Oxidative balance score and risk for incident prostate cancer in a prospective U.S. cohort study

Oxidative balance score as a useful predictive marker for new-onset type 2 diabetes mellitus in Korean adults aged 60 years or older: The Korean Genome and Epidemiologic Study-Health Examination (KoGES-HEXA) cohort

BACKGROUND

The oxidative balance score (OBS) is a comprehensive pro- and anti-oxidative marker for assessing the risk of various metabolic diseases and cancers. However, it is not well established whether OBS is related to type 2 diabetes mellitus (T2DM), particularly in elderly populations. Therefore, our objective was to investigate the longitudinal effect of OBS on T2DM in a large cohort of Korean adults aged 60 years and older.

METHODS

We assessed the data for 3516 participants aged 60 years and older without diabetes mellitus from the Health Examinees cohort of the Korean Genome and Epidemiology Study. We classified the participants into three groups according to OBS tertiles. We prospectively assessed hazard ratios (HRs) with 95 % confidence intervals (CIs) for new-onset T2DM using multivariable Cox proportional-hazard regression models during the mean 3.5 years following the baseline survey.

RESULTS

A total of 109 participants (3.1 %) developed T2DM during a mean follow-up of 3.5 years. The incidence rates per 1000 person-years were 11.73 for the lowest OBS tertile (T1), 8.19 for the second tertile (T2), and 6.23 for the highest tertile (T3). Adjusting for all confounding factors, compared with the referent T1, the HR (95 % CI) of new-onset T2DM was not significant in T2 (0.71 [0.47-1.07]) but was significant in T3 at (0.47 [0.30-0.75]) (p for trend = 0.002).

CONCLUSIONS

The study suggests that a OBS could serve as a valuable predictive marker for new-onset T2DM in older adults. Our study suggests that maintaining an appropriate body weight through healthy lifestyle modification has the potential to lower T2DM incidence in elderly. This implies that the OBS may be a useful tool for assessing the incidence of T2DM even in older individuals.

Association between oxidative balance score in adults with and without chronic kidney disease: 2011-2028 NHANES

Introduction

Oxidative stress status is associated with CKD; however, few studies have investigated this association. The oxidative balance score (OBS) reflects systemic stress status and consists of 16 anti-and pro-oxidant dietary factors and four anti-and pro-oxidant lifestyle factors. Higher OBS implies exposure to more antioxidants. The purpose of this study was to explore the association between OBS and CKD.

Methods

We enrolled 8,134 study participants from the 2011-2018 National Health and Nutrition Examination Survey and obtained OBS by adding the 20 dietary and lifestyle factors. Based on OBS, the participants were divided into three groups. We performed logistic regression, subgroup analyzes, and restricted cubic spline regression to explore the association between OBS and CKD. In addition, we tested the adjusted model.

Results

OBS was negatively associated with CKD (OR: 0.54; 0.66, 0.82). After adjusting for all confounders, when dietary OBS was >20, the prevalence of CKD was reduced by 42% for each unit increase in OBS (p < 0.05). The negative associations of total OBS, dietary OBS, and lifestyle OBS with CKD were more significant in the female group. When the total OBS was ~20, the trend of decreasing prevalence in the female group was more significant.

Conclusion

OBS is negatively associated with chronic kidney disease.

Association between the oxidative balance score and low muscle mass in middle-aged US adults

Background

Oxidative Balance Score (OBS) is a tool for assessing the oxidative stress-related exposures of diet and lifestyle. The study aimed to investigate the association between OBS and low muscle mass.

Methods

Overall, 6,307 individuals over the age of 18 were assessed using data from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES). Weighted logistic regression and models were used, together with adjusted models.

Results

There was a negative relationship between OBS and low muscle mass [odds ratio (OR): 0.96, 95% confidence interval (CI): 0.94-0.97, p< 0.0001] using the first OBS level as reference. The values (all 95% CI) were 0.745 (0.527-1.054) for the second level, 0.650 (0.456-0.927) for the third level, and 0.326 (0.206-0.514) for the fourth level (P for trend <0.0001). Independent links with low muscle mass were found for diet and lifestyle factors. A restricted cubic spline model indicated a non-linear association between OBS and low muscle mass risk (P for non-linearity<0.05). In addition, the inflection points of the nonlinear curves for the relationship between OBS and risk of low muscle mass were 20.

Conclusion

OBS and low muscle mass were found to be significantly negatively correlated. By modulating oxidative balance, a healthy lifestyle and antioxidant rich diet could be a preventive strategy for low muscle mass.

Association between the oxidative balance score and thyroid function: Results from the NHANES 2007-2012 and Mendelian randomization study

BACKGROUND

Oxidative stress is a significant contributor to the development of various diseases, and the oxidative balance score (OBS) is a valuable tool for assessing the impact of dietary and lifestyle factors on oxidative stress in humans. Nevertheless, the precise relationship between OBS and thyroid function in adults remains elusive.

METHODS

This cross-sectional study comprised 6222 adult participants drawn from the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2012. Employing weighted multivariable linear regression modeling, the study estimated the connection between OBS quartiles and thyroid functions. The causal relationship between OBS components and thyroid function was analyzed by Mendelian randomization (MR).

RESULTS

We found a significant negative correlation between OBS and free thyroxine (FT4) and total thyroxine (TT4). Univariate and multivariate MR Analyses showed a causal relationship between BMI and FT4. Copper, smoking, and riboflavin showed a causal relationship with FT4 after moderation.

CONCLUSION

We found that a lifestyle high in antioxidant exposure reduced FT4 and TT4 levels in the population. We suggest that BMI, Copper, and Riboflavin are important factors in the regulation of FT4 levels.

Association between oxidative balance score and sarcopenia in older adults

Sarcopenia is a progressive skeletal muscle disease in which oxidative stress has been proposed as one of the primary markers. The oxidative balance score (OBS) represents the oxidative balance of a person's dietary pattern using the merged intake of anti-oxidants and pro-oxidants. Therefore, the present study assessed the association between OBS and sarcopenia in Iranian older adults. In the current study, 80 people with sarcopenia and 80 without it were considered the case and control groups, respectively. All controls were matched by sex with cases. To confirm sarcopenia, skeletal muscle mass index (SMI), handgrip strength (HGS) measurement, and gait speed were used. Also, body composition was measured by bioelectrical impedance analysis (BIA). A valid and reliable food frequency questionnaire (FFQ) was used to assess all participants' dietary intake of pro-oxidants and anti-oxidants. Conditional logistic regression was applied to assess the association between OBS and sarcopenia. In the bivariate model, we observed lower odds of sarcopenia in the second and last tertile of OBS in comparison to the first tertile (T) (T2 - odds ratio (OR) = 0.414, 95% confidence interval (CI) : 0.186-0.918 and T3 - OR = 0.101, 95% CI: 0.041-0.248). After adjusting for potential confounders, the association was not significant in second and last tertile of OBS in comparision to the first one. The present study's findings demonstrated that overcoming exposure to anti-oxidants over pro-oxidants, as illustrated by a higher OBS, is not related to lower odds of sarcopenia in older adults.

Oxidative Balance Score and New-Onset Type 2 Diabetes Mellitus in Korean Adults without Non-Alcoholic Fatty Liver Disease: Korean Genome and Epidemiology Study-Health Examinees (KoGES-HEXA) Cohort

The oxidative balance score (OBS) is a novel composite of pro- and anti-oxidative markers for assessing the risk of cardiometabolic diseases and non-alcoholic fatty liver disease (NAFLD). However, it has not yet been established whether the OBS is related to type 2 diabetes mellitus (T2DM), especially in a population without NALFD. Therefore, we aimed to investigate the longitudinal effect of the OBS on T2DM in a large cohort of Korean adults without NALFD. Data were assessed from 9798 participants without NALFD from the Korean Genome and Epidemiology Study-Health Examinees (KoGES-HEXA) cohort. The participants were divided into three groups according to OBS tertiles, identified as T1-T3. We prospectively assessed the hazard ratios (HRs) with 95% confidence intervals (CIs) for new-onset T2DM using multivariable Cox proportional hazard regression models over 6 years following the baseline survey. During the mean 3.5 years of follow-up, 145 individuals (1.48%; 56 men and 89 women) developed T2DM. The HRs of T2DM for the OBS tertiles were 0.79 (95% CI, 0.53-1.18) and 0.60 (95% CI, 0.39-0.93) in the T2 and T3 groups after adjusting for metabolic parameters in subjects without NALFD, respectively; however, the T2 group did not show statistical significance toward a decrease in incident T2DM. A low OBS may be a useful predictive marker in new-onset T2DM for middle-aged and older subjects without NALFD. This implies that the OBS could be an additional valuable tool for assessing the incidence of T2DM among individuals without NAFLD.

Association between oxidative stress exposure and colorectal cancer risk in 98,395 participants: results from a prospective study

Background

The intricate role of oxidative stress (OS) in colorectal cancer (CRC) initiation is underscored by an imbalance between pro-oxidants and antioxidants. Utilizing the Oxidative Balance Score (OBS) as a metric, this study aims to investigate the association between OS exposure and CRC risk, while also examining potential sex-specific differences in a large U.S. cohort.

Methods

The study included 98,395 adults from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. To construct the OBS, 14 dietary and lifestyle factors intricately associated with oxidative stress were quantified. A higher OBS value indicated a more favorable oxidative balance pattern or diminished OS exposure. Due to sex-specific differences in OBS, associations were evaluated separately for men and women based on Cox regression analysis. Subgroup analyses were conducted to elucidate potential modifiers.

Results

During 867,963.4 person-years of follow-up, 1,054 CRCs occurred. The mean (SD) age and OBS were 65.52 (5.73) years and 14.09 (3.95) points, respectively. In the fully adjusted Cox model, we observed an inverse association between OBS and CRC incidence in women (HRQ5vsQ1: 0.72; 95% CI: 0.52, 0.99; P for trend = 0.018) but not men. Subgroup analyses revealed the inverse association was more pronounced among women without versus with a family history of CRC (HRQ5 vsQ1: 0.66, 95% CI: 0.47-0.93; P for trend = 0.001; P for interaction = 0.001). The results remained robust after several sensitivity analyses.

Conclusion

Higher OBS was associated with lower CRC risk in women but not men; this inverse association was stronger among women without a family history of CRC. These findings suggest exposure to OS may confer sex-specific CRC risk effects, especially for women without a family history of CRC.

Oxidative balance score and risk of cancer: a systematic review and meta-analysis of observational studies

BACKGROUND

The oxidative balance score (OBS) has been utilized to assess the overall pro- and antioxidant exposure status in various chronic diseases. The current meta-analysis was carried out to pool the association between OBS and the risk of cancer.

METHODS

We systematically searched the Web of Science, PubMed, Scopus, Embase, and Google Scholar up to August 2023. All observational studies which evaluated the association of OBS with the risk of cancers were included. There was no time of publication or language restrictions. Heterogeneity between studies was assessed using the Chi-square-based Q-test and the I2. A random-effects model meta-analysis was conducted to estimate the pooled effect sizes. Possible sources of heterogeneity were explored by subgroup and meta-regression analysis.

RESULTS

Totally, 15 studies (9 case-control and 6 cohorts) were eligible for meta-analysis. Random effect model meta-analysis of case-control studies showed that higher OBS significantly decreases the odds of cancers (pooled OR: 0.64, 95% CI: 0.54, 0.74). In the cohort studies, the association of OBS with the risk of cancers was not significant (pooled HR: 0.97, 95% CI: 0.80,1.18). The subgroup analysis showed that cancer type and gender were the potential sources of heterogeneity.

CONCLUSION

Our results show an inverse and significant association between higher OBS and odds of colorectal cancers in case-control and cohort studies. In the case of prostate cancer in cohort studies, our results did not align with the hypothesis. Considering the importance of diet and antioxidant balance in the conditions of malignancy, it is suggested to conduct more comprehensive studies with standard measurement methods to obtain conclusive results.

Higher oxidative balance score decreases risk of stroke in US adults: evidence from a cross-sectional study

Background

The oxidative balance score (OBS) can be used to represent the overall burden of oxidative stress in an individual. This study aimed to explore the association between the risk of stroke and OBS.

Methods and materials

The National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 was used to extract a series of variables for participants who took the stroke questionnaire. The construction of OBS relied on diet and lifestyle components, which included 16 nutrients and 4 lifestyle factors. Weighted multivariable-adjusted logistic regression was performed to investigate the association between stroke risk and OBS. A stratified analysis was also conducted. The dose-response relationship between stroke risk and OBS was elucidated by performing a restricted cubic spline function.

Results

A total of 20,680 participants were included for analysis, 768 of whom suffered from stroke. Based on weighted multivariable logistic regression analysis, we discovered that the stroke prevalence decreased by 2% for each OBS unit added [OR: 0.98 (0.97-1.00), P < 0.01]. For the OBS subgroup, we also discovered that higher OBS was related to a reduction in the risk of stroke [Q4 vs. Q1: OR:0.65 (0.46-0.90), P < 0.01]. The prevalence of stroke declined by 3% with every OBS unit added to the diet component [OR: 0.97 (0.96-0.99), P < 0.01]. For the dietary OBS subgroup, higher OBS in diet components was associated with a decrease in the prevalence of stroke [Q4 vs. Q1: OR: 0.65, (0.47-0.91), P < 0.05]. Further stratified analysis showed that every OBS unit raised was associated with a decline in stroke prevalence, which was statistically significant in participants in subgroups of ≥60 years, female, no-diabetes mellitus and no-hypertension. OBS and stroke prevalence were correlated in a linear manner.

Conclusion

The study found that a higher OBS was associated with a decrease in stroke prevalence, which could be a significant indicator for evaluating stroke risk.

The Association between Oxidative Balance Score and Urinary Levels of 8-Hydroxydeoxyguanosine among Japanese Adults

The oxidative balance score (OBS), wherein higher OBSs indicate lower oxidative stress, was designed to assess a composite measure of multiple pro-oxidant and antioxidant effects on an individual's oxidative stress status. This study aimed to evaluate whether OBSs were inversely associated with urinary levels of 8-hydroxydeoxyguanosine (8-OHdG)-an oxidative stress marker-among Japanese adults. This cross-sectional study was based on data obtained during 2010-2012. Overall, 7552 participants from the J-MICC Study Saga who answered a self-administered food frequency questionnaire were recruited for the final analysis. OBSs were calculated from 11 pro-oxidant and antioxidant lifestyle factors, including dietary intake, physical activity, and alcohol and smoking status. Urinary 8-OHdG values were corrected by creatinine level (ng/mg creatinine). Our findings revealed a higher total OBS was significantly associated with lower urinary 8-OHdG/creatinine levels after adjustment for covariates in men and women (p for trend < 0.01 in both sexes). We performed a multiple regression analysis of the association between OBSs and urinary 8-OHdG/creatinine levels stratified by age, body mass index (BMI), and menopausal status and found consistent negative associations in most groups for both sexes. No significant differences in the 60-64 age group for women (standardized β = -0.09, p = 0.13) or BMI < 18.5 kg/m2 for men (standardized β = -0.18, p = 0.17) were observed. A higher OBS had a strong inverse association with urinary 8-OHdG/creatinine levels in men and women among Japanese adults. The OBS might be a useful tool for evaluating the roles of oxidative stress-related lifestyle factors, including diet.

Oxidative balance score inversely associated with the prevalence and incidence of metabolic syndrome: analysis of two studies of the Korean population

Background

Pro-oxidant/antioxidant imbalances leading to chronic inflammation and insulin resistance can contribute to the development of metabolic syndrome (MetS). Oxidative Balance Score (OBS), a comprehensive measure of exposure to pro- and anti-oxidants, represents an individual's total oxidative balance. This study aimed to evaluate the association between OBS and MetS using two large datasets.

Methods

We analyzed data from 2,735 adults older than 19 years from the 2021 Korean National Health and Nutritional Examination Survey (KNHANES) and 5,807 adults aged 40-69 years from the Korean Genome and Epidemiology Study (KoGES). In each dataset, OBS was categorized into sex-specific tertiles (T).

Results

In KNHANES, the odds ratios and 95% confidence intervals for prevalent MetS in T3, compared to T1, were 0.44 (0.29-0.65) in men and 0.34 (0.23-0.50) in women after adjusting for confounders. In KoGES, the hazard ratios and 95% confidence intervals for incident MetS in T3, compared to T1, were 0.56 (0.48-0.65) in men and 0.63 (0.55-0.73) in women after adjusting for confounders.

Conclusion

OBS appears to be inversely related to MetS, which suggests that adopting lifestyle behaviors that decrease oxidative stress could be an important preventive strategy for MetS.

Oxidative balance score is inversely associated with the incidence of non-alcoholic fatty liver disease

BACKGROUND & AIMS

The contribution of the balance between overall oxidative stress and antioxidant status in non-alcoholic fatty liver disease (NAFLD) is unclear. The oxidative balance score (OBS) comprises dietary and lifestyle pro- and antioxidant components that indicate the overall oxidative stress burden. We investigated the association between OBS and the incidence of NAFLD in middle-aged and older Korean adults.

METHODS

Among the 10,030 participants of the Korean Genome and Epidemiology Study_Ansan and Ansung cohort, 5065 without NAFLD at baseline were selected for secondary analysis. OBS was categorized into quartiles. Multiple Cox proportional hazard regression analyses were performed to estimate the hazard ratio (HR) and 95% confidence interval (CI) for NAFLD incidence by sex-specific OBS quartile groups after adjusting for confounders.

RESULTS

During the follow-up period (median 13.4 years), 913 (43.2%) men and 1288 (43.9%) women were newly diagnosed with NAFLD. Compared with that of the lowest quartile (Q1) group, the adjusted HR (95% CI) for NAFLD incidence in Q2, Q3, and Q4 groups was 0.85 (0.71-1.00), 0.65 (0.54-0.78), and 0.50 (0.40-0.62) in men, and 0.85 (0.73-0.99), 0.66 (0.56-0.77), and 0.48 (0.40-0.59) in women, respectively, and for NAFLD incidence, per incremental change in OBS, was 0.90 (0.87-0.92) in men and 0.88 (0.86-0.90) in women.

CONCLUSIONS

A higher OBS was significantly associated with a lower risk for NAFLD incidence. Maintaining a healthy lifestyle and an antioxidant-rich diet is a potentially viable strategy for preventing NAFLD.

Oxidative balance score and dietary phytochemical index can reduce the risk of colorectal cancer in Iranian population

BACKGROUND

No previous study has assessed the association between oxidative balance score (OBS) and dietary phytochemical index (DPI) with colorectal cancer (CRC) simultaneously. Therefore, this study investigated the association between OBS and DPI with the odds of CRC among the Iranian population.

METHODS

This hospital-based age and sex-matched case-control study was conducted between September 2008 and January 2010 (142 controls and 71 cases were entered for analysis). New diagnosed CRC cases were selected from the Cancer Institute, Imam Khomeini Hospital of Tehran. Dietary intakes were determined by a semi-quantitative food frequency questionnaire (FFQ). Then, dietary indices were calculated by food items and nutrient intake. Logistic regression was utilized for assessing the tertiles of OBS and DPI.

RESULTS

In multivariate analysis, OBS was associated with a 77% reduction in CRC odds in the last tertile than the first tertile (odds ratio (OR) = 0.23, confidence interval (CI): 0.07-0.72, P_trend = 0.017). Also, we found a 64% reduction in CRC odds in the last tertile of DPI compared to the first tertile (OR = 0.36, CI: 0.15-0.86, P_trend = 0.015).

CONCLUSIONS

A diet rich in phytochemicals and anti-oxidants, including fruits and vegetables (citrus fruits, colored berries, and dark-green leafy vegetables) and whole grains, may reduce the CRC odds.

PM2.5 exposure and its interaction of oxidative balance score on ovarian cancer survival: A prospective cohort study

Recent evidence advises particles with a diameter of 2.5 µm or less (PM_2.5) might be a prognostic factor for ovarian cancer (OC) survival. The oxidative balance score (OBS) incorporates diet-lifestyle factors to estimate individuals' anti-oxidant exposure status which may be relevant to cancer prognosis. We aimed to investigate the roles of PM_2.5, and OBS and their interaction in OC prognosis. 663 patients with OC were enrolled in the current study. Satellite-derived annual average exposures to PM_2.5 based on patients' residential locations. The OBS was calculated based on 16 different diet-lifestyle components derived using an acknowledged self-reported questionnaire. The Cox regression model was performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS). We also assessed the effect of modification between PM_2.5 and OS by OBS via interaction terms. During a median follow-up of 37.57 (interquartile:35.27-40.17) months, 123 patients died. Compared to low-concentration PM_2.5 exposure, high PM_2.5 during 1 year before diagnosis was associated with worse OC survival (HR= 1.19, 95% CI = 1.01-1.42). We observed an improved OS with the highest compared with the lowest OBS (HR = 0.46, 95% CI = 0.27-0.79, P for trend < 0.05). Notably, we also found an additive interaction between low OBS and high exposure to PM_2.5, with the corresponding associations of PM_2.5 being more pronounced among participants with lower OBS (HR = 1.42, 95% CI = 1.09-1.86). PM_2.5 may blunt OC survival, but high OBS represented an antioxidative performance that could alleviate the adverse association of PM_2.5 and OS.

Adherence to oxidative balance scores and lower odds of non-alcoholic fatty liver disease: a case-control study

Evidence has also shown that oxidative stress and systemic inflammation, or in other words, disruption of the oxidant and antioxidant balance, can play an important role in the initiation or progression of NAFLD. The purpose of this study was to investigate the associations between the oxidative balance scores (OBS) and the risk of NAFLD. 552 healthy and 340 patients adult over the age of 18 with NAFLD participated in this case-control research. A validated 168-item quantitative food frequency questionnaire (FFQ) and indicators of physical activity, obesity, and smoking status were used to assess OBS score. The connection between OBS and NAFLD was discovered using binary logistic regression. The mean (± SD) age and (body mass index) BMI of the study population was 40.22 ± 9.79 years and 29.06 ± 3.92 kg/m², respectively. The mean ± SD of OBS was 41.48 ± 5.23. After adjustment for potential confounders, higher scores of adherence to the OBS conferred a protection for the presence of NAFLD (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.15-0.49; P for trend < 0.001). The findings of the present study indicate an approximately 80% reduction in the odds of developing NAFLD with higher OBS adherence in the overall population. However, prospective studies are needed to further investigate this association.

Association between the Oxidative Balance Score and Incident Chronic Kidney Disease in Adults

Oxidative stress is a novel risk factor for chronic kidney disease (CKD). The oxidative balance score (OBS) was developed to represent the overall oxidative balance based on dietary and lifestyle pro-oxidant and antioxidant components. The aim of this study is to verify the relationship between the OBS and the incidence of CKD. Data from 5795 participants without CKD at the baseline survey of the Korean Genome and Epidemiology Study were analyzed. Participants were classified into sex-specific OBS tertiles. During the mean follow-up period of 13.6 years, 286 men and 382 women newly developed CKD. The Cox proportional hazard spline curve revealed an inverse dose-response association between the OBS and incident CKD in both men and women. Multiple Cox proportional hazard regression analysis revealed that the adjusted hazard ratios (95% confidence intervals) for sex-specific highest (T3) and middle (T2) OBS tertile groups were 0.80 (0.59-1.08) and 0.70 (0.51-0.95), respectively, in men and 0.76 (0.59-0.98) and 0.73 (0.55-0.96), respectively, in women, with the sex-specific lowest OBS tertile group (T1) as the reference. These results suggest that a healthy diet and lifestyle that increases the OBS may help prevent CKD in both men and women.

Dietary Antioxidant Capacity Indices are Negatively Correlated to LDL-Oxidation in Adults

INTRODUCTION

Former research studies have demonstrated controversial associations between dietary indices and oxidative stress biomarkers including oxidized low-density lipoprotein (ox-LDL) and malondialdehyde (MDA). So, in this cross-sectional study, we aimed to assess the association of dietary total antioxidant capacity (DTAC), oxidative balance score, and phytochemical index (PI) with ox-LDL/MDA in a healthy adult population of Shiraz, Iran.

METHODS

236 individuals participated in this cross-sectional study. DTAC, OBS, and PI were calculated using a 168-item food frequency questionnaire (FFQ), which was previously validated in Iran. We measured ox-LDL and MDA in blood samples of the participants using commercially existing kits. Crude and adjusted models of linear regression were used to evaluate the relation of dietary indices with ox-LDL and MDA.

RESULTS

There was a significant association between ox-LDL and DTAC in both crude (β = -1.55; 95% CI: -2.53, -0.58; P-trend = 0.002) and adjusted (β = -1.65 95% CI: -2.66, -0.64; P-trend = 0.001) models. Also, a negative association was observed between ox-LDL and PI in the crude (β = -1.26 95% CI: -2.33, -0.29; P-trend = 0.01) and adjusted (β = -1.36 95% CI: -2.38, -0.34; P-trend = 0.01) models.

CONCLUSION

Results of this study showed that DTAC and PI were inversely associated with ox-LDL as markers of lipid peroxidation. But no correlations were seen between MDA and dietary antioxidant indices.

Oxidative balance score reflects vascular endothelial function of Chinese community dwellers

Background: The oxidative balance score (OBS) is a composite estimate of the overall pro- and antioxidant risk status in an individual. The aim of this study is to explore the association between the OBS and vascular endothelial function in Chinese community dwellers. Methods: In total, 339 community dwelling adults (aged 20-75 years) were recruited in this study. The overall OBS was calculated on the basis of 16 pro- and antioxidant factors related to diet (measured by fasting blood samples) and lifestyle (evaluated by questionnaires). The dietary OBS and lifestyle OBS were calculated on the basis of the corresponding components. Serum iso-prostaglandin F2α (FIP) was measured to evaluate the oxidative stress degree, and brachial artery blood flow-mediated dilation (FMD) was measured for vascular endothelial function. The FIP and FMD levels were dichotomized as "low" or "high" using the corresponding median values (low FIP, n = 159; high FIP, n = 180; low FMD, n = 192; and high FMD, n = 147). The components of the OBS were compared between the stratified FIP and FMD groups. Logistic regression was used to analyze the OBS associations with FIP and FMD. Results: The higher overall OBS and dietary OBS were associated with lower FIP (p < 0.001), whereas the higher overall OBS (p < 0.01) and dietary OBS (p < 0.05) were associated with higher FMD. The lifestyle OBS was not associated with FIP and FMD (p > 0.05). Except for the body mass index (BMI) and low physical activity, all other OBS components were significantly different between the low FIP and high FIP groups (p < 0.05). Four diet-related antioxidants (α-carotene, zeaxanthin, α-tocopherol, and γ-tocopherol) showed significant differences between the high and low FMD groups (p < 0.05). Conclusion: The decreasing OBS level was associated with low endothelial function and high oxidative stress. The dietary OBS, rather than the lifestyle OBS, was more closely associated with endothelial function.

Association between oxidative balance score and new-onset hypertension in adults: A community-based prospective cohort study

Introduction

Oxidative stress plays a key role in the pathophysiology of hypertension development. The oxidative balance score (OBS) comprises dietary and lifestyle pro- and anti-oxidant components and reflects the overall oxidative stress burden. We aimed to evaluate the association between the OBS and new-onset hypertension (HTN) using large, community-based, prospective Korean cohort data.

Methods

Among 10,030 participants aged 40-69 years included in the Korean Genome and Epidemiology Study, the data of 5,181 participants were analyzed. The hazard ratio (HR) and 95% confidence interval (CI) for new-onset HTN according to sex-specific OBS quartile groups were calculated using univariable and multivariable Cox proportional hazard regression analyses.

Results

During the mean 13.6-year follow-up period, 1,157 men and 1,196 women developed new-onset HTN. Compared to the Q1 group, the adjusted HRs (95%CI) for new-onset HTN in the Q2, Q3, and Q4 groups were 0.96 (0.82-1.16), 0.85 (0.72-0.99), and 0.71 (0.59-0.86) in men and 0.81 (0.69-0.95), 0.81(0.68-0.95), and 0.70 (0.57-0.84) in women, respectively.

Discussion

Individuals with high OBS are at lower risk of developing HTN. This study suggests that a healthy lifestyle and antioxidant rich diet could be a preventive strategy for HTN.

Adherence to Oxidative Balance Scores is Associated with a Reduced Risk of Breast Cancer; A Case-Control Study

We aimed to examine whether anthropometric indices, dietary factors, and nutrient intakes of women with and without breast cancer (BrCa) are associated with the oxidative balance score (OBS). This case-control study was carried out among 253 patients with BrCa and 267 healthy subjects aged >18 years. The OBS was calculated by using the following 13 dietary and non-dietary 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 binary logistic regression was used to determine the association OBS with BrCa. After adjusting for potential confounders in the final model, there was evidence that the odds of BrCa decreased with increasing categories of the OBS (OR = 0.53, 95% CI 0.28 - 0.98; P-trend = 0.021). When we made stratified analysis by menopausal status, OBS was inversely associated with odds of BrCa in premenopausal women after adjusting for potential confounders. No significant association was found between OBS and odds of BrCa among post-menopausal women. Our data suggest that OBS scores were associated with decreased BrCa risk in the overall population.

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.

Oxidative balance score and risk of osteoporosis among postmenopausal Iranian women

To our knowledge, this is the first study to examine the association of oxidative balance score (OBS) and risk of osteoporosis. Findings suggest that a predominance of anti- over pro-oxidant exposures, as reflected by a higher OBS, is associated with lower risk of lumbar spine osteoporosis among postmenopausal Iranian women.

PURPOSE

The oxidative balance score (OBS) is a combined measure of pro- and anti-oxidant exposure status, with a higher OBS indicating a predominance of anti- over pro-oxidant exposures. We aimed to examine the potential association of OBS and risk of osteoporosis among postmenopausal Iranian women, hypothesizing that a higher OBS is associated with lower risk of postmenopausal osteoporosis.

METHODS

This cross-sectional study was conducted among 151 postmenopausal Iranian women aged 50-85 y. Bone mineral density (BMD) at lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry, and osteoporosis was defined using the WHO criteria as a BMD T-score of ≤ - 2.5 standard deviations. The OBS was calculated by combining information from 17 a-priori selected pro- and anti-oxidant components classified in the following four categories: non-dietary pro-oxidants (i.e., obesity and smoking); non-dietary anti-oxidants (i.e., physical activity); dietary pro-oxidants (i.e., saturated fatty acid, poly-unsaturated fatty acid, and iron); and dietary anti-oxidants (i.e., fiber, vitamin E, folate, vitamin C, alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene, zinc, and selenium).

RESULTS

After controlling for several potential covariates in the multivariable-adjusted binary logistic regression analysis, subjects in the highest tertile of OBS had a lower risk of lumbar spine osteoporosis than those in the lowest tertile (odds ratio = 0.14; 95% confidence interval, 0.04-0.45; p = 0.001). The OBS was not associated with risk of femoral neck osteoporosis.

CONCLUSION

Findings suggest that a predominance of anti- over pro-oxidant exposures, as indicated by a higher OBS, is associated with lower risk of lumbar spine osteoporosis among postmenopausal Iranian women.

Oxidative Stress Indexes for Diagnosis of Health or Disease in Humans

Oxidative stress (OS) is the imbalance between oxidant and antioxidant molecules, in favor of oxidants, that causes aging and disease. Many studies have been published that demonstrate the relationship between OS and human health and disease; however, the following questions arise: (i) how are we sure that the OS is present in a biological process? (ii) Is the OS reported in the different investigations equivalent? (iii) What are the best oxidant and antioxidant markers for OS diagnosis? (iv) Can we establish the types and the intensity of the OS? (v) Does OS index could be useful for research and/or application in clinical medicine? In this regard, several indexes have been proposed to measure OS in humans relative to the state of health and disease, among which the following can be highlighted: Oxidative Stress Index (OSI), Tiol Ratios (-SH/TT, -SS/-SH, and-SS/TT), Glutathione Ratio (GSSG/GSH), Oxidative Stress Score (OSS), and OXY-index. Therefore, the aim of this review is to present the state of the art of knowledge about OS indexes for diagnosis of health or disease in humans. We searched for articles in English or Spanish in the PubMed/MEDLINE and Scopus electronic databases published up until May 2019. The keywords used were “oxidative stress,” “index,” and “oxidative stress index.” It was identified 11479 records in both databases, and 490 articles were analyzed. Our review suggests that all indexes analyzed allow diagnose and differentiate the OS related to human health and disease. Also, the studies on OSI, Oxy-score, and OSS indexes have proven to be reliable, practical, and with clinical utility. However, it is necessary to continue with longitudinal studies, especially assess the usefulness of the indexes in the clinical prognosis, and make comparative studies between the different indexes.

Relationship between oxidative balance score and quality of life in patients with osteoarthritis: Data from the Korea National Health and Nutrition Examination Survey (2014-2015)

Osteoarthritis (OA) has a multifactorial etiology that includes oxidative stress. Oxidative balance score (OBS) is a well-known indicator of oxidative stress. However, the association between OBS and OA has not been assessed. Thus, this study aimed to investigate the associations of OBS with OA and quality of life (QOL) in patients with OA.By using data from the Korea National Health and Nutrition Examination Survey VI, patients previously diagnosed and/or treated by a physician were considered to have OA regardless of the affected joints. The control group was defined as participants without any form of chronic arthritis. OBS was calculated by combining 10 pro-oxidant and antioxidant factors through a baseline nutritional and lifestyle assessment. Higher OBS scores indicated a predominance of antioxidant exposure. Multivariable logistic regression was used to estimate the adjusted odds ratios (ORs) for OA, and the EuroQoL five-dimensional questionnaire (EQ5D) was used in patients with OA after adjusting for demographic factors and comorbidities.Among the 14,930 participants, 296 patients with OA, and 1,309 controls were included in the analysis. In the age- and sex-adjusted model, the OR of the total OBS for OA was significant. In the full model adjusted for age, sex, education, income, and comorbidities, the total OBS for OA was not significant. Only the non-dietary pro-oxidant OBS had a significant inverse association with OA. The patients with OA who had a high EQ5D score had a higher total OBS than those with a low EQ5D score. The OR of the total OBS for a high EQ5D score was 1.14 in the multivariable logistic regression model. As we analyzed the OBS as a categorical variable (reference = Q1), the ORs of the Q2, Q3, and Q4 (highest) total OBS were 1.43, 2.71, and 2.22, respectively.In the fully adjusted model, the total OBS was not associated with OA. However, a positive association was observed between the total OBS and QOL in the patients with OA, indicating that antioxidative status was associated with better QOL in patients with OA.

A Review of A Priori Defined Oxidative Balance Scores Relative to Their Components and Impact on Health Outcomes

Oxidative Balance Scores (OBSs) are tools that have emerged to evaluate the global balance of individuals’ oxidation—reduction status. The aim was to compare OBSs available in the literature regarding their characteristics and associations with chronic diseases in epidemiological studies. Studies that developed OBSs were searched in PubMed until August 2018. A total of 21 OBSs were identified. These OBSs presented different scoring schemes and different types of anti- and pro-oxidant components, including dietary factors (dietary intake and/or nutrient biomarkers), lifestyle factors, and medications. Most OBSs were based on over 10 components, and some included only dietary factors. Few considered weighted components in the score. Only three OBSs were validated as potential surrogates of oxidative balance through inflammation and OS-related biomarkers. Notably, all the OBSs were associated—to a varying degree—with a reduced risk of cardiovascular diseases, chronic kidney disease, colorectal adenomas, and different cancer types (colorectal and breast cancer), as well as with all-cause and cancer-related mortality. For other outcomes, e.g., prostate cancer, contradictory results were reported. In summary, there is a great heterogeneity in the definition of OBSs. Most studies are concordant in supporting that excessive OS reflected by a lower OBS has deleterious effects on health. Unified criteria for defining the proper OBSs, valuable to gauge OS-related aspects of the diet and lifestyle that may lead to adverse health outcomes, are needed.

Index-Based Dietary Patterns and the Risk of Prostate Cancer

Prostate cancer is the second leading cause for cancer incidence in male. Although this high incidence is due to prostate specific antigen screening, other risk-factors, such as diet, might also be involved. The results of previous studies on the association between prostate cancer risk and individual dietary components have been conflicting. Thus, evaluation by dietary pattern analysis rather than individual dietary factors is suggested. The purpose of this study was to review the association of prostate cancer with a priori dietary indices, which are less studied and reviewed to date compared to a posteriori indices. Studies reviewed in this research were published from January 1997 to March 2017. Seventeen studies with nine indices were selected. In Mediterranean Diet Score (MDS), all four studies were non-significant. In Dietary Inflammatory Index (DII), 3 out of 4 studies significantly increased risk by 1.33-2.39 times, suggesting that a higher pro-inflammatory diet may be a possible prostate cancer risk factor. In Oxidative Balance Score (OBS), 2 out of 5 studies had decreased risk by 0.28 and 0.34 times, whereas 1 study had increased risk by 1.17 times. Among other indices, Healthy Eating Index (HEI) and prostate cancer dietary index were associated with decreased risk, while the results from 2 studies of Low Carbohydrate, High Protein Diet (LCHP) score were conflicting. In conclusion, we observed that it is insufficient to support the association between a priori indices and prostate cancer risk, except for MDS and DII, which had relatively constant results among studies. Therefore, further studies are required to identify consistent criteria for each a priori index, and should be conducted actively in various populations.

Oxidative balance score and serum γ-glutamyltransferase level among Korean adults: a nationwide population-based study

PURPOSE

The oxidative balance score (OBS) comprises dietary and non-dietary lifestyle pro-oxidants and antioxidants. Elevated serum γ-glutamyltransferase (GGT) level has currently emerged as a biomarker of oxidative stress. In this study, we examined whether OBS was inversely associated with serum GGT level and whether OBS could be a useful marker to predict GGT among Korean adults.

METHODS

This cross-sectional study was based on data obtained from the 2010 and 2011 Korea National Health and Nutrition Examination Survey. 2087 men and 2071 women were included in final analysis. The OBS was divided into five equal interval categories, and GGT was dichotomized into low and high using its sex-specific median value. Multiple logistic regression analysis was conducted to assess the association between OBS categories and high GGT.

RESULTS

Compared with the lowest OBS category as reference, the multivariable adjusted ORs (95% CIs) for the highest OBS category of men and women were 0.05 (0.01-0.19) and 0.27 (0.09-0.78), respectively (p for trend <0.01).

CONCLUSION

A higher OBS that indicates a predominance of antioxidant over pro-oxidant exposure was strongly inversely associated with GGT level among Korean adults.

DNA base excision repair genetic risk scores, oxidative balance, and incident, sporadic colorectal adenoma

Associations of individual base excision repair (BER) genotypes with colorectal adenoma risk are unclear, but likely modest. However, genetic risk scores (GRS) that aggregate information from multiple genetic variants might be useful for assessing genetic predisposition to colorectal adenoma. We analyzed data pooled from three colonoscopy-based case-control studies of incident, sporadic colorectal adenoma (n = 488 cases, 604 controls) that collected blood for genotyping and extensive dietary and other data. We randomly split our population sample into training samples (half of the participants) and validation samples (the remaining participants) 10 times. Associations of 65 individual single nucleotide polymorphisms (SNPs) in 15 BER genes were assessed in the training samples and used to combine information from multiple risk variants into a BER GRS among the validation samples using unweighted and weighted methods. We also combined 15 extrinsic exposures with known pro- or antioxidant properties into an oxidative balance score (OBS). Associations of the BER GRS with colorectal adenoma, overall and jointly with the OBS, were assessed using multivariable logistic regression. The odds ratio for those in the highest relative to the lowest tertile of the weighted BER GRS was 2.07 (95% confidence interval, 1.26-3.40; p_trend  = 0.01). Relative to those with both a low GRS and a high (more antioxidant) OBS, the estimated direct association for those with both a high BER GRS and a low OBS was stronger than for those in other GRS/OBS categories. Our findings suggest that BER genotypes collectively may be associated with incident sporadic colorectal adenomas.

Pathway-Driven Approaches of Interaction between Oxidative Balance and Genetic Polymorphism on Metabolic Syndrome

Despite evidences of association between basic redox biology and metabolic syndrome (MetS), few studies have evaluated indices that account for multiple oxidative effectors for MetS. Oxidative balance score (OBS) has indicated the role of oxidative stress in chronic disease pathophysiology. In this study, we evaluated OBS as an oxidative balance indicator for estimating risk of MetS with 6414 study participants. OBS is a multiple exogenous factor score for development of disease; therefore, we investigated interplay between oxidative balance and genetic variation for development of MetS focusing on biological pathways by using gene-set-enrichment analysis. As a result, participants in the highest quartile of OBS were less likely to be at risk for MetS than those in the lowest quartile. In addition, persons in the highest quartile of OBS had the lowest level of inflammatory markers including C-reactive protein and WBC. With GWAS-based pathway analysis, we found that VEGF signaling pathway, glutathione metabolism, and Rac-1 pathway were significantly enriched biological pathways involved with OBS on MetS. These findings suggested that mechanism of angiogenesis, oxidative stress, and inflammation can be involved in interaction between OBS and genetic variation on risk of MetS.

Oxidative stress, inflammation, and markers of cardiovascular health

OBJECTIVE

To investigate associations of a oxidative balance score (OBS) with blood levels of total cholesterol, low-density lipoprotein- (LDL)-cholesterol, high-density lipoprotein- (HDL) cholesterol and triglycerides, and biomarkers of inflammation (serum C-reactive protein [CRP], albumin and venous total white blood cell [WBC] counts) among 19,825 participants in a nationwide study.

METHODS

Using cross-sectional data 14 dietary and lifestyle components were incorporated into the OBS and the resulting score (range 3-26) was then divided into five equal intervals. Multivariable-adjusted odds ratios (ORs) for abnormal biomarker levels and 95% confidence intervals (CIs) were calculated using logistic regression models.

RESULTS

The ORs (95% CIs) comparing those in the highest relative to those in the lowest OBS equal interval categories were 0.50 (0.38-0.66) for CRP, 0.50 (0.36-0.71) for the total WBC count, and 0.75 (0.58-0.98) for LDL-cholesterol; all three p-values for trend were <0.001. The OBS-HDL-cholesterol association was statistically significantly inverse among females, but not among males. The OBS was not associated with serum albumin or triglycerides.

CONCLUSION

Our findings suggest that an OBS may be associated with some, but not all, circulating lipids/lipoproteins and biomarkers of inflammation.

Oxidative balance score as predictor of all-cause, cancer, and noncancer mortality in a biracial US cohort

PURPOSE

We previously proposed an oxidative balance score (OBS) that combines pro- and anti-oxidant exposures to represent the overall oxidative balance status of an individual. In this study, we investigated associations of the OBS with all-cause and cause-specific mortality, and explored alternative OBS weighting methods in the Reasons for Geographic and Racial Differences in Stroke Study cohort.

METHODS

The OBS was calculated by combining information from 14 a priori selected pro- and anti-oxidant factors and then divided into quartiles with the lowest quartile (predominance of pro-oxidants) as reference. Cox proportional hazard models were used to estimate adjusted hazard ratios and 95% confidence intervals for each OBS category compared with the reference.

RESULTS

Over a median 5.8 years of follow-up, 2079 of the 21,031 participants died. The multivariable-adjusted hazard ratios (95% confidence interval) for all-cause, cancer, and noncancer mortality for those in the highest versus the lowest equal-weighting OBS quartile were 0.70 (0.61-0.81), 0.50 (0.37-0.67), and 0.77 (0.66-0.89), respectively (P trend < .01 for all). Similar results were observed with all weighting methods.

CONCLUSIONS

These results suggest that individuals with a greater balance of antioxidant to pro-oxidant lifestyle exposures may have lower mortality.