Negative association between oxidative balance score and stroke prevalence in US adults with metabolic syndrome: mediating roles of HDL-C and NHHR.

BACKGROUND: Metabolic syndrome (MetS) populations are at increased risk of stroke, and oxidative stress is an important pathogenesis of stroke. The oxidative balance score (OBS) is an emerging tool for the assessment of an individual's overall oxidative balance. We aimed to investigate the association of OBS with stroke in the MetS population through NHANES 1999-2018. METHODS: OBS consisted of dietary OBS and lifestyle OBS and were assessed by validated methods. MetS was assessed by NCEP-ATP III criteria, whereas stroke was assessed according to self-report. Multivariable logistic regression analyses were used to explore these associations and to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 6125 MetS participants were included. After adjusting for all confounders, OBS was negatively associated with the odds of stroke (OR 0.937, 95% CI 0.916-0.959, p < 0.0001). Compared to Q1, OBS at Q3 and Q4 was associated with significantly lower stroke prevalence (OR 0.580 and 0.370, respectively; p for trend < 0.0001). Similar findings were found for dietary and lifestyle OBS. OBS and dietary OBS were nonlinearly associated with stroke, whereas lifestyle OSB was linearly associated. High-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio significantly mediated the association between OBS and stroke in MetS, with mediation percentages of 16.51% and 13.67%, respectively. Education level and coronary heart disease influenced the association. CONCLUSIONS: OBS was negatively associated with stroke prevalence in the MetS, and certain serum lipid profiles mediated this association. Adherence to an antioxidant diet and lifestyle can help reduce stroke in MetS.