Associations between oxidation balance score and abdominal aortic calcification, and the mediating role of glycohemoglobin: a nationally representative cross-sectional study from NHANES

Abstract

Background: Abdominal aortic calcification (AAC) is prevalent among middle-aged and elderly populations, elevating the risk of cardiovascular and cerebrovascular events. Leveraging data from the National Health and Nutrition Examination Survey (NHANES), we conducted a nationally representative cross-sectional study. Our aim was to evaluate whether subjective interventions could influence AAC scores by modifying the antioxidant/pro-oxidant status of individuals and to investigate the role of glycohemoglobin in this relationship.

Methods: The study analyzed data from 1,600 U.S. adults. The study used oxidation balance score (OBS) as an exposure variable derived from 16 dietary and 4 lifestyle factors, as well as glycohemoglobin obtained from blood tests. The main outcome measure was AAC, which was evaluated by dual-energy X-ray absorption and quantified by Kauppila scoring system.

Results: The mean (SD) age of the 1,600 patients was 56.53 (10.90) years, with a female predominance (50.22%). According to weighted linear regressions not adjusted for covariates, the AAC scores were lower in the third and fourth quartile groups of OBS than in the first quartile group of OBS (Q3: coefficients [coef], -0.92 [95% CI, -1.64 to-0.20], p = 0.017; Q4: coefficients [coef], -0.97 [95% CI, -1.86 ~ -0.08; p < 0.035]). According to the weighted linear regression subgroup analyses, there were no significant OBS-AAC correlations among males (p > 0.05), but there were significant correlations among females (p < 0.05). Smooth fitting curves showed a more significant trend of change in the negative correlation between OBS and AAC scores in postmenopausal women than in premenopausal women. In further mediation analyses, glycohemoglobin was identified as a mediator of the relationship between the oxidative balance score and AAC.

Conclusion: This study revealed a significant negative correlation between OBS and AAC scores, particularly in postmenopausal women. The negative correlation between OBS and AAC is partly mediated by glycohemoglobin.

Keywords: abdominal aortic calcification; glycohemoglobin; mediating role; oxidation balance score; postmenopausal women.

Figure 1

Flowchart of the sample selection process. AAC, abdominal aortic calcification.

Figure 2

Oxidative balance score component and abdominal aortic calcification score criteria. OBS, oxidation balance score.

Figure 3

Multivariate adjusted linear regression for oxidation balance score quartile and abdominal aortic calcification score. Crude model: no covariates were adjusted; Model 1: adjusted for sex, age and body mass index; Model 2: adjusted for variables in Model 1 plus race, education and poverty; OBS, oxidation balance score; Q1 ~ Q4: the first to fourth quantiles of the oxidation balance score.

Figure 4

Multivariate linear regression of dietary OBS quartile and abdominal aortic calcification scores. Crude model: no covariates were adjusted; Model 1: Adjusted for sex, age and body mass index; Model 2: Adjusted for variables in Model 1 plus race, education and poverty; OBS, oxidation balance score; DQ1 ~ DQ4: The first to fourth quantiles of dietary oxidation balance score.

Figure 5

Multivariate linear regression of lifestyle OBS quartiles and abdominal aortic calcification scores. Crude model: no covariates were adjusted; Model 1: Adjusted for sex, age and body mass index; Model 2: Adjusted for variables in Model 1 plus race, education and poverty; OBS, oxidation balance score; LQ1 ~ LQ4: The first to fourth quantiles of lifestyle oxidation balance score.

Figure 6

Subgroup analysis of linear regression between oxidation balance score quartile and abdominal aortic calcification score. Model 1: Adjusted for sex, age and body mass index; Model 2: Adjusted for variables in Model 1 plus race, education and poverty.

Figure 7

Smooth curve fitting analysis of the association between the oxidative balance score and the AAC score. (A) Shows the smooth curve fitting analysis of the correlation between the oxidation balance scores and the AAC scores of male and female. (B) Shows the smooth curve fitting analysis of the correlation between the oxidative balance score and the AAC score of premenopausal and postmenopausal women. AAC, abdominal aortic calcification.

Figure 8

Mediation analysis of oxidation balance score and abdominal aortic calcification score. IE, indirect effect; DE, direct effect; Proportion of mediation = IE/(DE + IE).