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. 2025 Mar 18;15(1):9258.
doi: 10.1038/s41598-025-90640-w.

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

Yu-Qing Li  1 , Ping Li  1 , Ran Chu  1 , Wei-Wei Tian  1 , Jia-Xin Wang  1 , Yin Liu  2 , Jing Gao  3   4   5   6
Affiliations

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

Yu-Qing Li et al. Sci Rep. .

Abstract

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.

Keywords: Metabolic syndrome; Mortality; NHANES; Nutrition; Oxidative balance scores.

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Conflict of interest statement

Ethics approval and consent to participate: The National Health and Nutrition Examination Survey (NHANES) is a publicly available dataset sanctioned by the Institutional Review Board (IRB) of the National Center for Health Statistics (NCHS). All participants consented in writing during their involvement in the survey. Since no further IRB approval was necessary for the secondary analysis, this study was exempt from additional ethical review. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Association between baseline OBS and future risk of mortality. Abbreviations: K-M survival curves of OBS with mortality in patients with metabolic syndrome: (A) total OBS and all-cause mortality; (B) dietary OBS and all-cause mortality; (C) lifestyle OBS and all-cause mortality; (D) total OBS and cardiovascular mortality; (E) dietary OBS and cardiovascular mortality; (F) lifestyle OBS and cardiovascular mortality. Q1 through Q4, quartile 1 through 4.
Fig. 2
Fig. 2
Dose–response relationship between baseline OBS and future risk of mortality. Abbreviations: RCS of OBS with mortality in patients with metabolic syndrome: (A) total OBS and all-cause mortality; (B) dietary OBS and all-cause mortality; (C) lifestyle OBS and all-cause mortality; (D) total OBS and cardiovascular mortality; (E) dietary OBS and cardiovascular mortality; (F) lifestyle OBS and cardiovascular mortality. All models were adjusted for age, gender, race, education, marital status, poverty-to-income ratio, hypertension history, diabetes mellitus history, drinking, and smoking.
See this image and copyright information in PMC

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