| Summary: | Purpose We aimed to prospectively investigate the association of an overall oxidative balance score (OBS) with all-cause
death and cause-specifc mortality among participants in the Seguimiento Universidad de Navarra (SUN) Study, a Mediterranean cohort of Spanish graduates.
Methods Using baseline information on 12 a priori selected dietary and non-dietary lifestyle pro- and antioxidants exposures—vitamins C and E, β-carotenes, selenium, zinc, heme iron, polyphenols, total antioxidant capacity, body mass index,
alcohol, smoking, and physical activity—we constructed an equally weighted OBS categorized into quartiles, with higher
scores representing greater antioxidant balance. Cox proportional hazards models were ftted to evaluate the association
between the OBS and mortality.
Results A total of 18,561 participants (mean [SD] age, 38.5 [12.4] years; 40.8% males) were included in the analysis. During a median follow-up of 12.2 years (interquartile range 8.3–14.9), 421 deaths were identifed, including 80 deaths from
cardiovascular disease (CVD), 215 from cancer, and 126 from other causes. After adjustment for potential confounders,
the hazard ratios and 95% confdence interval (CIs) between the highest quartile (predominance of antioxidants) vs. the
lowest quartile (reference category) were 0.35 (95% CI 0.22–0.54, P-trend<0.001) for all-cause mortality, 0.18 (95% CI
0.06–0.51, P-trend=0.001) for CVD mortality, 0.35 (95% CI 0.19–0.65, P-trend=0.002) for cancer mortality, and 0.45
(95% CI 0.20–1.02, P-trend=0.054) for other-cause mortality.
Conclusion Our fndings suggest a strong inverse association between the OBS and all-cause, CVD, and cancer mortality.
Individuals exposed to both antioxidant dietary and lifestyle factors may potentially experience the lowest mortality risk.
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