ObjectiveOxidative stress likely contributes to the pathogenesis of prediabetes. The oxidative balance score is an emerging metric for quantifying exposure to dietary and lifestyle oxidative stress. This study aimed to investigate the association between oxidative balance score and the prevalence of prediabetes, impaired fasting glucose, and impaired glucose tolerance based on data from the National Health and Nutrition Examination Survey 1999-2018.MethodsIn this cross-sectional study, the oxidative balance score was derived from 16 dietary and 4 lifestyle components, as outlined in previous research. Prediabetes, impaired fasting glucose, and impaired glucose tolerance were diagnosed based on the American Diabetes Association criteria. Multivariate logistic regression models were employed to analyze these associations.ResultsIn total, 22,960 participants with a mean age of 44.7 years were included in this study. In fully adjusted models, dietary oxidative balance score, lifestyle oxidative balance score, and overall oxidative balance score were all inversely associated with the prevalence of prediabetes among the general US adult population (odds ratios and 95% confidence intervals of 0.956 (0.949, 0.963), 0.914 (0.891, 0.937), and 0.957 (0.950, 0.964), respectively; all p <0.0001). Compared with quartile 1, dietary oxidative balance score, lifestyle oxidative balance score, and overall oxidative balance score at quartile 4 were all associated with a significantly lower prevalence of prediabetes (odds ratios and 95% confidence intervals 0.515 (0.449, 0.591), 0.834 (0.740, 0.940), and 0.505 (0.440, 0.579), respectively; all p for trend <0.0001). Similar results were observed for impaired fasting glucose and impaired glucose tolerance. Restricted cubic spline analysis showed that most of the associations were nonlinear and that significant negative correlations were observed only after a certain threshold. Stratified and sensitivity analyses confirmed the robustness of the findings.ConclusionsAdherence to an antioxidant-rich diet and healthy lifestyle may aid in the prevention of prediabetes, impaired fasting glucose, and impaired glucose tolerance among the general US adult population. Further cohort studies are needed to validate these findings.