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Background <p>The high risk of frailty in patients with asthma is of increasing concern. Oxidative stress is an important mechanism in the pathogenesis of asthma, and the oxidative balance score (OBS) is a new index reflecting the state of oxidative homeostasis in the body that integrates dietary and physical activity factors. However, the relationship between the OBS and risk of frailty in patients with asthma remains unclear.</p> Method <p>A weighted analysis was conducted by using 3338 adult patients with asthma from the 1999–2018 National Health and Nutrition Examination Survey. Odds ratios (ORs) and 95% confidence intervals (CI) between the OBS and frailty in patients with asthma were determined through multivariate logistic regression. Multivariate Cox regression was conducted to determine the hazard ratio (HR) and 95% CI for the association between the OBS and risk of mortality in patients with asthma. The dose–response relationship between the OBS and risk of frailty and mortality in patients with asthma was assessed through restricted cubic spline analysis. Mediation analyses were performed to examine potential mediators. Subgroup and sensitivity analyses were conducted to investigate the stability of results.</p> Results <p>All patients with asthma had a mean age of 44.02 ± 0.42 years. A total of 56.17% of the patients were females. After adjustment for covariates, each one-unit increase in the OBS was associated with a 4% reduction in the risk of frailty (OR: 0.96, 95% CI: 0.94–0.99) and a 5% reduction in the risk of mortality (HR: 0.95, 95% CI: 0.93–0.97). Compared with the lowest quartile of the OBS, the highest quartile of the OBS had a 50% lower risk of frailty (OR: 0.50, 95% CI: 0.34–0.74) and the highest quartile had a 63% lower risk of mortality (HR: 0.37, 95% CI: 0.22–0.63). The results of curve fitting showed that the OBS was negatively associated with the risk of mortality and frailty in patients with asthma. The mediation analysis revealed that albumin and uric acid were mediators between the OBS and risk of frailty, and total bilirubin mediated the relationship between the OBS and risk of mortality.</p> Conclusion <p>This study found that the OBS was associated with the reduced risk of frailty and mortality in patients with asthma, and albumin, uric acid, and bilirubin may act as mediators of this association. These findings support the importance of an antioxidant-rich diet and lifestyle in reducing the risk of frailty and mortality in patients with asthma. This work provides a valuable perspective for clinical strategies to improve survival and frailty status in patients with asthma.</p>

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Relationship of the oxidative balance score with the risk of frailty and mortality in patients with asthma: a mediation analysis of NHANES

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月3日

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  • Minghao Liang,
  • Hongling Jia,
  • Lili Sun,
  • Wenjing Xi,
  • Feilong Guan,
  • Di Huang,
  • Yifei Xu,
  • Guangfeng Chen,
  • Xianhai Chen,
  • Minyan Jin,
  • Zhanjun Qiu

摘要

Background

The high risk of frailty in patients with asthma is of increasing concern. Oxidative stress is an important mechanism in the pathogenesis of asthma, and the oxidative balance score (OBS) is a new index reflecting the state of oxidative homeostasis in the body that integrates dietary and physical activity factors. However, the relationship between the OBS and risk of frailty in patients with asthma remains unclear.

Method

A weighted analysis was conducted by using 3338 adult patients with asthma from the 1999–2018 National Health and Nutrition Examination Survey. Odds ratios (ORs) and 95% confidence intervals (CI) between the OBS and frailty in patients with asthma were determined through multivariate logistic regression. Multivariate Cox regression was conducted to determine the hazard ratio (HR) and 95% CI for the association between the OBS and risk of mortality in patients with asthma. The dose–response relationship between the OBS and risk of frailty and mortality in patients with asthma was assessed through restricted cubic spline analysis. Mediation analyses were performed to examine potential mediators. Subgroup and sensitivity analyses were conducted to investigate the stability of results.

Results

All patients with asthma had a mean age of 44.02 ± 0.42 years. A total of 56.17% of the patients were females. After adjustment for covariates, each one-unit increase in the OBS was associated with a 4% reduction in the risk of frailty (OR: 0.96, 95% CI: 0.94–0.99) and a 5% reduction in the risk of mortality (HR: 0.95, 95% CI: 0.93–0.97). Compared with the lowest quartile of the OBS, the highest quartile of the OBS had a 50% lower risk of frailty (OR: 0.50, 95% CI: 0.34–0.74) and the highest quartile had a 63% lower risk of mortality (HR: 0.37, 95% CI: 0.22–0.63). The results of curve fitting showed that the OBS was negatively associated with the risk of mortality and frailty in patients with asthma. The mediation analysis revealed that albumin and uric acid were mediators between the OBS and risk of frailty, and total bilirubin mediated the relationship between the OBS and risk of mortality.

Conclusion

This study found that the OBS was associated with the reduced risk of frailty and mortality in patients with asthma, and albumin, uric acid, and bilirubin may act as mediators of this association. These findings support the importance of an antioxidant-rich diet and lifestyle in reducing the risk of frailty and mortality in patients with asthma. This work provides a valuable perspective for clinical strategies to improve survival and frailty status in patients with asthma.