SUN-263 Association of Oxidative Balance Scores with Cardiovascular-Kidney-Metabolic Syndrome Risk and All-Cause Mortality: Evidence from NHANES 2005-2017

Abstract Disclosure: Y. Zheng: None. X. Lin: None. W. Liu: None. H. Lan: None. J. Wen: None. G. Chen: None. W. Lin: None. Background: Type 2 diabetes, cardiovascular diseases, and chronic kidney disease collectively constitute Cardiovascular-Kidney-Metabolic Syndrome (CKM), representing a major public health challenge worldwide. While oxidative stress has been linked to CKM pathogenesis, the association between oxidative balance scores (OBS, comprising lifestyle [LOBS], dietary [DOBS], and total [TOBS] components) and CKM risk and all-cause mortality remains unclear. Methods: This cross-sectional study analyzed data from 12,290 U.S. adults who participated in the National Health and Nutrition Examination Survey (NHANES) 2005-2017. We examined associations between oxidative balance scores (LOBS, DOBS, and TOBS) and risk of single CKM (CKM=1) and multiple CKM (CKM>1) using logistic regression, and assessed mortality risk using Cox models. Restricted cubic spline analyses explored non-linear relationships, while parallel mediation analyses assessed the role of biological aging markers. Subgroup analyses identified variations across population characteristics. All analyses incorporated survey weights to ensure nationally representative estimates. Results: Among 12,290 participants, 82.4% had no CKM, 13.8% had single CKM, and 3.7% had multiple CKM. LOBS showed the strongest protective effect against CKM, with each point increase reducing single CKM risk by 12% (OR 0.88, 95% CI: 0.82-0.95) and multiple CKM risk by 11% (OR 0.89, 95% CI: 0.80-0.99), while DOBS and TOBS showed modest 2-3% risk reduction. Participants in the highest versus lowest quartile of TOBS showed substantially lower mortality risk: 51% in single CKM (HR 0.49, 95% CI: 0.28-0.85) and 56% in multiple CKM (HR 0.44, 95% CI: 0.26-0.74). The association between oxidative balance and CKM risk was linear (P-overall < 0.0001, P-nonlinear > 0.05), whereas all-cause mortality followed a U-shaped pattern, reaching minimum risk at a LOBS value of 5.0. Biological aging markers mediated these associations, with LOBS having the most substantial impact through phenotypic age (45.84%), homeostatic dysregulation (39.84%), and biological age (38.30%). Subgroup analyses showed the protective effects were most pronounced in middle-aged adults (40-59 years), particularly in those without hypertension or hypercholesterolemia. Conclusions: Higher oxidative balance scores are consistently associated with lower CKM risk and reduced all-cause mortality. Lifestyle factors showed the strongest protective effects (12% risk reduction per point increase), while individuals with the highest total oxidative balance demonstrated more than 50% reduction in mortality risk. Healthcare providers should prioritize lifestyle interventions targeting oxidative balance in middle-aged adults (40-59 years), particularly those without hypertension or hypercholesterolemia. Presentation: Sunday, July 13, 2025