Zhao Leying, Zhao Cong, Fu Yuchen, Wu Xiaochang, Wang Xuezhe, Wang Yaoxian, Zheng Huijuan
Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Beijing University of Chinese Medicine, Beijing, China.
Front Nutr. 2025 Jul 16;12:1641496. doi: 10.3389/fnut.2025.1641496. eCollection 2025.
Oxidative stress plays a pivotal role in the pathogenesis of chronic kidney disease (CKD), particularly in overweight and obese populations where adipose tissue dysfunction exacerbates systemic inflammation and metabolic derangements. The oxidative balance score (OBS) is a composite index that integrates dietary antioxidants and pro-oxidant exposures, offering a quantifiable surrogate of oxidative burden. However, its utility in CKD prediction among overweight adults remains unclear.
We analyzed data from 28,377 overweight or obese participants in ten NHANES cycles (1999-2018). OBS was calculated based on 16 dietary components and 4 lifestyle factors. CKD was defined using KDIGO guidelines. Survey-weighted logistic regression models were used to assess the association between OBS and CKD, with multivariable adjustment. Restricted cubic spline regression examined dose-response patterns, and subgroup analyses evaluated effect modifiers. Additionally, 14 machine learning algorithms were trained and validated using SMOTE-balanced data and five-fold cross-validation. Model interpretability was enhanced through SHapley Additive exPlanations (SHAP) analysis.
A higher OBS was inversely associated with CKD risk (fully adjusted OR per unit increase, 0.975; 95% CI, 0.969-0.981; < 0.0001), with a significant linear dose-response relationship. This protective association was attenuated in morbid obesity (BMI ≥ 40 kg/m; < 0.001), a finding driven by the abrogation of the dietary score's effect, while the lifestyle score remained protective in this subgroup. Among 14 machine learning models, GLMBoost was the top performer, achieving an Area Under the Curve (AUC) of 0.833 on the independent test set. SHAP analysis identified age, LDL-C, and SBP as primary predictors, but also revealed the significant protective contributions of OBS components-most notably physical activity and magnesium-and showed that age critically modifies the effects of both clinical and lifestyle factors.
Higher OBS was associated with lower CKD risk in overweight and obese adults. This may support the role of oxidative balance in kidney health and its potential for early prevention strategies.
氧化应激在慢性肾脏病（CKD）的发病机制中起关键作用，尤其是在超重和肥胖人群中，脂肪组织功能障碍会加剧全身炎症和代谢紊乱。氧化平衡评分（OBS）是一个综合指标，整合了膳食抗氧化剂和促氧化剂暴露情况，可提供氧化负担的可量化替代指标。然而，其在超重成年人CKD预测中的效用仍不明确。
我们分析了十个国家健康与营养检查调查（NHANES）周期（1999 - 2018年）中28377名超重或肥胖参与者的数据。OBS基于16种膳食成分和4种生活方式因素计算得出。CKD根据KDIGO指南定义。使用调查加权逻辑回归模型评估OBS与CKD之间的关联，并进行多变量调整。受限立方样条回归检查剂量反应模式，亚组分析评估效应修饰因素。此外，使用合成少数过采样技术（SMOTE）平衡数据和五折交叉验证对14种机器学习算法进行训练和验证。通过夏普利值附加解释（SHAP）分析增强模型可解释性。
较高的OBS与CKD风险呈负相关（每单位增加的完全调整比值比为0.975；95%置信区间为0.969 - 0.981；P < 0.0001），存在显著的线性剂量反应关系。这种保护关联在病态肥胖（BMI≥40 kg/m²；P < 0.001）中减弱，这一发现是由于膳食评分的效应消失所致，而生活方式评分在该亚组中仍具有保护作用。在14种机器学习模型中，GLMBoost表现最佳，在独立测试集上的曲线下面积（AUC）为0.833。SHAP分析确定年龄、低密度脂蛋白胆固醇（LDL-C）和收缩压（SBP）为主要预测因素，但也揭示了OBS成分的显著保护作用——最显著的是身体活动和镁——并表明年龄对临床和生活方式因素的影响有重要调节作用。
较高的OBS与超重和肥胖成年人较低的CKD风险相关。这可能支持氧化平衡在肾脏健康中的作用及其在早期预防策略中的潜力。
