Dietary creatine intake and all-cause mortality among U.S. adults: a linked mortality analysis from the NHANES study

Evidence linking dietary creatine intake with mortality remains scarce and inconclusive. This study aimed to investigate the relationship between creatine consumption and all-cause mortality, as well as to evaluate the potential impact of meeting the recommended dietary creatine intake of ≥1 g per day in a nationally representative sample of U.S. adults. We evaluated creatine intake, estimated from a single 24 h dietary recall in the 1999-2000 National Health and Nutrition Examination Survey, with mortality follow-up extending through 2019. Of the 4041 participants enrolled at baseline, 858 deaths were recorded over a median follow-up period of 19.8 years. Creatine as a continuous variable (grams per day) had inverse association with all-cause mortality (<i>B</i> = -0.094; <i>P</i> = 0.04). The hazard ratio for all-cause mortality was 0.85 (95% CI: 0.72-1.00) for participants consuming at least 1 g of creatine per day, compared to those consuming less than 1 g/day (<i>P</i> = 0.05), suggesting that individuals meeting the recommended creatine intake had a significantly lower risk of early mortality compared to those with suboptimal intake. Proportional hazards regression analysis indicated that this association remained robust after adjusting for certain covariates, such as dietary macronutrients (<i>B</i> = -0.234; <i>P</i> = 0.01) and physical examination measures (<i>B</i> = -0.206; <i>P</i> = 0.02); however, it weakened when demographic and lifestyle factors were included in the model. In this sample of U.S. adults, higher creatine intake was inversely associated with all-cause mortality; however, this relationship may be influenced by other contributing factors. These findings underscore the need for further research on the relationship between dietary creatine intake and mortality outcomes.