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Association Between an Oxidative Balance Score and Mortality: A Prospective Analysis in the SUN Cohort


 
 
 Whether oxidative balance impacts mortality risk requires accounting not only for dietary patterns but also for lifestyle exposures. We aimed to investigate the association between an overall oxidative balance with all-cause, cardiovascular, and cancer mortality risk among participants in the Seguimiento Universidad de Navarra (SUN) Study, a Mediterranean cohort of middle-aged Spanish graduate students.
 
 
 
 Using baseline information from 12 a priori selected dietary and non-dietary lifestyle pro- and antioxidants exposures — vitamins C and E, betacarotenes, minerals (Se, Zn, heme-Fe), polyphenols, total antioxidant capacity, body mass index, alcohol, smoking, and physical activity — we constructed an oxidative balance score (OBS) categorized in equal-weighting quartiles, with higher scores meaning greater antioxidant balance. Cox proportional hazards models were fitted to evaluate the association between the OBS and mortality risk. Cases were ascertained through consultation of the National Death Index.
 
 
 
 A total of 19,083 participants (mean [SD] age, 38.5 [12.4] years; 59.2% females) were included in the analysis. During a median follow-up of 12.2 years (interquartile range, 8.1–14.9), 421 deaths were identified, including 80 cardiovascular (CV) deaths and 215 cancer deaths. After adjustment for potential confounders, the hazard ratio between the highest quartile (predominance of antioxidant) vs. the lowest quartile (reference category) was 0.43 (95% confidence interval [CI], 0.29–0.66, P-trend < 0.001) for all-cause mortality; 0.19 (95% CI 0.07–0.50, P-trend = 0.012) for CV mortality; 0.47 (95% CI 0.26–0.84, P-trend = 0.012) for cancer mortality. The antioxidant balance of dietary exposures and lifestyle exposures contributed towards reducing mortality risk, however, the individual effects were smaller than the combination of both exposures, suggesting the utility of the OBS to reflect the synergistic effect between the individual components.
 
 
 
 Our findings suggest a strong inverse association between OBS score and decreased all-cause, CV, and cancer mortality. Individuals exposed to both antioxidant dietary and lifestyle factors may potentially experience the lowest mortality risk.
 
 
 
 Instituto de Salud Carlos III, FEDER, Navarra Regional Government and University of Navarra.
