Association between the oxidative balance score and all-cause and cardiovascular mortality in populations with cardiovascular-kidney-metabolic syndrome stages 0–3: a prospective cohort study

Q: What are the key findings of this study?

Each standard deviation increase in the Oxidative Balance Score reduced all-cause mortality by 13% and cardiovascular mortality by 18% in CKM syndrome stages 0–3.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular-kidney-metabolic (CKM) syndrome stages 0–3 (n=17677). Intervention: Oxidative Balance Score (OBS, per standard deviation increment) vs. Lower Oxidative Balance Score (or lowest OBS quartile Q1). Primary outcome: All-cause mortality (HR 0.87, 95% CI 0.82-0.92, p=<0.001).

Q: What does this research mean for the field?

A higher Oxidative Balance Score is significantly associated with reduced risks of all-cause and cardiovascular mortality in individuals with cardiovascular-kidney-metabolic syndrome stages 0–3. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the association between the oxidative balance score and all-cause and cardiovascular mortality in individuals diagnosed with cardiovascular-kidney-metabolic syndrome stages 0 to 3.

Yue Zhang; Rui Tian; Bicong Gao; Xiaochen Wang; Feng Gao; Yating Chen

doi:10.21203/rs.3.rs-11363194/v1

November 9, 2026Open Access

Association between the oxidative balance score and all-cause and cardiovascular mortality in populations with cardiovascular-kidney-metabolic syndrome stages 0–3: a prospective cohort study

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Key result

Higher Oxidative Balance Score linked to ~13% lower all-cause mortality per SD in CKM syndrome.

HR 0.87
95% CI 0.82-0.92
P<0.001
n=17,677

Why the study?

The association between the Oxidative Balance Score and mortality outcomes in individuals with cardiovascular-kidney-metabolic syndrome stages 0–3 required investigation.

Does a higher Oxidative Balance Score reduce all-cause and cardiovascular mortality in adults with cardiovascular-kidney-metabolic syndrome stages 0–3?

Key Points

To investigate the association between the oxidative balance score and all-cause and cardiovascular mortality in individuals diagnosed with cardiovascular-kidney-metabolic syndrome stages 0 to 3.
Analyzed prospective cohort data from 17,677 participants with CKM syndrome stages 0–3 across ten NHANES cycles (1999–2018).
Calculated the oxidative balance score (OBS) using 20 components, encompassing 16 nutritional elements and 4 lifestyle factors.
Evaluated mortality risk using multivariable Cox proportional hazards models adjusting for sociodemographic and clinical covariates.
Over a mean follow-up of 122.4 months, 1,983 participants (8.16%) died from all causes, including 439 cardiovascular deaths (1.71%).
In fully adjusted models, each standard deviation increment in OBS was associated with a 13% reduction in all-cause mortality (HR 0.87, 95% CI 0.82–0.92, P < 0.001) and an 18% reduction in cardiovascular mortality (HR 0.82, 95% CI 0.72–0.92, P < 0.001).
Compared with the lowest quartile, the highest OBS quartile had lower risks of all-cause mortality (HR 0.67, 95% CI 0.57–0.79, P for trend < 0.001) and cardiovascular mortality (HR 0.66, 95% CI 0.46–0.94, P for trend < 0.001).

Study Design

Type

Cohort (n=17,677)

Structured PICO

Does a higher Oxidative Balance Score reduce all-cause and cardiovascular mortality in adults with cardiovascular-kidney-metabolic syndrome stages 0–3?

P

Population

17,677 non-pregnant United States adults aged ≥20 years with cardiovascular-kidney-metabolic syndrome stages 0–3 and free of established clinical cardiovascular disease, followed for a mean/median of 122.4 months.

E

Exposure

Higher Oxidative Balance Score (OBS, range 3–36), calculated at baseline from 20 components (16 nutritional elements from dietary recall and 4 lifestyle factors: physical activity, BMI, alcohol consumption, and serum cotinine), evaluated per 1-SD increment and across quartiles (highest quartile Q4).

C

Comparator

Lower Oxidative Balance Score (evaluated continuously per 1-SD increment, or lowest OBS quartile Q1 as reference).

O

Outcome

All-cause mortality and cardiovascular mortality over a mean/median follow-up of 122.4 months.hard clinical

Main Result

Hazard Ratio: 0.87 (95% CI 0.82–0.92)

p-value: p=<0.001

Limitations

Observational nature precludes causal inference, and residual confounding cannot be ruled out despite extensive adjustment.
OBS was calculated from a single baseline assessment without accounting for changes in diet or lifestyle during follow-up.
The 20 OBS components may not capture all relevant pro-oxidant and antioxidant exposures.
Classification of CKM syndrome stages was based on clinical criteria and may not perfectly reflect underlying pathophysiological processes.
Findings from a US cohort may not be fully generalizable to populations with different dietary patterns, lifestyle habits, or genetic backgrounds.
Observational design precludes causal inference and leaves potential for residual confounding
OBS was assessed only once at baseline, not accounting for longitudinal changes in diet or lifestyle
The 20 OBS components may not capture all relevant pro-oxidant and antioxidant exposures
CKM syndrome staging relied on clinical criteria that may not fully reflect underlying pathophysiology
Limited generalizability to non-US populations with different dietary, lifestyle, or genetic profiles

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Answers are grounded in this paper and cite their sources.

Implication

In US adults with CKM syndrome stages 0–3, a higher dietary and lifestyle antioxidant profile (Oxidative Balance Score) is independently associated with lower all-cause and cardiovascular mortality, particularly in CKM stages 1 and 2.

Abstract

Background This study aims to investigate the association between the Oxidative Balance Score (OBS) and mortality outcomes in individuals with cardiovascular-kidney-metabolic (CKM) syndrome stages 0–3. Methods Using data from ten National Health and Nutrition Examination Survey cycles (1999–2018), we analyzed 17677 participants with CKM syndrome stages 0–3. OBS was calculated using 20 components (16 nutritional elements and 4 lifestyle factors). Cox proportional hazards models evaluated associations between OBS and mortality outcomes, adjusting for relevant covariates. Results During the follow-up period (mean 122.4 months), there were 1983 deaths (8.16% of participants), of which 439 (1.71%) were due to cardiovascular disease. Multifactorial Cox regression showed that each standard deviation increment in the OBS corresponded to a significant 13% decrease in all-cause mortality risk (HR 0.87, 95% CI 0.82–0.92, P < 0.001) and an 18% reduction in cardiovascular mortality risk (HR 0.82, 95% CI 0.72–0.92, P < 0.001). When examining quartiles, individuals in the highest OBS quartile exhibited a 33% reduced risk of all-cause mortality (HR 0.67, 95% CI 0.57–0.79, P for trend < 0.001) and a 34% lower cardiovascular mortality risk (HR 0.66, 95% CI 0.46–0.94, P for trend < 0.001) compared to those in the lowest quartile. Subgroup analyses indicated that this protective relationship was most evident in CKM syndrome stages 1 and 2, with a significant interaction detected between OBS and CKM stage for all-cause mortality ( P for interaction < 0.05). Conclusions The study demonstrated that elevated OBS was significantly associated with reduced risks of both all-cause and cardiovascular mortality among populations with CKM syndrome stages 0–3.

Discussion

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Cite This Study

Zhang et al. (2026) conducted a cohort in Cardiovascular-kidney-metabolic (CKM) syndrome stages 0–3 (n=17,677). Oxidative Balance Score (OBS, per standard deviation increment) vs. Lower Oxidative Balance Score (or lowest OBS quartile Q1) was evaluated on All-cause mortality (HR 0.87, 95% CI 0.82-0.92, p=<0.001). Each standard deviation increase in the Oxidative Balance Score reduced all-cause mortality by 13% and cardiovascular mortality by 18% in CKM syndrome stages 0–3.

synapsesocial.com/papers/6af4053e82354de27a4ae461 https://doi.org/10.21203/rs.3.rs-11363194/v1

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Association between the oxidative balance score and all-cause and cardiovascular mortality in populations with cardiovascular-kidney-metabolic syndrome stages 0–3: a prospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association between the oxidative balance score and all-cause and cardiovascular mortality in populations with cardiovascular-kidney-metabolic syndrome stages 0–3: a prospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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