Discussion
cancer
CVD, CANCER, OXIDATIVE STRESS, OXIDATIVE STRESS
We investigated the association of overall oxidative balance with all-cause, CVD, cancer, and other-cause mortality risk among nearly 20,000 middle-aged Spanish adults in a Mediterranean cohort. We used a novel holistic score based on 12 a priori selected dietary and non-dietary lifestyle pro- and antioxidants exposures to represent the overall oxidative balance status of an individual in a comprehensive manner. Our results suggested a statistically significant strong inverse association between the OBS and all-cause and cause-specific mortality. In addition, our stratified analyses suggested that women, older participants, and those without any chronic conditions may experience lower mortality risk when achieving a better antioxidant balance status, although no significant interaction effect was observed.Oxidative stress is a well-studied topic in research, with the theory of aging having been proposed decades ago [Our study may help better understand the beneficial effect of a combined set of dietary and lifestyle factors on the prevention of mortality centered on their potential to reduce oxidative stress. Based on our results, the combination of non-smoking, low consumption or abstinence of alcohol, regular physical activity, and maintaining a normal BMI has a strong antioxidant effect, which could be helpful toward the prevention of premature mortality. Moreover, following a dietary pattern rich in antioxidant compounds may further contribute to this preventive effect. In this regard, identification of individuals with an adequate oxidant balance provides a novel approach to design multidimensional interventions aimed at improving dietary patterns accompanied by healthy lifestyle behavior changes. A shift from a unidimensional to a more multidimensional approach with dietary and lifestyle interventions may be warranted in the current nutritional epidemiology.Certain limitations of our study should be acknowledged. First, information used to construct the OBS was collected at baseline, and participants may have modified their dietary and lifestyle exposures throughout follow-up. However, we were not able to update the OBS because a new FFQ was collected only after 10 years of follow-up, other lifestyle factors were not available in this follow-up questionnaire, and the number of participants with information available at this time was limited. Second, our OBS may not capture certain antioxidant factors, such as total fat, certain PUFAS (ω-6 and ω-3), saturated fatty acids, vitamin D, folate, calcium, and fiber; however, diverse discrepancies arose about the inclusion of these factors in OBSs [