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Associations of dietary and lifestyle oxidative balance scores with mortality risk among older women: the Iowa Women’s Health Study

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Abstract

Purpose

Substantial basic science evidence suggests that oxidative stress may play a role in aging-related health outcomes, including cardiovascular diseases (CVD) and cancer, and oxidative stress markers were linked with all-cause and cause-specific mortality in epidemiologic studies. However, the associations of many individual dietary and lifestyle anti-/pro-oxidant exposures with mortality are inconsistent. Oxidative balance scores (OBS) that incorporated multiple dietary and lifestyle factors were previously developed and reported to reflect the collective oxidative effects of multiple exposures.

Methods

We investigated associations of 11-component dietary and 4-component (physical activity, adiposity, alcohol, and smoking) lifestyle OBS (higher scores were considered more anti-oxidative) with all-cause and cause-specific mortality among women 55–69 years of age at baseline in the prospective Iowa Women’s Health Study (1986–2012). We assessed OBS-mortality associations using multivariable Cox proportional hazards regression.

Results

Of the 34,137 cancer-free women included in the analytic cohort, 18,058 died (4521 from cancer, and 6825 from CVD) during a mean/median 22.0/26.1 person-years of follow-up. Among participants in the highest relative to the lowest lifestyle OBS quintiles, the adjusted hazards ratios and their 95% confidence intervals for all-cause, all-cancer, and all-CVD mortality were 0.50 (0.48, 0.53), 0.47 (0.43, 0.52), and 0.54 (0.50, 0.58) (all Ptrend < 0.001), respectively. The associations of the dietary OBS with mortality were close to null.

Conclusion

Our findings, combined with results from previous studies, suggest that a predominance of antioxidant over pro-oxidant lifestyle exposures may be associated with lower all-cause, all-CVD, and all-cancer mortality risk.

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Availability of data and material

Data from this study are available upon application to DeAnn Lazovich, PhD, MPH, Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St., Room 300 West Bank Office Building, Minneapolis, MN 55,454.

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Funding

This work was supported by the National Cancer Institute at the National Institutes of Health under Grant R01 CA039742, and the Wilson P. and Anne W. Franklin Foundation. None of the funding agencies had any role in the conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Department of Epidemiology, Rollins School of Public Health, Emory University, Mailstop 1518-002-3BB, 1518 Clifton Road NE, Atlanta, GA, 30322, USA

    Ziling Mao & Roberd M. Bostick

  2. Division of Haematology, Oncology and Transplantation, Medical School, University of Minnesota, Minneapolis, MN, USA

    Anna E. Prizment

  3. Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA

    Anna E. Prizment & DeAnn Lazovich

  4. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA

    DeAnn Lazovich

  5. Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Roberd M. Bostick

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  1. Ziling Mao
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Contributions

All authors contributed to the study conception and design, data interpretation, and manuscript writing. R.M.B. and Z.M. were primarily responsible for the project conception and design. D.L. and A.E.P. collected the data. Z.M. and R.M.B. were primarily responsible for analyzing and interpreting the data and writing the manuscript. R.M.B. supervised the analysis project and manuscript writing. All authors read and approved the final manuscript.

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Correspondence to Roberd M. Bostick.

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The study was approved by the Minnesota Institutional Review Board (IRB), and the current analysis was approved by the Emory University IRB.

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All participants provided written informed consent.

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The code supporting this current study is available from the corresponding author upon request.

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Mao, Z., Prizment, A.E., Lazovich, D. et al. Associations of dietary and lifestyle oxidative balance scores with mortality risk among older women: the Iowa Women’s Health Study. Eur J Nutr 60, 3873–3886 (2021). https://doi.org/10.1007/s00394-021-02557-5

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