Association Between an Oxidative Balance Score and Mortality: A Prospective Analysis in the SUN Cohort

Objectives Whether oxidative balance impacts mortality risk requires accounting not only for dietary patterns but also for lifestyle exposures. We aimed to investigate the association between an overall oxidative balance with all-cause, cardiovascular, and cancer mortality risk among participants in the Seguimiento Universidad de Navarra (SUN) Study, a Mediterranean cohort of middle-aged Spanish graduate students. Methods Using baseline information from 12 a priori selected dietary and non-dietary lifestyle pro- and antioxidants exposures — vitamins C and E, betacarotenes, minerals (Se, Zn, heme-Fe), polyphenols, total antioxidant capacity, body mass index, alcohol, smoking, and physical activity — we constructed an oxidative balance score (OBS) categorized in equal-weighting quartiles, with higher scores meaning greater antioxidant balance. Cox proportional hazards models were fitted to evaluate the association between the OBS and mortality risk. Cases were ascertained through consultation of the National Death Index. Results A total of 19,083 participants (mean [SD] age, 38.5 [12.4] years; 59.2% females) were included in the analysis. During a median follow-up of 12.2 years (interquartile range, 8.1–14.9), 421 deaths were identified, including 80 cardiovascular (CV) deaths and 215 cancer deaths. After adjustment for potential confounders, the hazard ratio between the highest quartile (predominance of antioxidant) vs. the lowest quartile (reference category) was 0.43 (95% confidence interval [CI], 0.29–0.66, P-trend < 0.001) for all-cause mortality; 0.19 (95% CI 0.07–0.50, P-trend = 0.012) for CV mortality; 0.47 (95% CI 0.26–0.84, P-trend = 0.012) for cancer mortality. The antioxidant balance of dietary exposures and lifestyle exposures contributed towards reducing mortality risk, however, the individual effects were smaller than the combination of both exposures, suggesting the utility of the OBS to reflect the synergistic effect between the individual components. Conclusions Our findings suggest a strong inverse association between OBS score and decreased all-cause, CV, and cancer mortality. Individuals exposed to both antioxidant dietary and lifestyle factors may potentially experience the lowest mortality risk. Funding Sources Instituto de Salud Carlos III, FEDER, Navarra Regional Government and University of Navarra.

Association of Oxidative Balance Score with the Metabolic Syndrome in a Sample of Iranian Adults

Objective. We aimed to assess the association of the oxidative balance score (OBS) with metabolic syndrome (MetS) in adults. Design. A population-based cross-sectional study Setting. Health centers from five districts in Tehran, Iran. Methods. We recruited 847 participants with an age range of 18-65 years. Dietary intake was assessed by a semiquantitative food frequency questionnaire with 168 items. The OBS was calculated by using the following 13 dietary and nondietary anti- and prooxidant components: dietary antioxidants (selenium, fiber, β-carotene, vitamin D, vitamin C, vitamin E, and folate), dietary prooxidants (iron and saturated and polyunsaturated fatty acids), and nondietary anti- (physical activity) and prooxidants (smoking and obesity). The odds ratio (OR) and 95% confidence interval (CI) of the MetS and its components across tertiles of the OBS were calculated by logistic regression analysis, controlling for age, sex, energy intake, occupation, and educational level. Results. The range of OBS was between 16 and 39. Being in the top versus the bottom tertile of the OBS was not associated with the MetS ( OR = 0.71 , 95% CI 0.48-1.03; P = 0.07 ), after controlling for potential confounders. Higher OBS score was associated with a lower likelihood of abdominal obesity (OR: 0.55, 95% CI: 0.38-0.81; P = 0.003 ) and increased diastolic blood pressure (OR: 0.64, 95% CI: 0.41-0.99; P = 0.04 ). Higher OBS was not associated with other components of the MetS. Conclusion. Overall, the present study showed that there was no significant relationship between OBS and MetS in Tehranian adults.

Higher Oxidative Balance Score Is Associated with Better Glycemic Control among Iranian Adults with Type-2 Diabetes

The oxidative balance score (OBS) is a measure of combined pro- and anti-oxidant exposure status, with a higher OBS representing a predominance of anti- over pro-oxidant exposures. We aimed to examine the association of OBS and glycemic control among Iranian adults with type-2 diabetes. This cross-sectional study was conducted among 476 adults with type-2 diabetes (mean age 56.2 y; 66.6% female). Fasting glycosylated hemoglobin (HbA1c) and serum glucose (FSG) levels were measured as markers of glycemic control. The OBS was calculated by combining information from a total of 18 a priori selected pro- and anti-oxidant components. These components were comprised of the following four categories: dietary anti-oxidants (i.e., dietary intakes of selenium, fiber, retinol, α-carotene, β-carotene, β-cryptoxanthin, lutein, lycopene, vitamin D, vitamin E, folate, and vitamin C); dietary pro-oxidants (i.e., dietary intakes of iron, saturated fatty acid, and poly-unsaturated fatty acid); non-dietary anti-oxidants (i.e., physical activity); and non-dietary pro-oxidants (i.e., smoking and obesity). After adjusting for several potential confounders in the analysis of covariance models, multivariable adjusted means of HbA1c and FSG of subjects in the highest tertile of OBS were significantly lower than those in the lowest tertile (for HbA1c: mean difference –0.73%; and for FSG: mean difference –10.2 mg/dL; both P < 0.050). The findings suggest that a higher OBS, indicating a predominance of anti- over pro-oxidant exposures, is associated with a better glycemic control among Iranian adults with type-2 diabetes. However, future prospective studies of adequate methodological quality are warranted to confirm these findings.

Dietary Oxidative Balance Score and Disease Characteristics in Patients with Rheumatoid Arthritis (P01-036-19)

Objectives Rheumatoid arthritis (RA) is an autoimmune disease accompanied by pain, joint stiffness, and swelling, impacting quality of life. RA is also an articular disorder affecting multiple organ systems. Oxidative stress and antioxidants may play a role in the disease process. The oxidative balance score (OBS) is a composite estimate of exogenous dietary, lifestyle, and medication factors associated with antioxidant and pro-oxidant properties. This study examined the relationship between OBS and disease activity in RA. Methods 84 adults with RA (mean age: 52.9 ± 14.4 years; RA disease duration: 13.5 ± 9.2 years) were recruited from the NYU Langone Orthopedic Center. Disease activity was assessed via C-reactive protein, erythrocyte sedimentation rate, and the Multi-Dimensional Health Assessment Questionnaire, which includes self-reported measures of physical function, pain, & global status (summed into the RAPID3 score), fatigue, painful joint count, and duration of morning stiffness. Higher scores indicate greater disease activity. Participants completed 7-day food records, which were analyzed using Nutrition Data System for Research. OBS was calculated by analyzing 13 a priori-defined pro-oxidant (polyunsaturated fatty acid and iron) and antioxidant (selenium, vitamin C, vitamin E, α-carotene, β-carotene, lutein + zeaxanthin, lycopene, cryptoxanthine; use of aspirin and non-steroidal anti-inflammatory drugs, and alcohol) exposure factors. A higher OBS scored indicated more antioxidant and less pro-oxidant exposure. Partial correlations examined the relationship between OBS and disease activity, while controlling for age, using IBM SPSS Statistics. Results There was a negative association between OBS and duration of morning stiffness (r = −0.290, P = 0.010); as OBS increased, duration of morning stiffness decreased. Although not statistically significant, there was a negative trend between OBS and physical function (r = −0.180, P = 0.113), pain (r = −0.194, P = 0.086), and RAPID3 (r = −0.195, P = 0.103); as OBS increased, physical function, pain, and disease activity improved. No statistically significant relationships were seen between OBS and the other measures of disease activity. Conclusions In this study, a higher OBS score was associated with lower disease activity. More research is needed to understand the relationship of these lifestyle exposures to RA. Funding Sources NYU Steinhardt Research Challenge Grant.

Oxidative Balance Score and the Risk of End-Stage Renal Disease and Cardiovascular Disease

Background: Oxidative balance score (OBS) is a composite measure of oxidative stress-related exposures. The aim of this study was to investigate the association between OBS, end-stage renal disease (ESRD), and cardiovascular disease (CVD). Methods: Using data from the Chronic Renal Insufficiency Cohort, we calculated the main exposure OBS by summing up 12 apriori-defined pro- and antioxidant factors obtained from the diet history questionnaire and lifestyle assessment. We divided OBS into quartiles (Q1-Q4), with Q1 (predominance of pro-oxidants) as the reference. We analyzed OBS quartiles as an ordinal variable. Crude and adjusted hazards ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models for time to ESRD and CVD. Results: Compared to Q1, Q4 (high antioxidant) was associated with ESRD in the crude model (HR 1.35, 95% CI 1.08-1.69) and adjusting for age, sex, and race (HR 1.36, 95% CI 1.09-1.71) but not in the fully adjusted model (HR 1.12, 95% CI 0.84-1.51). HR of ESRD increased as the OBS quartiles increased in the crude model (ptrend < 0.05) but not in the fully adjusted model (ptrend = 0.30). Compared to Q1, Q4 was associated with CVD in the crude (HR 1.33, 95% CI 1.06-1.68) but not adjusted models. The HR of CVD increased with an increase in OBS quartiles in the crude model (ptrend < 0.05). Conclusion: The reverse association between OBS and progression to ESRD suggests that perhaps the effect of oxidative balance-related exposure is different in the setting of established chronic kidney disease.