Association between oxidative balance score and cardiometabolic multimorbidity: differential mortality, mediation
Siyuan Tan1, Gaoming Zeng1, Ting Huang2
1Department of Cardiology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Furong District, Changsha City, Hunan Province, People's Republic of China.
Insights
A higher oxidative balance score (OBS), reflecting diet and lifestyle, is linked to lower cardiometabolic multimorbidity (CMM) and reduced mortality risk. This score may aid in assessing cardiometabolic health and predicting outcomes.
Area of Science:
- Nutrition and Dietetics
- Cardiovascular Health
- Epidemiology
Background:
- Cardiometabolic multimorbidity (CMM) presents a significant global health challenge, increasing morbidity and mortality.
- The oxidative balance score (OBS), a composite measure of diet and lifestyle factors, has not been extensively studied in relation to CMM and mortality.
Purpose of the Study:
- To investigate the association between the oxidative balance score (OBS) and cardiometabolic multimorbidity (CMM).
- To evaluate the relationship between OBS and all-cause, cardiovascular, and non-cardiovascular mortality.
- To explore potential mediating pathways and key predictive components of OBS for CMM and mortality.
Main Methods:
- Analysis of 11,365 participants from the National Health and Nutrition Examination Survey (NHANES).
- Utilized logistic regression, Cox proportional hazards models, and restricted cubic splines to assess OBS associations.
- Employed mediation analysis and machine learning (LightGBM) to identify mediators and predictors.
Main Results:
- Higher OBS was associated with lower CMM prevalence and reduced odds of CMM (OR=0.96).
- Each 5-point increase in OBS correlated with reduced all-cause mortality risk (HR=0.85), with similar trends for cardiovascular and non-cardiovascular mortality.
- Inflammatory and insulin resistance pathways partially mediated the OBS-mortality association; key predictors included BMI, physical activity, and vitamin intake.
Conclusions:
- Elevated OBS is linked to decreased CMM prevalence and lower mortality risk, particularly in individuals without CMM.
- Inflammatory and insulin resistance pathways play a partial role in mediating these associations.
- OBS shows potential as a valuable tool for cardiometabolic risk assessment.
Background:
Cardiometabolic multimorbidity (CMM) is a major global health burden associated with increased morbidity and mortality. The oxidative balance score (OBS), a composite measure of dietary and lifestyle factors related to oxidative balance, has not been systematically evaluated in relation to CMM and mortality.
Methods:
We analyzed 11,365 NHANES participants. Logistic regression, Cox proportional hazards models, and restricted cubic splines were used to evaluate associations of OBS with CMM and mortality. Mediation analysis further evaluated inflammatory and insulin resistance indicators as potential mediators among non-CMM participants. Machine learning identified key OBS components for predicting outcomes.
Results:
Among 11,365 participants (median age, 45 years; 52.55% male), higher OBS was associated with more favorable sociodemographic characteristics and a lower prevalence of chronic conditions. OBS was lower in participants with CMM and decreased further with a greater number of comorbidities. CMM was associated with higher mortality, whereas each 5-point increase in OBS was associated with lower odds of CMM (OR = 0.96) and reduced risks of all-cause mortality (HR = 0.85), with similar inverse associations observed for cardiovascular and non-cardiovascular mortality. These associations remained robust among non-CMM individuals but were attenuated among those with CMM. Mediation analysis suggested partial mediation of the association between OBS and mortality through inflammatory and insulin resistance pathways. In machine learning analysis, LightGBM achieved the best predictive performance (AUC: 0.817 and 0.849), with body mass index, physical activity, and vitamin intake identified as key predictors.
Conclusion:
Higher OBS was associated with lower CMM prevalence and reduced mortality risk among non-CMM participants, partially through inflammatory and insulin resistance pathways, underscoring its potential relevance in cardiometabolic risk assessment.
