Gout Prevalence Decreases with a Greater Oxidative Balance Score

Credit: Adobe Stock/ boyloso

A new study observed a negative linear relationship between gout and the Oxidative Balance Score, indicating that increasing the score may reduce the gout risk.¹

“Our findings suggest that [Oxidative Balance Score] can be managed in terms of dietary intake and lifestyle can the incidence of gout,” wrote investigators, led by Fanzhang Meng, from the School of Clinical Medicine at Beijing University of Chinese Medicine in China.

Previous studies suggest gout has a negative relationship with dietary antioxidant indices and is impacted by certain lifestyle factors such as smoking, alcohol consumption, physical activity, and obesity.^2,3 Literature also demonstrates gout is also associated with oxidative stress. Since dietary antioxidants, lifestyle choices, and oxidative stress have been shown to interact with gout, investigators sought to explore the potential relationship between the Oxidative Balance score and gout in US adults.¹

“It is necessary to introduce comprehensive scoring systems reflecting dietary and nondietary antioxidant and pro-oxidant exposures to assess the relationship between oxidative stress and gout,” investigators wrote. “[Oxidative Balance Score] combines dietary and lifestyle factors and has been shown to be a useful marker of inflammatory diseases in studies in different countries and regions.”

The Oxidative Balance Score has a negative association with several diseases, namely depression, kidney stones, cardiovascular disease, and aging. However, no studies reported the relationship between Oxidative Balance Score and gout, so investigators sought to explore the potential relationship in US adults.

Meng and colleagues conducted a cross-sectional study of 10,492 participants, leveraging data from the National Health and Nutrition Examination Survey. The primary endpoint was the Oxidative Balance Score, comprised of 16 dietary and 4 lifestyle factors, and was analyzed using multivariate logistic regression and restricted cubic spline regression. Investigators examined for potential confounders by evaluating the following covariates in subgroup analyses: age, sex, race, marriage, income, smoking, diabetes mellitus, hypertensive disorders, and hyperlipidemia.

Among the recruited participants, 3.44% (n = 361) had gout. Most participants with gout were ≥ 60 years (58.72), followed by 40 – 59 years (35.46%) and 18 – 39 (5.82%). They also had the greatest prevalence of diabetes, hypertension, and dyslipidemia.

Furthermore, participants without gout demonstrated significantly greater Oxidative Balance Scores and dietary Oxidative Balance Scores with no significant differences in ethnicity (P = .06), PRI (P =.2), and lifestyle Oxidative Balance Scores (P = .29).

All participants were categorized into 4 groups based on Oxidative Balance Scores quartile: Q1 (score: 1–14), Q2 (15–20), Q3 (21–26), and Q4 (27–39). Participants in the top quartile were more likely to be married, White, and have greater levels of education and PIR than the bottom quartile. Additionally, participants in the top quartile had a lower prevalence of blood uric acid levels, diabetes mellitus, hypertension, hyperlipidemia, and cigarette smoking (P < .0001). Neither the top nor bottom quartiles showed significant differences in gender and age.

Multivariate analyses showed a greater Oxidative Balance Score was associated with lower odds of gout (odds ratio [OR], 0.72; 95% CI, 0 .52 – 1.00) but the trend was not statistically significant (P = .13). The Restricted Cubic Splines showed a negative linear relationship between gout and Oxidative Balance Score, but again it was not significant (P = .606).

Subgroup analyses revealed, for the most part, covariates did not impact the relationship. However, diabetes was the exception; investigators observed a significant interaction between diabetes and gout (P < .05). Understanding how diabetes alters the oxidative stress status of patients with gout needs to be evaluated in further animal and clinical studies.

“We hypothesize that diabetes may affect uric acid metabolism by influencing other metabolic markers,” investigators wrote.

Investigators outlined multiple limitations, such as unknown confounders, the cross-sectional design making it difficult to infer a causal relationship, and the finding of the negative linear relationship between Oxidative Balance Score and gout was not statistically significant due to the small sample size and study design.

“Higher [Oxidative Balance Score] suggests that dietary and lifestyle antioxidant exposure is superior to prooxidant exposure and is associated with a lower risk of gout, and diabetes may modify this negative association,” investigators concluded. “However, further studies are still needed to validate our findings.”

References

1. ^{Meng F, Lu S, Li Y, et al. Association between oxidative balance score and risk of gout: The NHANES cross-sectional study, 2007-2018. Int J Rheum Dis. 2024;27(7):e15255. doi:10.1111/1756-185X.15255}
2. ^{Hu W, Ye Z, Li T, Shi Z. Associations between composite dietary antioxidant index and gout: National Health and Nutrition Examination Survey 2007–2018. Biol Res Nurs. 2024;26(1):150-159.}
3. ^{Yokose C, McCormick N, Choi HK. Dietary and lifestyle-centered approach in gout care and prevention. Curr Rheumatol Rep. 2021;23(7):51.}