Association between oxidative equilibrium values ​​and myocardial infarction in diabetics: Findings from Nhanes 1999–2018 | BMC public health

Study context

Myocardial infarction (mi), a main cause of mortality and disability globally, represents an even higher risk for people with diabetes mellitus [23]. These factors accelerate the development of atheriosclerosis [24, 25]The main cause of Wed. Diet plays a crucial role in modulation of oxidative stress, which makes it a key factor for the treatment of cardiovascular risk among diabetics. The oxidation balance score (DOBS) is an index that can be recorded the balance between prooxidative and antioxidant food components and can be used to evaluate the cardiovascular risk [26]. A relatively high concentration of DOBS reflects a diet with a higher antioxidant potential, which could reduce the MI risk.

This study used data from the National Health and Nutrition Examination Survey 1999–2018 (Nhanes) to investigate the connection between Dobs and the incidence of MI for diabetics. The dobs were calculated on the basis of the intake of antioxidative and prooxidative components in the diet, and their relationship with MI was assessed using a cross -sectional study design and multivariabler regression models.

Key results

The study showed a significant reverse connection between DOBS and the likelihood of MI in diabetic patients. Each one-point increase of the DoBS was associated with a less adapted model with a lower Mi probability of approximately 3%, and after adaptation to age, gender, ethnicity, educational level, family status, BMI, smoking, sedentary behavior, medication use, hypertension, hypertension and Chronacyney diagram (0.97). It is important that the association in PSM analysis (PSM analysis of Neight Score) existed, which further confirmed its robustness. Subgroup analyzes also showed consistent associations across various demographic and clinical layers.

Although formal tests did not support non -linear association, the visual inspection of Spline curves indicated a threshold effect: Inverse association between DOBS and MI was more pronounced at lower DOBS values ​​and gradually flattened at higher levels. A secondary analysis using a cutoff from DOBS = 7 supported this trend and showed a significantly lower probability of a Mi among participants with doBs> 7.

Clinical and epidemiological evidence

The results of this study agree and expand the results of earlier studies in which relationships between nutrition, oxidative stress and cardiovascular results are examined.

In a clinical study, Jordi Salas-Salvadó and colleagues stated [27]. Obesity, oxidative stress and nutrition are closely connected, whereby a diet is rich in antioxidants, which are associated with less obstacy of obesity [28,29,30,31]. Another clinical study resulted in a strong inverse association between the oxidative balance score (OBS) and the mortality of the cardiovascular diseases (CVD). The Hazard Ratio (HR) for CVD mortality in the highest quartile (favorites of antioxidants) compared to the lowest quartile (reference category) was 0.18, whereby a 95% confidence interval (CI) of 0.06–0.51 95% (CI) was [32]. A cross-sectional study showed that a decrease in OBS, which includes both dietary and lifestyle components, is positive with an increased risk for overall and specific cardiovascular diseases [33]. Similarly, Yingzi Li and colleagues reported a protective connection between compliance with an antioxidant diet and reduced incidence and reduced incidence and mortality of CVD in adults with non-alcoholic fatty liver diseases (NAFLD) (NAFLD) [34]. Kai Chen and colleagues reported a significant negative correlation between the observatory and the risk of disease of the coronary arteries (CAD) [35]. A recently Korean cohort study with 5,181 participants showed a negative correlation between observatory and the likelihood that the development of new high blood pressure was developed [36]. A study by the Nhanes, which analyzed 4,955 participants, showed a significant negative correlation between the OBS and the 10-year risk of an atherosclerotic cardiovascular disease (ASCVD). Continuous OBS was associated with an adapted quota ratio (OR) of 0.97 (95% CI: 0.95–0.99). [37].

Basic medical evidence

Numerous studies have all shown that oxidative stress plays a crucial role in promoting the development of atherosclerosis (AS) and MI, especially in patients with diabetes. Reactive oxygen species (ROS) play a crucial role in all stages of atherosclerotic inflammation. In the initial stages of AS, the endothelial dysfunction leads to a reduction in nitrogen oxide (NO) bioavailability and an increase in the deteriorated, which promotes ROS production and triggers oxidative stress reactions [38]. This oxidative stress facilitates the oxidation of lipoprotein with low density, leukocyta wheion and migration, proliferation of the vascular muscle cell (VSMC) and thrombocyte aggregation, all of which accelerate the formation of lipidplaques [39]. The primary redox-sensitive transcription factor that is involved in the nuclear factor-κB (NF-κB). NF-κB not only promotes the production of ROS, but also induces the synthesis of pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α). This leads to an increased infiltration of immune cells into the affected vascular regions, which exacerbates the vascular inflammation reaction [40, 41]. In addition, the primary ROS source within the vessel wall is attributed to the NADPH -Oxidase (NOx) in the context of AS. Toll -Like Receptor 2 (TLR2) signaling can promote the progression of AS by activating NOx, which increases the migration of the smooth muscle cells of the vessels [42,43,44]. Studies have shown that the Inos/NO -Signalweg is closely connected to the pathogenesis of myocardial memia -Reperfusion violation (Miri). It is well documented that this path can worsen heart damage and myocardial infarction by promoting oxidative stress [45]. ROS that is generated by NOx enzymes [46]. In diabetic patients, metabolic anomalies and chronic hyperglycaemia lead to excessive production of mitochondrial ROS in the endothelial cells of both large and small vessels and in the myocardium. This overproduction worsens oxidative stress and significantly increases the likelihood of cardiovascular events [10, 20, 47].

Geographical and regional variability in DOBS-related nutritional patterns

Although essential evidence supports the role of oxidative balance of food in reducing cardiovascular risk, the composition of DOBS-related nutrients in countries and regions varies significantly. A global analysis with 195 countries showed that the absorption of antioxidative-rich components such as whole grains, fruit and nuts is often inadequate worldwide, with striking regional differences that are driven by cultural and economic factors [48]. For example, Mediterranean diets are rich in adinosurated fats and antioxidants, while western diets in pro-oxidants such as saturated fats and sodium tend to be higher. These differences indicate that the distribution and health relevance of DOBS in the population groups can be significantly different.

In addition, even within a single country, regional heterogeneity in nutritional quality can affect the dolls. For example, nationally representative studies in China have shown that urban population groups typically more fruits, Marine Omega-3 [49]. These intranational variations suggest that the values ​​and their associations with illness results, even within a single national context, may not be uniform. In addition, region -specific food sources, cooking habits and environmental pollution can influence the physiological effects of similar nutrient shots and the interpretation of dobbungs across the populations more difficult.

In the present study, DOBS was calculated on the basis of the US nutrition data. Although the observed inverse association with MI was robust and consistent in diabetic patients in the subgroups, caution is guaranteed to generalize these findings on populations with different nutritional structures or nutrient sources.

Implication of clinical and public health

The results of this study can have an important relevant clinical and public health. As a simple nutritional index, the DOBs serve as a useful instrument to evaluate cardiovascular risk profiles in diabetic patients and to inform nutritional ratings. The consistent inverse association, which is observed in demographic and clinical subgroups, suggests that a higher antioxidation compensation in diet can be associated with a cheaper cardiovascular status. Efforts in the public health system promote antioxidant-rich dieting, especially for high-risk groups such as people with diabetes skills, improve cardiovascular results at the population level, although causal relationships are still being built up.

In order to examine potential non -linearity, we carried out an RCS analysis of the connection between DOBS and MI. While the formal test for non -linearity was not statistically significant, the spine curve resulted in a possible threshold pattern by a DOB value of 7. In particular, participants with DOBS ≤ 7 showed a steeper decline in the MI chances with increasing browsing, while the association's association -plateau among those with a dobs> 7 risk in the lower food oxide -Mearout with the lower oxide compensation with the cardboard room can be connected to the card recording area with the cardocress level. With the support of future longitudinal studies, this threshold -like pattern can help refine the dietary instructions by identifying people who may have the greatest relative benefit from antioxidant nutritional improvement.

restrictions

Although this study offers valuable insights, it has several restrictions. First, due to its cross -section design, the time relationship between DOBS and MI cannot be determined, and the causality cannot be derived. An opposite cause is possible because patients who had experienced Mi then changed their eating habits, which led to changed DOBS values. Secondly, the diet data was collected with a 24-hour self-reported recall, which is recalled in a reduction in recall and daily variability, especially in diabetic populations. Although we used an average of two days to reduce this distortion, the restrictions remain. Thirdly, the self-reported MI status can be subject to malfunction, especially for diabetic persons in which possibly atypical symptoms can occur, which may affect the validity of our result evaluation. Fourth, although several covariates have been adapted, the remaining confusion cannot be ruled out by non -measured factors (such as compliance with medication, genetic predisposition or psychosocial stress). Fifthly, the results are based on the US Nhanes population and may not be generalized to other ethnic or regional groups with different food structures and oxidative stress loads. Future longitudinal studies and randomized controlled studies are necessary to validate the observed associations and evaluate whether an increasing antioxidant balance can effectively reduce cardiovascular risk in diabetic persons through intervention.