamin C against human papillomavirus infection was driven mainly by supplemental vitamin C rather than dietary vitamin C.