Association of the Oxidative Balance Score with GOLD BioAge: Potential Mediating Roles of SIRI and UHR among US Adults

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INTRODUCTION: This study aimed to evaluate the dose-response relationship between the Oxidative Balance Score (OBS) and a novel Gompertz law-based biological age (GOLD BioAge) and to quantify the potential mediating contributions of the Systemic Inflammation Response Index (SIRI) and uric acid to high-density lipoprotein cholesterol ratio (UHR). METHODS: This cross-sectional study included 20,930 adults aged ≥20 years (weighted mean age: 47.79 years) from seven cycles of the National Health and Nutrition Examination Survey (2001-2010 and 2015-2018). Survey-weighted regressions were used to estimate independent associations of OBS with GOLD BioAge and Accelerated GOLD BioAge. Restricted cubic spline analysis was performed to assess potential nonlinearity. Robustness was assessed through sensitivity and stratified subgroup analyses. Exploratory mediation analyses using a bootstrap resampling-based framework were performed separately for SIRI and UHR to quantify their potential mediating contributions. RESULTS: The weighted proportion of Accelerated GOLD BioAge in the overall sample was 37.57%. The OBS was inversely and linearly associated with GOLD BioAge (P for nonlinearity = 0.723). In the fully adjusted models, each 1-point increment in OBS was associated with a 0.11-year lower GOLD BioAge (β = -0.11, 95% confidence interval [CI]: -0.13 to -0.10, P < 0.001) and 5% lower odds of Accelerated GOLD BioAge (odds ratio [OR] = 0.95, 95% CI: 0.94 to 0.96, P < 0.001). Compared with the lowest OBS tertile (T1), the highest tertile (T3) had 51% lower odds of Accelerated GOLD BioAge (OR = 0.49, 95% CI: 0.43 to 0.56, P for trend < 0.001). The inverse association was directionally consistent across examined subgroups, although its magnitude differed by sex (P for interaction < 0.001). Exploratory mediation analyses showed that SIRI and UHR accounted for 21.10% and 8.30% of the OBS-GOLD BioAge association, respectively. CONCLUSIONS: In a nationally representative sample, higher OBS was linearly associated with lower GOLD BioAge, with SIRI and UHR statistically accounting for part of this association. These findings provide epidemiological evidence that a comprehensive antioxidant-oriented dietary and lifestyle profile is associated with lower biological age, warranting further prospective investigation.