# Diet–lifestyle oxidative balance in relation to cardiometabolic multimorbidity: findings from the national health and nutrition examination survey

## TL;DR

A new score combining diet and lifestyle factors is linked to lower risk of multiple heart and metabolic diseases.

## Contribution

The Oxidative Balance Score (OBS) is shown to robustly predict cardiometabolic multimorbidity in a large population.

## Key findings

- Each standard deviation increase in OBS was linked to a 26.1% lower risk of cardiometabolic multimorbidity.
- Participants with the highest OBS had half the risk of those with the lowest OBS.
- Adding OBS to standard risk factors slightly improved disease identification accuracy.

## Abstract

Oxidative stress is a critical factor in the development of cardiometabolic diseases. The Oxidative Balance Score (OBS), integrating dietary and lifestyle factors, has been proposed as a measure of the balance between pro-oxidants and antioxidants. This study aims to explore the relationship between OBS and prevalent cardiometabolic multimorbidity (CMM), and to evaluate whether adding OBS into clinical practice is associated with better CMM identification in the general population. A total of 26,191 participants were selected from the National Health and Nutrition Examination Survey. CMM was defined as having a history of two or more conditions: diabetes mellitus, stroke, or coronary heart disease. The prevalence of CMM was 2.95%. After adjusting for demographic, anthropometric, laboratory, and medical history data, each standard deviation increase in OBS was associated with a 26.1% reduction in the risk of prevalent CMM. Participants in the highest quartile of OBS had a 0.530-fold risk of prevalent CMM compared to those in the lowest quartile. Smooth curve fitting indicated a proportional reduction in CMM risk with increasing OBS. Sensitivity analysis confirmed significant associations between both dietary and lifestyle OBS with prevalent CMM. ROC analysis revealed that incorporating OBS into conventional cardiometabolic risk factors was associated with a slight improvement in CMM identification (AUC: 0.912 vs. 0.916, P = 0.001). Reclassification analysis further indicated the incremental value of OBS. This study revealed a negative, linear, and robust association between OBS and prevalent CMM in the general population. However, reverse causation cannot be ruled out. Future studies should use longitudinal or Mendelian randomization approaches to establish causality.