Dietary and lifestyle oxidative balance scores are independently and jointly associated with nonalcoholic fatty liver disease: a 20 years nationally representative cross-sectional study

Abstract

BackgroundOxidative stress is an important contributor to the progression of nonalcoholic fatty liver disease (NAFLD), but whether dietary and lifestyle pro- and antioxidants may have combined or independent effects on NAFLD, and advanced liver fibrosis (AHF) remains unclear. We aimed to elucidate the relationship between a well-established oxidative balance score (OBS) and NAFLD/AHF.MethodsThis was a cross-sectional study. We included adult participants with complete data from the National Health and Nutrition Examination Survey 1999–2018. Survey-weighted adjusted multivariate regression analyses were used to examine the association of all OBS with NAFLD/AHF. A combination of restricted cubic splines, mediation analysis, stratified analysis, and sensitivity analysis were used to further elucidate these associations.ResultsWe included 6,341 eligible adult participants with prevalence of NAFLD and AHF of 30.2 and 13.9%, respectively. In the fully adjusted model, the highest quartile of OBS, dietary OBS, and lifestyle OBS were associated with 65, 55, and 77% reduced risk of NAFLD, respectively, compared with the reference population, respectively. However, all OBS were not associated with the risk of AHF. All OBS were nonlinearly associated with risk of NAFLD and had a more pronounced reduced risk for OBS, dietary OBS, and lifestyle OBS after exceeding 26, 21, and 5 points, respectively. OBS may exert a protective effect indirectly through inflammation, oxidative stress, and glycolipid metabolism markers. Stratification and sensitivity analyses demonstrate the robustness of our findings.ConclusionAll OBS were nonlinearly and negatively associated with NAFLD risk. These effects may exert indirectly through inflammation, oxidative stress, and glycolipid metabolism markers.

New insights into metabolic dysfunction-associated steatotic liver disease and oxidative balance score

“…Consequently, there is a need for a comprehensive assessment of index-OBS to evaluate oxidative balance in individuals and to investigate the impact of this balance on MASLD. Prior investigations have examined the potential benefit of this index on NAFLD through inflammation, oxidative stress, and glycolipid metabolism (38). By the way, OBS is not associated with progression of liver fibrosis.…”

Adherence to an antioxidant diet and lifestyle is associated with reduced risk of cardiovascular disease and mortality among adults with nonalcoholic fatty liver disease: evidence from NHANES 1999–2018

“…Numerous studies have previously demonstrated the viability of OBS using the NHANES database. We defined the OBS utilizing well-validated components and calculation schemes derived from prior NHANES investigations ( 11 , 16 ). The OBS comprises the dietary OBS, consisting of 16 dietary components, and the lifestyle OBS, comprising 4 lifestyle components.…”

“…Consequently, antioxidant-based dietary and lifestyle interventions have attracted attention as potential strategies to diminish the risk of NAFLD progression and related complications. Despite an incomplete understanding of NAFLD's pathogenesis, numerous studies have emphasized the pivotal role of oxidative stress, stemming from an imbalance in oxidative and antioxidant processes, in the initiation and progression of NAFLD (9)(10)(11). Dietary and lifestyle adjustments rich in antioxidants, such as regular exercise and smoking cessation, have been proposed (12).…”

Association between oxidative balance score and metabolic syndrome and its components in US adults: a cross-sectional study from NHANES 2011–2018

“…We constructed and calculated OBS on the basis of previous studies. In this study, the OBS was composed of four lifestyle factors and 16 dietary components ( 13 , 21 ). The dietary factors were classified into prooxidants (total fat and iron) and antioxidants (β-carotene, dietary fiber, copper, vitamin B6, vitamin B12, vitamin C, niacin, vitamin E, total folate, vitamin B2, magnesium, calcium, zinc, and selenium) according to the effect on oxidative stress.…”