The association between oxidative balance score and gallstones in adults: a population-based study

Abstract

Purpose: Oxidative stress is a significant contributor to the progression of gallstones. However, the combined or independent effects of dietary and lifestyle pro-antioxidants and antioxidants on gallstone formation remain unclear. Our study aims to investigate the potential link between the oxidative balance score (OBS) and the occurrence of gallstones.

Patients and methods: This study utilized data from the National Health and Nutrition Examination Survey (NHANES), conducted in the United States between 2017 and March 2020, identifying 750 gallstone cases among the 7,489 participants. Gallstone status was self-reported. The data in this study were analyzed using a range of statistical techniques, such as Multivariable logistic regression, restricted cubic spline curves (RCS), mediation effects analysis, subgroup analyses and sensitivity analysis.

Results: Using fully adjusted multivariable logistic regression analysis, we identified a significant negative correlation between OBS and the occurrence of gallstones, with an odds ratio (OR) of 0.97 and a 95% confidence interval (CI) of 0.96 to 0.99. Furthermore, participants in the highest quartile of OBS exhibited a 41% reduced risk of gallstones compared to those in the lowest quartile, with an OR of 0.59 (95% CI: 0.45, 0.79) relative to the reference population. Additionally, a linear inverse association between OBS and gallstones was observed. Mediation analysis indicated that diabetes and cardiovascular diseases (CVD) mediated 3.5 and 4% of the association between OBS and gallstones, respectively.

Conclusion: This research suggests that lower OBS levels are associated with a higher susceptibility to gallstone formation, potentially offering a new perspective on clinical strategies for the management and prevention of gallstones.

Keywords: National Health and Nutrition Examination Survey; cross-sectional study; diabetes mellitus; gallstones; mediation analyses; oxidative balance score.

Figure 1

Flowchart of participants selection from NHANES 2017–2020. A total of 23,883 participants recruited between 2017 and 2020 from NHANES were included in the current study, and those younger than age 20 years old (N = 0), pregnant (N = 140), without data about gallstone questionnaire (N = 9,119), OBS (N = 303), OBS dietary and lifestyle (N = 3,668), diabetes (N = 2), BMI (N = 105), cholesterol data (N = 650), hypertension data (N = 8) were excluded. Finally, a total of 7,489 participants were included to evaluate the associations between OBS and gallstones. BMI, body mass index; OBS, oxidative balance score; NHANES, National Health and Nutrition Examination Survey.

Figure 2

Non-linear relationship of all oxidative balance score with gallstone. (A) Non-linear relationship between OBS and gallstone. (B) Non-linear relationship between dietary OBS and gallstone. (C) Non-linear relationship between lifestyle OBS and gallstone. OBS, oxidative balance score; OR, odds ratio; 95% CI, 95% confidence interval.

Figure 3

Path diagram of the mediation analysis model for the 7,489 adult participants in the 2017–2020 National Health and Nutrition Survey. In the mediation analysis, OBS is defined as the exposure factor; gallstones are defined as the outcome; and diabetes and cardiovascular diseases is defined as the mediator. Path a represents the regression coefficient for the association of OBS with diabetes or cardiovascular diseases. Path b represents the regression coefficient for the association of diabetes or cardiovascular diseases with gallstones. Path c denotes the simple total effect of OBS versus gallstones, unadjusted for diabetes or cardiovascular diseases. OBS, oxidative balance score.

Figure 4

Forest plot for stratified analysis. The participants were classified into quintiles and we used the stratified multivariable regression analysis. The solid dot and the line represent estimates of hazard ratios and the 95% confidence intervals, respectively. Covariates included age, sex (male or female), race (non-Hispanic White, non-Hispanic Black, Mexican American, or other), diabetes, hypertension, and CVD. 95% CI, 95% confidence interval; CVD, cardiovascular diseases.