Negative and nonlinear association between oxidative balance score and hyperuricemia: a cross-sectional analysis...

Hyperuricemia (HUA) is a prevalent metabolic disorder linked to substantial morbidity. Oxidative stress is a key pathogenic mechanism, yet the cumulative effect of dietary and lifestyle pro- and anti-oxidants remains unclear. The Oxidative Balance Score (OBS) offers a comprehensive metric of oxidative potential. This study aimed to investigate the association between OBS and HUA in a large, nationally representative US adult population.

This cross-sectional study included 29,876 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The OBS was constructed from 16 dietary and 4 lifestyle components. HUA was defined as serum uric acid ≥ 7.0 mg/dL for men and ≥ 6.0 mg/dL for women. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between OBS quartiles and HUA. Restricted cubic splines (RCS) were employed to model non-linear relationships. Subgroup analyses were conducted by gender, age, and estimated glomerular filtration rate (eGFR).

The overall prevalence of HUA was 20.2%. A significant inverse association was observed between OBS and HUA. After adjusting for multiple confounders, participants in the highest OBS quartile (Q4, most anti-oxidant profile) had a 42% lower odds of HUA compared to those in the lowest quartile (Q1) (OR: 0.58, 95% CI: 0.51-0.66, P-trend < 0.001). This association was more pronounced for lifestyle OBS (OR for Q4 vs. Q1: 0.35, 95% CI: 0.29-0.42) than for dietary OBS (OR for Q4 vs. Q1: 0.70, 95% CI: 0.61-0.81). RCS analysis revealed a significant nonlinear relationship (P-nonlinearity < 0.001), with the protective effect of OBS plateauing at higher scores. The inverse association was consistent across gender and age subgroups but appeared stronger in individuals with normal renal function (eGFR ≥ 90 mL/min/1.73m²).

A higher OBS, reflecting a lifestyle and diet rich in antioxidants, is independently and non-linearly associated with a lower prevalence of hyperuricemia. These findings highlight the importance of a holistic approach targeting overall oxidative balance, particularly through modifiable lifestyle factors, for the primary prevention of hyperuricemia. Key Points • A higher Oxidative Balance Score is linked to lower hyperuricemia prevalence. • Lifestyle factors show a stronger protective association than dietary factors. • The relationship is nonlinear, with benefits plateauing at higher scores.