Association between oxidative balance score and metabolic syndrome: a systematic review and meta-analysis

Metabolic syndrome (MetS) is a global health concern that threatens human well-being. The oxidative balance score (OBS) is a tool to identify the level of oxidative stress that is correlated with MetS risk. However, association between OBS and MetS and its components has not been reported. This cross-sectional study included adult individuals with complete OBS and MetS data from National Health and Nutrition Examination Survey (NHANES) 2011-2018. A weighted logistic regression analysis was conducted to identify the association of the total, dietary, and lifestyle OBS scores with MetS. Subgroup analyses and restricted cubic splines were used to further explore associations. In total, 10,025 eligible adult individuals (51.48% were males at a median age of 46 years) were included, with a MetS prevalence of 29.98%. In fully adjusted model, higher total OBS was associated with reduced risk of MetS (Q3 vs. Q1: odds ratio [OR] = 0.57, 95% confidence interval [CI], 0.46-0.71, p < 0.001; Q4 vs. Q1: OR = 0.42, 95% CI, 0.33-0.53, p < 0.001; P for trend <0.001). Significant differences were observed in the relationship between dietary OBS and lifestyle OBS and MetS risk (continuous dietary OBS: OR = 0.97, 95% CI, 0.96-0.98, p < 0.001; continuous lifestyle OBS: OR = 0.61, 95% CI, 0.58-0.64, p < 0.001), as well as negative relationship between total OBS and risk of five MetS components (all p < 0.05). Subgroup analysis showed marital status modified the negative association between OBS and MetS in subgroup analysis (P for interaction = 0.014). Moreover, a nonlinear correlation between OBS and MetS (including its components) was found, further elucidating associations (all p < 0.05). Restricted cubic splines demonstrated not obviously U-shape correlation between OBS and MetS components (elevated triglyceride and blood pressure). This study suggests a strong association between the OBS and MetS and its components. Our data indicated that a higher OBS score was correlated with a decreased risk of MetS and its components in a nonlinear manner. Hence, the OBS may serve as an effective marker for identifying individuals with MetS, with a higher score indicating a predominance of more antioxidants.

BackgroundThe oxidative balance score (OBS), an encompassing scoring mechanism for assessing oxidative stress, is formulated based on nutritional and lifestyle components. The emergence of metabolic syndrome (MetS) is intricately linked to oxidative stress. Nonetheless, the correlation between OBS and MetS displays variability within distinct cohorts.ObjectiveWe worked on the relationships between OBS and the risk of MetS, MetS severity, and all-cause mortality of MetS patients.MethodsA total of 11,171 adult participants were collected from the U.S. National Health Examination Survey (NHANES) 2007-2018. Employing survey-weighted logistic models, we evaluated the relationship between OBS and MetS risk. Furthermore, survey-weighted linear models were utilized to investigate the connection between OBS and MetS severity. Among the participants, 3,621 individuals had their survival status recorded, allowing us to employ Cox proportional hazards regression models in order to ascertain the association between OBS and the all-cause mortality within the subset of individuals with MetS. The OBS (where a higher OBS signified an increased prevalence of anti- or pro-oxidant exposures) weighed the 20 factors, while the MetS severity score weighed the five factors.ResultsAfter multivariable adjustment, individuals with elevated OBS were found to exhibit a decreased susceptibility to MetS [odds ratio (OR) 0.95; 95% CI 0.94-0.96]. The adjusted OR was 0.42 (95% CI 0.33-0.53) for MetS risk in the fourth OBS quartile compared with those in the first OBS quartile (P for trend < 0.001). A one-unit increase in OBS was linked to a 3% reduction in MetS severity score by 3% (mean difference, -0.03; 95% CI, -0.04 to -0.03). Moreover, increased OBS correlated with decreased hazard of all-cause mortality risk among MetS subjects (adjusted hazard ratio, 0.95; 95% CI, 0.93-0.98). These associations retained their strength even subsequent to the introduction of sensitivity analyses. There existed a statistically significant negative correlation between diet/lifestyle OBS and both MetS risk as well as MetS severity.ConclusionsAn inverse correlation was observed between OBS and the susceptibility to MetS, MetS severity, and all-cause mortality of MetS patients. Health outcomes for MetS patients were positively related to antioxidant diets and lifestyles.

Introduction: Nephrolithiasis is a prevalent urological condition. Given the kidney’s vulnerability to oxidative stress-induced damage, exploring the relationship between the oxidative balance score (OBS) and nephrolithiasis formation holds significant clinical relevance. This study systematically reviews and meta-analysis the association between OBS and nephrolithiasis. Materials and Methods: A comprehensive literature search was conducted across ProQuest, PubMed, Embase, Web of Science, Cochrane, and Google Scholar through January 20, 2025, without time restrictions. Data were imported into SPSS 19 and analyzed using STATA 14. Results: A higher OBS was associated with a reduced risk of nephrolithiasis in the overall population (OR: 0.74, 95% CI: 0.70, 0.79), as well as in men (OR: 0.98, 95% CI: 0.96, 0.99) and women (OR: 0.98, 95% CI: 0.96, 0.99). Additionally, increasing OBS was inversely correlated with kidney stone risk across quartiles; quartile 2 (OR: 0.78, 95% CI: 0.80, 0.87), quartile 3 (OR: 0.75, 95% CI: 0.68, 0.83), and quartile 4 (OR: 0.68, 95% CI: 0.59, 0.77). Both dietary OBS (OR: 0.97, 95% CI: 0.96, 0.98) and lifestyle OBS (OR: 0.95, 95% CI: 0.90, 1.00) were associated with a lower risk of nephrolithiasis. Among hypertensive patients, a higher OBS correlated with reduced nephrolithiasis risk (OR: 0.97, 95% CI: 0.96, 0.99), whereas in diabetic patients, the association was not statistically significant (OR: 1.00, 95% CI: 0.96, 1.04). Conclusion: A higher total OBS, along with dietary and lifestyle OBS, was significantly linked to a lower risk of nephrolithiasis. Notably, increased OBS scores were consistently associated with a decreased likelihood of nephrolithiasis formation. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (ID: CRD42025643705) and Research Registry (UIN: reviewregistry1952) website.

The Oxidative Balance Score (OBS) is a comprehensive biomarker that assesses an individual’s oxidative/antioxidative status, encompassing both dietary and lifestyle aspects. Excessive oxidative stress has been associated with the occurrence of metabolic syndrome (MetS), making the exploration of the relationship between OBS and MetS crucial for understanding metabolic health. This study utilized data from the National Health and Nutrition Examination Survey for the years 2007 to 2014. Through questionnaire surveys and data analysis, the OBS was calculated, and an assessment of MetS and its constituent factors was conducted. Logistic regression analysis was employed to clarify the relationship between OBS and the risk of MetS. Pearson correlation analysis was used to describe the relationship between OBS and the abnormal quantity of MetS components. Subgroup analysis and sensitivity analysis were also conducted to elucidate the stability and generalizability of the results. A total of 19,289 participants were included in this study, with an average age of 46.93 ± 16.55 years. An increase in OBS, whether attributed to dietary or lifestyle OBS, is associated with a reduced risk of developing MetS (odds ratio = 0.87, 95% confidence interval: 0.82–0.93). Specifically, OBS is negatively correlated with the abnormal quantity of MetS components. This association remains stable across different subgroups and sensitivity analyses. This study has unveiled the relationship between OBS and MetS in the American population. An elevated OBS is significantly associated with a reduced risk of MetS. Improving dietary and lifestyle linked to OBS may contribute to the prevention and management of MetS.

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.

Association between the oxidative balance score and mortality in patients with metabolic syndrome

Anti-oxidant/Pro-oxidant oxidant imbalance leads to chronic inflammation and insulin resistance can lead to the development of metabolic syndrome (MetS). The oxidative balance score (OBS) is a tool for assessing oxidative stress associated with MetS risk. However, the association between OBS and mortality in patients with MetS remains unclear. This study analyzed 10,647 MetS patients from the 1999–2018 National Health and Nutrition Examination Survey (NHANES). OBS were calculated using a combination of 16 dietary and 4 lifestyle factors. Multivariate Cox proportional hazards regression models, Kaplan–Meier survival analysis, restricted cubic splines (RCS), and subgroup analyses were used to evaluate the potential association between OBS and the risk of all-cause and cardiovascular mortality. Sensitivity analyses confirmed the robustness of the results. This study found that OBS was inversely associated with all-cause and cardiovascular mortality in patients with MetS, a result consistent across most subgroups. Both the Kaplan–Meier curve and RCS analysis supported these findings. Sensitivity analysis was used to verify the robustness of the results. Maintaining an antioxidant-based diet and lifestyle may help reduce the risk of all-cause and cardiovascular mortality in patients with MetS. These findings underscore the significance of incorporating antioxidant-rich dietary patterns and behavioral practices in strategies aimed at preventing and managing MetS.

Oxidative stress is a key contributor to the development of chronic kidney disease (CKD) in individuals with metabolic syndrome (MetS). The oxidative balance score (OBS) is an emerging composite assessment tool for dietary and lifestyle oxidative balance. We aimed to explore the association of OBS with CKD prevalence in MetS in this national cross-sectional analysis. This was a national cross-sectional analysis. Eligible MetS participants ≥20 years of age from NHANES 1999-2018 were included. OBS was assessed according to previous well-validated methods and consisted of 16 dietary components and 4 lifestyle components. MetS was diagnosed by NCEP-ATP III criteria, while CKD was diagnosed by KDIGO 2021 Clinical Practice Guideline. Multivariate logistic regression models were used to explore the association of OBS with CKD in MetS in this national cross-sectional analysis. A total of 8,095 MetS participants were included, with a CKD prevalence of 24.8%. In fully adjusted models, each score increases in OBS, dietary OBS, and lifestyle OBS was associated with a 2, 1.7, and 7.3% reduction in the prevalence of CKD, respectively. Higher OBS, dietary OBS, and lifestyle OBS were all associated with significantly lower odds of CKD (p for trend all <0.05). Restricted cubic spline analysis showed that these associations all exhibited inverse dose-response. Interaction analyses indicated that cardiovascular disease (CVD) status significantly influenced the impact of OBS and dietary OBS, and these associations were only present in CVD-free subjects. Defining MetS using the IDF criteria did not significantly change the results. OBS was inversely associated with the prevalence of CKD in MetS, especially in CVD-free settings. These findings emphasize that adherence to an antioxidant diet and lifestyle contributes to the early prevention of CKD in the MetS population and necessitates attention to CVD interactions. Future prospective cohort studies are needed to confirm these results.

Metabolic syndrome (MetS) populations are at increased risk of stroke, and oxidative stress is an important pathogenesis of stroke. The oxidative balance score (OBS) is an emerging tool for the assessment of an individual's overall oxidative balance. We aimed to investigate the association of OBS with stroke in the MetS population through NHANES 1999-2018. OBS consisted of dietary OBS and lifestyle OBS and were assessed by validated methods. MetS was assessed by NCEP-ATP III criteria, whereas stroke was assessed according to self-report. Multivariable logistic regression analyses were used to explore these associations and to calculate odds ratios (ORs) and 95% confidence intervals (CIs). A total of 6125 MetS participants were included. After adjusting for all confounders, OBS was negatively associated with the odds of stroke (OR 0.937, 95% CI 0.916-0.959, p < 0.0001). Compared to Q1, OBS at Q3 and Q4 was associated with significantly lower stroke prevalence (OR 0.580 and 0.370, respectively; p for trend < 0.0001). Similar findings were found for dietary and lifestyle OBS. OBS and dietary OBS were nonlinearly associated with stroke, whereas lifestyle OSB was linearly associated. High-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio significantly mediated the association between OBS and stroke in MetS, with mediation percentages of 16.51% and 13.67%, respectively. Education level and coronary heart disease influenced the association. OBS was negatively associated with stroke prevalence in the MetS, and certain serum lipid profiles mediated this association. Adherence to an antioxidant diet and lifestyle can help reduce stroke in MetS.

This research seeks to explore the link between the oxidative balance score (OBS) and sarcopenia in American adults with Metabolic Syndrome (MetS) using data from a national, population-based survey. The study included 3,625 participants diagnosed with Metabolic Syndrome, all aged 20 years and above, derived from NHANES datasets spanning 1999-2006 and 2011-2018. OBS evaluation was based on 16 dietary and 4 lifestyle elements. MetS diagnosis followed the NCEP-ATP III guidelines, while sarcopenia identification was based on FNIH standards. We employed multivariate logistic regression analyses to delve into the connections between OBS and sarcopenia within the MetS cohort. Sarcopenia was found in 17.46% of the participants. In models adjusted for all variables, OBS, dietary OBS, and lifestyle OBS each showed a significant inverse relationship with sarcopenia among MetS individuals [OBS: OR = 0.959, 95%CI: (0.948, 0.982), P trend = 0.0005; dietary OBS: OR = 0.963, 95%CI: (0.939, 0.989), P trend = 0.0055; lifestyle OBS: OR = 0.860, 95%CI: (0.787, 0.939), P trend = 0.0011]. Higher scores in OBS were consistently linked with a decreased incidence of sarcopenia (all P for trend < 0.05). Restricted cubic spline analysis confirmed that these relationships were linear. The impact of age was significant, with OBS benefits only observed in those aged 40 and older. Maintaining a diet and lifestyle rich in antioxidants is both independently and collectively linked with a lower occurrence of sarcopenia in individuals with MetS. These results bolster the proposition of developing OBS-centered preventive strategies for sarcopenia in MetS patients, particularly those aged 40 years and older.

The prevalence of metabolic syndrome (MetS) among middle-aged and older individuals in the U.S. is rising, posing significant mortality risks. Diet is a key factor in MetS development, yet few studies have examined the combined effects of dietary and lifestyle factors on MetS in this group. Recently, the oxidative balance score (OBS), an indicator of oxidative status encompassing diet and physical activity, has attracted interest. This study explores the association between OBS and MetS, as well as its individual components, in middle-aged and older Americans. Data from 6,157 participants aged 45 years and older in the National Health and Nutrition Examination Survey (NHANES) (1999-2018) were analyzed. The OBS was calculated using 16 dietary and four lifestyle factors. Logistic regression was used to assess associations between OBS and MetS. Separate analyses examined dietary OBS (DOBS) and lifestyle OBS (LOBS) in relation to MetS. Higher OBS quartiles were associated with a reduced MetS risk (OR 0.25; 95% confidence interval [CI]: 0.12-0.51; p < 0.0001), after adjusting for confounders. Increased OBS was linked to decreases in waist circumference (WC) (OR 0.41; 95% CI: 0.30-0.51; p < 0.0001), triglycerides (TG) (OR 0.71; 95% CI: 0.53-0.92; p = 0.0139), blood pressure (BP) (OR 0.53; 95% CI: 0.40-0.69; p < 0.0001), and fasting glucose (FG) (OR 0.61; 95% CI: 0.45-0.81; p < 0.0001), while HDL-C increased (OR 0.68; 95% CI: 0.51-0.90; p = 0.0065). DOBS was inversely associated with MetS through reductions in BP and FG and increased HDL-C, though it showed no significant effect on WC or TG. LOBS was associated with reductions across WC, BP, FG, TG, and an increase in HDL-C. OBS is inversely associated with MetS in middle-aged and older U.S. adults. Enhancing OBS through dietary guidelines emphasizing antioxidant-rich foods, fiber, and unsaturated fats, alongside lifestyle changes like regular exercise, smoking cessation, and moderate alcohol intake, may be crucial in MetS prevention for this population.

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

There is limited research on the relationship between Systemic Oxidative Stress (SOS) status and inflammatory indices. Adding onto existing literature, this study aimed to examine the association between dietary Oxidative Balance Score (OBS) and lifestyle OBS (which make up the overall OBS), and Cardiovascular Disease (CVD) prevalence at different Systemic Immune Inflammation Index (SII) and Systemic Inflammatory Response Index (SIRI) levels. This study involved 9,451 subjects selected from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The OBS comprised 20 dietary and lifestyle factors. Statistical methods included Weighted Linear Regression Analysis (WLRA), Logistic Regression Analysis (LRA), Sensitivity Analysis (SA), and Restricted Cubic Spline (RCS) analysis. The multivariate WLRA revealed that OBS was significantly negatively correlated with both SII (β = -5.36, p < 0.001) and SIRI (β = -0.013, p < 0.001) levels. In SA, removing any single OBS component had no significant effect on the WLRA results of SII and SIRI. Further subgroup analyses revealed that OBS was more impactful in lowering SII in women than in men. Additionally, OBS was more significantly negatively correlated with SII and SIRI in the low-age group than in the high-age group. Moreover, RCS analysis confirmed this linear relationship. Compared to dietary OBS, lifestyle OBS exerted a more significant effect on Coronary Artery Disease (CAD) (OR: 0.794, p = 0.002), hypertension (OR: 0.738, p < 0.001), Congestive Heart Failure (CHF) (OR: 0.736, p = 0.005), Myocardial Infarction (MI) (OR: 0.785, p = 0.002), and stroke (OR: 0.807, p = 0.029) prevalence. Furthermore, SIRI exhibited a significant interaction in the relationship between overall OBS, dietary OBS, and CHF (P for interaction < 0.001). On the other hand, SII had a significant interaction in the relationship between overall OBS, dietary OBS, and MI (P for interaction < 0.05). OBS, including lifestyle and dietary OBS, were significantly negatively associated with SII and SIRI. Higher lifestyle OBS was associated with reduced risks of CAD, hypertension, CHF, MI, and stroke.

AimsThere is a potential association between oxidative stress and the development of diabetic kidney disease (DKD). The Oxidative Balance Score (OBS), derived from dietary and lifestyle factors, acts as a comprehensive marker of oxidative stress. Research examining the relationship between OBS and DKD is scarce. This study aims to evaluate the association between OBS and the risk of DKD among U.S. adults.MethodsThis study enrolled 6,725 eligible participants from the U.S. population through the National Health and Nutrition Examination Survey (2005–2020). Patients with DKD were defined as those with diabetes who had a urinary albumin-to-creatinine ratio ≥ 30 mg/g and/or an estimated glomerular filtration rate < 60 mL/min/1.73 m². The OBS consists of 20 composite scores derived from dietary and lifestyle factors. To assess the potential relationship between OBS and DKD, weighted logistic regression and restricted cubic spline statistical approaches were employed.ResultsThe risk of DKD was inversely correlated with OBS, dietary OBS, and lifestyle OBS (p < 0.05). Compared to the lowest quartile of OBS, the adjusted odds ratios (OR) for OBS, lifestyle OBS and dietary OBS, and DKD in the highest quartile were 0.58 (95% CI: 0.48–0.70), 0.64 (95% CI: 0.51–0.81), and 0.57 (95% CI: 0.46–0.70), respectively. A substantial nonlinear relationship between lifestyle OBS and DKD was identified using the RCS curve (p for nonlinearity = 0.0081), which appeared as an inverted ‘L’ shape. Using the two-piecewise logistic regression model, a turning point in lifestyle OBS was identified at a score of 3 (p < 0.001).ConclusionsAmong the American population, OBS and DKD are significantly negatively correlated, suggesting that maintaining a higher OBS may reduce the risk of developing DKD.

Oxidative stress has been implicated in the pathogenesis and progression of dyslipidemia. We aimed to investigate the association between the oxidative balance score, and dyslipidemia, as well as to assess the mortality risk associated with oxidative balance score in patients with dyslipidemia. We performed a mortality follow-up study of a cross-sectional cohort of 26,118 adults from the National Health and Nutrition Examination Survey 1999-2018. The total oxidative balance score was calculated by 16 dietary nutrients (dietary oxidative balance score) and four lifestyle factors (lifestyle oxidative balance score). Weighted Cox proportional hazard model was applied to determine the relationship between oxidative balance score and all-cause or cardiovascular disease (CVD) mortality within the dyslipidemia group. During a median follow-up of 118 months, 2448 all-cause deaths (766 CVD-related) occurred. A significant negative correlation was observed between total oxidative balance score, dietary oxidative balance score, lifestyle oxidative balance score, and dyslipidemia. The multivariable-adjusted odds ratios and 95% CIs for dyslipidemia were 0.86 (0.77-0.97), 0.80 (0.72-0.91), and 0.63 (0.56-0.70), respectively, when comparing the second, third, and fourth quartiles of total oxidative balance score to the reference lowest quartile (P for trend <0.0001). Increasing total oxidative balance score was inversely associated with all-cause (hazard ratio [HR] = 0.98, 95% CI 0.98-0.99) and CVD-specific mortality (HR = 0.98, 95% CI 0.97-0.99) in participants with dyslipidemia. Oxidative balance score is inversely associated with dyslipidemia and linked to all-cause and CVD-related mortality, highlighting the potentially protective role of an antioxidant-rich diet against dyslipidemia.