Association of oxidative balance score with the risk of all-cause and CVD mortality in younger US adults with diabetes.

Oxidative balance score (OBS) is a composite measures that assess the balance between pro-oxidant and antioxidant factors in an individual's diet and lifestyle, with higher scores indicating greater antioxidant exposure. Despite its potential significance, there is a limited body of research exploring the relationship between OBS and all-cause and cardiovascular disease (CVD) mortality specifically in younger patients with diabetes. We aimed to investigate the possible relationship between OBS and all-cause and CVD mortality in younger patients with diabetes. Data for this study were obtained from the 2003-2018 NHANES. This study enrolled 3501 participants. The endpoints were all-cause and CVD mortality, determined by the National Death Index (NDI). OBS, which consists of 16 dietary factors and 4 lifestyle factors, is categorized into pro-oxidants and antioxidants. The OBS was categorized into four quartiles (Q1-Q4). We used multivariable Cox proportional hazards regression models to examine the association between continuous and quartile measures of OBS, lifestyle OBS (lifestyle antioxidants such as physical activity, etc., and lifestyle pro-oxidants such as alcohol, smoking, etc.), and dietary OBS (dietary antioxidants such as fiber, β-carotene, riboflavin, etc., and dietary pro-oxidants, such as total fat, etc.) with all-cause and CVD mortality. Additionally, we explored restricted cubic spline (RCS) analysis and also performed subgroup analyses and interaction tests. The occurrence of 409 all-cause deaths (11.7%) and 108 CVD-related deaths (3.1%) was recorded during the follow-up period. Our results found that OBS, lifestyle OBS, and dietary OBS were negatively associated with patients' all-cause and CVD mortality. The RCS analysis further validated the association of a linear negative correlation between OBS and all-cause and CVD mortality. The results of our subgroup analyses revealed that the negative association between OBS and CVD mortality may be influenced by alcohol use. In conclusion, results from a nationally representative study of younger American patients with diabetes suggest a negative association between OBS, lifestyle OBS, and dietary OBS and all-cause and CVD mortality. Antioxidant-rich diets and lifestyle improvements are essential for reducing all-cause and CVD mortality in patients.

Liu C ，Xiang G ，Liang D ，Zhao X ，Xiao K ，Xie L ... -  《Scientific Reports》

Association between oxidative balance score and lung function and FeNO and mortality in the US population.

The Oxidative Balance Score (OBS) is a new indicator of overall antioxidant/oxidant balance that provides a comprehensive picture of the body's overall oxidative stress status, with higher OBS indicating greater antioxidant exposure. A limited number of studies have examined the association between OBS and lung function and FeNO, and we aimed to investigate the possible relationship between OBS and lung function and FeNO. Data utilized in this study were sourced from the 2007-2012 NHANES. Multivariable logistic regression was employed to investigate the association between OBS/lifestyle OBS (lifestyle antioxidants such as physical activity, etc., and lifestyle pro-oxidants such as alcohol, smoking, etc.)/dietary OBS (dietary antioxidants such as fiber, β-carotene, riboflavin, etc., and dietary pro-oxidants, such as total fat, etc.) and FEV1, FVC, PEF, FEF 25%- 75%, FeNO, as well as obstructive ventilation dysfunction. The dose-response association between the OBS and FEV1, FVC and PEF was explored using RCS analysis. Subgroup analysis and interaction tests were also conducted. We also used multivariable Cox regression modeling to explore the between OBS/lifestyle OBS/dietary OBS and all-cause and respiratory-related mortality. A total of 8,568 participants were enrolled. A statistically significant association was observed between OBS/lifestyle OBS/dietary OBS and FEV1, FVC, and PEF levels. There was no statistical association between OBS, lifestyle OBS, dietary OBS, and FeNO levels. RCS revealed a linear relationship between OBS and both FEV1 and FVC levels. Notably, the positive correlation between OBS and dietary OBS with FEV1 was more significant in male participants. Conversely, the relationship between OBS and FVC levels was influenced by gender and BMI. The effects of the overall OBS, lifestyle OBS, and dietary OBS on lung function parameters were independent of whether participants had restrictive ventilatory dysfunction or obstructive ventilatory dysfunction.In addition, both the overall OBS and dietary OBS demonstrated significant inverse associations with all-cause mortality, whereas no statistically significant relationships were observed between these scores and respiratory-related mortality. Notably, only lifestyle OBS exhibited a significant inverse association with respiratory-related mortality. In this study, OBS, lifestyle OBS, and dietary OBS levels were positively correlated with lung function parameters (FEV1, FVC and PEF) in U.S. adults. Exploring this association can enhance our understanding of how oxidative homeostasis influences lung function changes. This could provide valuable interventions for lung function decline. We also found that higher OBS was associated with lower all-cause mortality. Adopting a healthy lifestyle and consuming an antioxidant-rich diet may significantly improve the prognosis of patients by reducing oxidative stress-related damage.

Liu C ，Liang D ，Xiang G ，Xiao K ，Xie L ... -  《BMC Pulmonary Medicine》

Association between oxidative balance scores and all-cause and cardiovascular disease-related mortality in patients with type 2 diabetes: data from the national health and nutrition examination survey (2007-2018).

Oxidative Balance Scores (OBS) is composite measures that assess the balance between pro-oxidant and antioxidant factors in an individual's diet and lifestyle. Evidence on OBS and cardiovascular disease (CVD) in diabetic patients is scarce. This study investigates the potential association between OBS and CVD-prevalence and all-cause and CVD-related mortality in adult diabetic patients. Participants were selected from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. OBS-related data collection was initiated by linking the National Death Index to determine mortality due to all-cause and cardiovascular disease until December 31, 2019. Weighted logistic regression analyses explored the relationship between OBS and CVD. In addition, multivariable Cox proportional risk regression models and Kaplan-Meier curves were used to determine the correlation between OBS and mortality, with time to event as the time variable, as well as to estimate hazard ratios (HR) and 95% confidence interval (CI). A total of 3491 participants were included in the final analysis. Weighted logistic regression analysis of the relationship between OBS and CVD prevalence found that higher OBS was not associated with CVD prevalence compared with lower levels after fully adjustment in model 3 (OR: 0.82, 95% CI: 0.51-1.31, P = 0.39). During 3,491 person-years of follow-up, 408 deaths were recorded, of which 105 deaths were attributed to CVD. In fully adjusted model 3, participants in the highest quartile of OBS had significant reductions in all-cause mortality of 53% [HR: 0.47, 95% CI: 0.29-0.77), Ptrend= 0.002] and in cardiovascular disease mortality of 78% [HR: 0.22, 95% CI: 0.08-0.56), Ptrend= 0.004], compared with the lowest quartile groups of OBS. The Kaplan-Meier analysis results showed that participants in the highest quartile of OBS had the lowest risk of all-cause and CVD-related mortality and were statistically different (P < 0.05). Subgroup analysis confirmed that P for interaction was significant only concerning the educational level attained and in individuals with a history of CKD (P < 0.05). Although OBS wasn't very useful for assessing CVD prevalence outcomes, higher OBS was significantly associated with lower all-cause and CVD-related mortality, suggesting that maintaining adequate OBS may reduce mortality in patients with DM.

Wang H ，Chen YL ，Li XM ，Wu Q ，Xu Y ，Xu JS ... -  《BMC PUBLIC HEALTH》

Association of oxidative balance score with cardiovascular disease and all-cause and cardiovascular mortality in American adults with type 2 diabetes: data from the National Health and Nutrition examination survey 1999-2018.

Oxidative stress has an important role in type 2 diabetes (T2D). Oxidative balance score (OBS) is an emerging assessment of dietary and lifestyle oxidative balance. We aimed to explore the association of OBS with cardiovascular disease (CVD) and all-cause and CVD mortality in the T2D population through NHANES 1999-2018. OBS integrated 16 dietary components and 4 lifestyle components. T2D was diagnosed according to the American Diabetes Association criteria. Multivariate logistic regression and multivariate Cox proportional hazards regression analyses were used to explore the association of OBS with CVD and mortality in T2D, respectively. 3801 adult T2D participants were included. In fully adjusted models, OBS, dietary OBS, and lifestyle OBS were all negatively associated with the prevalence of CVD (odds ratios of 0.98, 0.98, and 0.85, respectively). Higher OBS and lifestyle OBS (p for trend 0.016 and <0.001, respectively) rather than dietary OBS (p for trend = 0.06) were associated with significantly lower odds of CVD. Higher OBS, dietary OBS, and lifestyle OBS were all negatively associated with all-cause mortality (hazard ratios [HR] of 0.98, 0.98, and 0.92, respectively; p for trend of 0.002, 0.009, and 0.035, respectively). Higher OBS and dietary OBS were negatively associated with CVD mortality (HR 0.96 and 0.95, respectively; p for trend both <0.001), whereas lifestyle OBS was not. Restricted cubic spline analysis suggested that most associations were linear. Stratified analyses showed that these associations were influenced by some demographic variables and disease status. Adherence to higher OBS was associated with reduced CVD prevalence and mortality risk in T2D. Antioxidant diet and lifestyle had more significant associations with mortality and CVD prevalence, respectively. However, as these findings are merely associations and do not allow causal inferences to be drawn, future validation in high-quality randomized controlled trials is needed.

Fan M ，Song S ，Chu T ，Li R ，Yue M ，Li X ，Yang J ... -  《Frontiers in Endocrinology》

Association between oxidative balance score and all-cause and cancer-specific mortality among cancer survivors.

The Oxidative Balance Score (OBS) represents a novel metric for assessing systemic oxidative stress, where elevated scores reflect increased antioxidant exposure. This study aims to explore the association between OBS and all-cause and cancer-specific mortality among cancer survivors. An observational cohort study was conducted involving 4099 cancer survivors, utilizing data obtained from the National Health and Nutrition Examination Survey (NHANES) covering the years 1999 to 2018. The endpoints were established by cross-referencing data with the National Death Index (NDI). The OBS was developed based on dietary and lifestyle factors. Cox proportional hazards regression models were employed to examine the relationship between OBS and mortality risks. Restricted cubic spline was utilized to evaluate whether OBS exhibited a nonlinear association with the risk of death. Furthermore, Kaplan-Meier survival curves were generated to assess cumulative survival differences across various OBS outcomes. Over an average follow-up of 84.00 months, 1481 (26.29%) participants died, including 484 (8.9%) who died from cancer. In the fully adjusted model, multivariable Cox regression revealed that each unit increase in OBS was linked to a 1.8% decrease in all-cause mortality risk (HR 0.982, 95%CI 0.972-0.991) and a 2.6% decrease in cancer-specific mortality risk (HR 0.974, 95%CI 0.958-0.991). In the context of all-cause mortality, the risk of death was found to be significantly lower in quartiles Q2, Q3 and Q4 when compared to the OBS in quartile Q1. The hazard ratios (HRs) and 95% confidence intervals (CIs) for Q2, Q3 and Q4 were as follows: Q2 (HR 0.833, 95%CI 0.707-0.981), Q3 (HR 0.789, 95%CI 0.650-0.958) and Q4 (HR 0.699, 95%CI 0.579-0.844). Regarding cancer-specific mortality, the HRs and 95%CIs for Q2, Q3 and Q4 in comparison to Q1 were as follows: Q2 (HR 0.663, 95%CI 0.505-0.869), Q3 (HR 0.688, 95%CI 0.488-0.969) and Q4 (HR 0.595, 95%CI 0.435-0.815). Similar associations were noted when the dietary and lifestyle components of the OBS were analyzed separately. The findings indicate that higher levels of OBS are associated with a decrease in all-cause and cancer-specific mortality among cancer survivors. Our findings may contribute to the refinement of lifestyle intervention recommendations for this population.

Gao Q ，Zhu X ，Chen M ，Xia R ，Zhang Q ... -  《Frontiers in Immunology》