Association between oxidative balance score and endometriosis findings from NHANES 1999–2006

Association between oxidative balance score and endometriosis findings from NHANES 1999–2006 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Association between oxidative balance score and endometriosis findings from NHANES 1999–2006 SU Luyang SU, Zeqing Du, Weilan Liu, Ren Xu, Cuiqiao Meng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4625367/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim The Oxidative Balance Score (OBS) functions as a measure for gauging the oxidative stress condition, OBS has been utilized to assess the overall oxidants and antioxidants exposure status in various chronic disease studies, Growing evidence suggests that oxidative stress is involved in the pathophysiologic mechanisms of endometriosis, The purpose of this study was to investigate the association between OBS and endometriosis in women between the ages of 20 and 54. Methods and Results The correlation between OBS and endometriosis was meticulously examined through a multifaceted approach, encompassing multivariate logistic regression, sensitivity analysis, and the application of smoothing techniques for curve fitting. This analysis was conducted utilizing the extensive dataset from the National Health and Nutrition Examination Survey (NHANES) spanning the years 1999 to 2006. To ascertain the stability of the observed relationship across diverse demographic segments, subgroup analysis, and interaction tests were meticulously implemented. Among the 3881 participants aged between 20 and 54 years, a significant inverse association was identified between OBS scores and the presence of endometriosis. Specifically, within the comprehensively adjusted model, for every 1 score increase in OBS, the odds of endometriosis prevalence decreased by 2.00%. The highest quartile of OBS demonstrated a 29.1% reduction in the prevalence of endometriosis when compared to those in the lowest quartile, with a confidence interval of [0.480, 1.048], underscoring the robustness of the observed trend. Conclusions OBS is related to endometriosis among American adults. Our results suggest that elevated OBS may potentially reduce the odds of endometriosis prevalence. Health sciences/Diseases Health sciences/Medical research Oxidative Balance Score endometriosis gynecological disease Oxidative stress NHANES Figures Figure 1 Figure 2 1. Introduction Endometriosis is defined by the presence of endometrial-like tissue outside the uterus 1 . Its exact cause has not yet been established 2 , The main mechanism of endometriosis is retrograde menstruation 3 . Recent research supports that endometriosis is a systemic disorder 4 . that transcends the affecting mood 5,6 , metabolism,reproductive organs,autoimmune diseases 7,8 , cancer risk, and the cardiovascular system.Although it is generally considered a benign disease associated with pelvic pain 9 , menorrhagia 10 and infertility 11,12 , It’s hereditary, report that when a mother has endometriosis 11 , her daughters have an 8% 1 , chance of inheriting it, and when, her sister is affected, the probability is 6% 12 . The Oxidative Balance Score (OBS) is constituted by dietary and lifestyle elements, it’s a refined indicator for evaluating an individual’s state of oxidative balance primarily 13 , Oxidation balance score (OBS), as a biomarker of oxidative stress, is of great significance for understanding the oxidation-reduction state status of individuals 14 .OBS was calculated by quantifying the presence of both antioxidant and pro-oxidant elements within dietary habits and lifestyle practices. There have been studies that postmenopausal Iranian women with higher scores on the Organic and Biological Survey (OBS) exhibit a decreased likelihood of encountering lumbar spine osteoporosis 15 , Patients with higher OBS are less likely to develop hypertension than those with lower OBS 16 . However, the association between OBS 17 and endometriosis is unknown. So, we launched a snapshot study 18 to explore the associations of OBS with endometriosis using Information from the 1999–2006 NHANES 19 . 2. Methods Study design and population The NHANES database is a health and nutrition survey dataset for the U.S. population, and it is a project of the Centers for Disease Control and Prevention (CDC) 20 . We identified 3881 women between 2003 and 2006, and various communities across the United States voluntarily engaged in the NHANES. They are between 20 and 54 years old. There was a total of 41474 participants in the NHANES during 1999–2006. We have excluded individuals without available OBS data and endometriosis data (n = 10583), Besides, participants without complete information about PIR, BMI, education status, alcohol user, smoke status Marry status(n = 26090), Missing data on Hyperlipidemia, Diabetes, Hypertension, CVD(n = 920), were also excluded. As a result, A total of 3881 individuals were included in our final analysis( Insert Fig. 1 ). The Oxidative Balance Score (OBS) The Oxidation Balance Score (OBS) is a quantitative measure 21 of the equilibrium between reducing agents and oxidants in a redox reaction 21 . In chemistry, this concept is frequently utilized to assess the state of equilibrium in a redox reaction 22 . It may be linked to a range of illnesses 23–25 , including gynecological conditions, and previous research has indicated that the development of endometriosis is significantly influenced by oxidative stress. Endometriosis The diagnosis of Self-reported endometriosis is derived from the “rhq360” questionnaire in the MEC. The structured questionnaire included the question, “Has a doctor or other health professional ever told you that you have endometriosis?” Respondents indicating 'yes' to having endometriosis constituted the case group, whereas those indicating 'no' formed the control group, self-identifying their endometriosis status. 26 . Based on this information, we created a dichotomous variable on the history of endometriosis diagnosis 27 . Covariables Covariates included age, race/ethnicity, education level, alcohol use, Hypertension, smoking, marriage, Family PIR and BMI, Hyperlipidemia, DM(Diabetes mellitus), and CVD( Cardiovascular disease). Statistical analysis NHANES, with its sampling approach to mirror the general population, uses standard errors to illustrate the sample-population discrepancy. Baseline characteristics are reported with means and their standard errors for continuous data and counts with percentages for categorical data. The analysis of variance is applied to compare continuous variables among groups, while the chi-square test addresses categorical comparisons. Smoothing curve fitting was used to examine the nonlinear relationship between OBS and endometriosis. To evaluate the link between OBS and endometriosis. Following NHANES-recommended weights, a weighted analysis was employed for statistical rigor. We refined our findings through three models: Model 1, the baseline unadjusted model; Model 2, adjusted for significant univariate logistic regression variables; and Model 3, adjusted for all potential covariates. Analysis was conducted using R (version 4.2) or EmpowerStats (version 5.0), with statistical significance determined at a two-tailed p-value below 0.05. 3. Results Baseline characteristic Insert Table 1 A total of3881 participants aged between 20 and 54 in our current study, consisting of 311(8.01%)with endometriosis. The distribution of participants across OBS quartiles is presented in Table 1: The average age of participants was 39.18 ± 0.36years, and the adjusted overall incidence of endometriosis within the US population was recorded at 8.01%. Individuals in the highest tertile of the OBS demonstrated a tendency towards higher levels of education, greater wealth, reduced alcohol intake, and lower smoking prevalence, predominantly identifying as married and non-Hispanic White. However, statistical analysis revealed no significant disparities in the rates of hypertension and diabetes mellitus (DM) across different OBS tertiles (p>0.05). In addition, participants with higher OBS typically had lower BMI, and the prevalence of hyperlipidemia and CVD as well as reduced(Table 1) . Association between the different OBS and Endometriosis Insert Table 2 Table 2 shows the correlation between total OBS, OBS quartiles, dietary OBS, lifestyle OBS, and Endometriosis. By weighted logistic modeling, We found that higher OBS scores have a significant positive impact on endometriosis in both the partial adjustment model [0.978(0.961,0.995)] and the comprehensive adjustment model[0.981(0.964,0.998)], After adjusting for total covariates, participants in the top quartile of OBS had a 29.1% lower prevalence rate of endometriosis than those in the bottom quartile [0.709 (0.480, 1.048)]. In model 2, when using the bottom quartile Dietary OBS group for comparison the prevalence rate of endometriosis in the top quartile Dietary OBS group was decreased by38.1% (95% CI 0.434–0.881;p=0.009). Moreover, we examined the relationships in the partial adjustment model between OBS and dietary OBS with the vulnerability to endometriosis, the results are all remarkable(p-values <0.05). Furthermore, the analysis of the smoothed curve fitting has further confirmed the non-linear inverse trend between OBS scores and the prevalence of endometriosis ( Insert Figure 2 ). Subgroup analyses Insert Table 3,4,5 We performed stratified subgroup analyses and interaction assessments by age, BMI, Hypertension, Hyperlipidemia, DM, and CVD to evaluate the uniformity of the association between OBS and endometriosis across the general population, as well as to uncover any distinct demographic patterns(Table 3 and Table 4 and Table5). The study discovered there are no significant differences in the association between OBS(including dietary OBS and lifestyle OBS) and endometriosis Within every subgroup. (P for interaction > 0.05). It reveals a significant inverse correlation between OBS and the incidence of endometriosis. Although the OR associated with did not exceed 1 among individuals aged 20 to 29 years (OR = 0.976, 95% CI (0.677–1.406), 30–39 years (OR = 0.970, 95% CI (0.796–1.181), BMI<= (OR = 0.981, 95% CI 0.806–1.195), the P value was not significant. 4. Discussion Using data from the NHANES spanning from 1999 to 2006, our research sheds fresh light on the correlation between the Oxidative Balance Score (OBS) and the susceptibility to endometriosis 28 . Our study finds that the Oxidative Balance Score (OBS) serves as a protective factor against endometriosis. The research indicated that overall OBS, as well as its dietary and lifestyle components 24 , exhibit a negative association with the incidence of endometriosis. Notably, individuals in the highest OBS bracket experienced a markedly lower endometriosis prevalence rate when contrasted with those in the lowest bracket. This association persisted after adjusting for various potential confounding influences. Additionally, The analysis demonstrated no substantial interactions among the various covariates considered and OBS (including dietary OBS and lifestyle OBS) (P for interaction > 0.05), indicating a strong negative association between OBS and the prevalence of endometriosis. In conclusion, higher levels of OBS are associated with a reduced incidence of endometriosis. Our study also emphasized the significance of adhering to a nutritious diet and lifestyle 29 , with significant implications for public healthcare. This suggests that the higher the OBS, the greater the exposure to antioxidants and the lower the indicators of pro-oxidant exposure. Endometriosis is a disorder associated with a general inflammatory response in the peritoneal cavity 30 . Studies have revealed that the global prevalence of endometriosis is approximately 10% among women of reproductive age, and can reach up to 40% among those experiencing pelvic pain or infertility symptoms 31,32 . The OBS aids in evaluating a person's oxidative stress index 33 by quantifying their anti-oxidant and pro-oxidant factors 34 . Oxidative stress is a potential factor 35 involved in the pathophysiology 36 of endometriosis. Women with this disease show evidence of increased systemic oxidative stress expressed 28 , In recent years the correlation between oxidative stress(OS) and endometriosis has been of affinity 37 , and a theory has been suggested that OS may be a cause of endometriosis development. Recent studies have indicated that antioxidant vitamin 38 supplementation plays a pivotal role in mitigating oxidative stress in women with endometriosis. Specifically, the introduction of these vitamins has been associated with a significant reduction in Plasma malondialdehyde (MDA) 39 concentration in patients with endometriosis levels, a biomarker for lipid peroxidation and oxidative stress 40 . In a clinical setting, this supplementation strategy has demonstrated a positive correlation with the diminished plasma MDA concentrations, suggesting a beneficial effect on the overall health of endometriosis patients. The administration of antioxidant vitamins 41 , therefore, emerges as a promising therapeutic adjunct to support the standard treatment of endometriosis, potentially improving the quality of life for women 41 affected by this chronic condition 42 . Our study's merits include lie in the utilization of a complex multi-stage probabilistic sampling framework, which improves the credibility and generalizability of our research outcomes. However, there exist several restrictions to our research. Firstly, given the study's cross-sectional design nature of the analysis, we cannot establish a causal link between OBS and endometriosis. Secondly, because of constraints in the database, we were unable to encompass data on every potential confounding variable that may impact endometriosis, as this would have compromised the size of our sample. Despite these limitations, the principal advantage of our study is rooted in the sampling framework of NHANES, which constitutes a representative sample of the civilian, non-hospitalized population in the United States. This helps to mitigate the effects of selection bias. Conclusions In summary, the research, drawing from a sample that is representative of the US adult population, indicates a significant association between OBS and the occurrence of endometriosis, This finding suggests that elevated OBS may potentially reduce the odds of endometriosis prevalence, both lifestyle and antioxidant die, improvements are key factors in reducing odds of endometriosis prevalence. Further research is essential to offer further validation. Abbreviations Oxidative Balance Score (OBS) National Health and Nutrition Examination Survey -- (NHANES) Cardiovascular disease (CVD) Body mass index (BMI) Income-to-Poverty Ratio (PIR) Diabetes mellitus (DM) Declarations Acknowledgments We would like to thank all participants in this study. Author contributions: SY: Formal analysis, Methodology, Software, Writing – original draft . DQ : analyzed the data, and drafted the manuscript.LL and XR revised the manuscript. All authors contributed to the article and approved the submitted version. Funding None. Consent for publication Not applicable. Competing interests All authors declare that they have no competing financial interests. Ethical statement This study was conducted by the principles of the Declaration of Helsinki. The NHANES protocol was revised and approved by the Ethics Review Committee of the National Center for Health Statistics. 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Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence. Nutrients 12, (2020). Mas-Bargues, C., Escrivá, C., Dromant, M., Borrás, C. & Viña, J. Lipid peroxidation as measured by chromatographic determination of malondialdehyde. Human plasma reference values in health and disease. Archives of Biochemistry and Biophysics 709, (2021). Tsikas, D., Tsikas, S. A., Mikuteit, M. & Ückert, S. Circulating and Urinary Concentrations of Malondialdehyde in Aging Humans in Health and Disease: Review and Discussion. Biomedicines 11, (2023). Jonscher, K. R., Chowanadisai, W. & Rucker, R. B. Pyrroloquinoline-Quinone Is More Than an Antioxidant: A Vitamin-like Accessory Factor Important in Health and Disease Prevention. Biomolecules 11, (2021). Habib, N. et al. Impact of lifestyle and diet on endometriosis: a fresh look to a busy corner. Menopausal Review 21, 124–132, (2022). Tables Table 1 and 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table.doc Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4625367","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":326730399,"identity":"a78c8244-58ca-48a3-90d7-11af97a066e3","order_by":0,"name":"SU Luyang SU","email":"","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":false,"prefix":"","firstName":"SU","middleName":"Luyang","lastName":"SU","suffix":""},{"id":326730400,"identity":"9008d9c8-21e5-4e41-8547-23376448792d","order_by":1,"name":"Zeqing Du","email":"","orcid":"","institution":"Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zeqing","middleName":"","lastName":"Du","suffix":""},{"id":326730401,"identity":"16dbb3a1-fef8-43a1-ad17-3bdf0f6a1afb","order_by":2,"name":"Weilan Liu","email":"","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Weilan","middleName":"","lastName":"Liu","suffix":""},{"id":326730402,"identity":"b9a993b3-4830-48fa-93c5-c04caa1eb2da","order_by":3,"name":"Ren Xu","email":"","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ren","middleName":"","lastName":"Xu","suffix":""},{"id":326730403,"identity":"8866845f-cf4a-4389-b613-0f45d4f32ba5","order_by":4,"name":"Cuiqiao Meng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYPACCQY2BgbmBx8qJOTkSdHCZjjjjIWxYQMpdknztlUkMhwgoEq3vffwi59tFrJ97IcPGM6cJ5HA2MD88NENPFrMzpxLs+xtkzBu40lLePBxm0QeOwObsXEOPi03csyMGdskEtsYcgwMZ26TKGZs4GGTxqvl/huoFv43BtK8cyQSGw4Q0nKDx/gxWItEDlBLAzFazuSYMfacA/pF4lma4YxjEsaGzYT8cvyM8YcfZXWy8/uTDz/4UFMnJ8/e/PAxPi1AwCYBJBgb4Hxm/MrBSj6gahkFo2AUjIJRgAYASfJLPN+XKOIAAAAASUVORK5CYII=","orcid":"","institution":"Hebei General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Cuiqiao","middleName":"","lastName":"Meng","suffix":""}],"badges":[],"createdAt":"2024-06-23 13:21:51","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4625367/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4625367/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60708659,"identity":"f20f85d8-c3de-4931-8b6f-549ceacdf63a","added_by":"auto","created_at":"2024-07-19 19:50:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64219,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of participants selection. NHANES, National Health and Nutrition Examination Survey.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4625367/v1/250c7b7584d2292d7d9c5bed.png"},{"id":60708661,"identity":"55f116c7-b3b1-486e-a067-94a4eaa2ff45","added_by":"auto","created_at":"2024-07-19 19:50:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":65353,"visible":true,"origin":"","legend":"\u003cp\u003eThe nonlinear associations between OBS and endometriosis. The solid red line represents the smooth curve fit between variables. A. OBS and endometriosis; B. dietary OBS and endometriosis.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4625367/v1/960676f49cfc0c2da7a519e5.png"},{"id":68424734,"identity":"a4c1bf2c-9c59-4f55-a61e-f7de9530e55f","added_by":"auto","created_at":"2024-11-07 06:47:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":481005,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4625367/v1/1d9938d0-e373-4258-851d-cab95b737473.pdf"},{"id":60708663,"identity":"47f73785-c058-4a8a-84dc-e8d18cce20cd","added_by":"auto","created_at":"2024-07-19 19:50:13","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1256960,"visible":true,"origin":"","legend":"","description":"","filename":"Table.doc","url":"https://assets-eu.researchsquare.com/files/rs-4625367/v1/4207516853b66aefff9a6909.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association between oxidative balance score and endometriosis findings from NHANES 1999–2006","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eEndometriosis is defined by the presence of endometrial-like tissue outside the uterus\u003csup\u003e1\u003c/sup\u003e. Its exact cause has not yet been established\u003csup\u003e2\u003c/sup\u003e, The main mechanism of endometriosis is retrograde menstruation\u003csup\u003e3\u003c/sup\u003e. Recent research supports that endometriosis is a systemic disorder\u003csup\u003e4\u003c/sup\u003e. that transcends the affecting mood\u003csup\u003e5,6\u003c/sup\u003e, metabolism,reproductive organs,autoimmune diseases\u003csup\u003e7,8\u003c/sup\u003e, cancer risk, and the cardiovascular system.Although it is generally considered a benign disease associated with pelvic pain\u003csup\u003e9\u003c/sup\u003e, menorrhagia\u003csup\u003e10\u003c/sup\u003e and infertility\u003csup\u003e11,12\u003c/sup\u003e, It\u0026rsquo;s hereditary, report that when a mother has endometriosis\u003csup\u003e11\u003c/sup\u003e, her daughters have an 8%\u003csup\u003e1\u003c/sup\u003e, chance of inheriting it, and when, her sister is affected, the probability is 6%\u003csup\u003e12\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe Oxidative Balance Score (OBS) is constituted by dietary and lifestyle\u003c/p\u003e \u003cp\u003eelements, it\u0026rsquo;s a refined indicator for evaluating an individual\u0026rsquo;s state of oxidative balance primarily\u003csup\u003e13\u003c/sup\u003e, Oxidation balance score (OBS), as a biomarker of oxidative stress, is of great significance for understanding the oxidation-reduction state status of individuals\u003csup\u003e14\u003c/sup\u003e.OBS was calculated by quantifying the presence of both antioxidant and pro-oxidant elements within dietary habits and lifestyle practices. There have been studies that postmenopausal Iranian women with higher scores on the Organic and Biological Survey (OBS) exhibit a decreased likelihood of encountering lumbar spine osteoporosis\u003csup\u003e15\u003c/sup\u003e, Patients with higher OBS are less likely to develop hypertension than those with lower OBS\u003csup\u003e16\u003c/sup\u003e. However, the association between OBS\u003csup\u003e17\u003c/sup\u003eand endometriosis is unknown. So, we launched a snapshot study\u003csup\u003e18\u003c/sup\u003e to explore the associations of OBS with endometriosis using Information from the 1999\u0026ndash;2006 NHANES\u003csup\u003e19\u003c/sup\u003e.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e \u003cb\u003eStudy design and population\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe NHANES database is a health and nutrition survey dataset for the U.S. population, and it is a project of the Centers for Disease Control and Prevention (CDC)\u003csup\u003e20\u003c/sup\u003e. We identified 3881 women between 2003 and 2006, and various communities across the United States voluntarily engaged in the NHANES. They are between 20 and 54 years old. There was a total of 41474 participants in the NHANES during 1999\u0026ndash;2006. We have excluded individuals without available OBS data and endometriosis data (n\u0026thinsp;=\u0026thinsp;10583), Besides, participants without complete information about PIR, BMI, education status, alcohol user, smoke status Marry status(n\u0026thinsp;=\u0026thinsp;26090), Missing data on Hyperlipidemia, Diabetes, Hypertension, CVD(n\u0026thinsp;=\u0026thinsp;920), were also excluded. As a result, A total of 3881 individuals were included in our final analysis(\u003cb\u003eInsert\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe Oxidative Balance Score (OBS)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe Oxidation Balance Score (OBS) is a quantitative measure\u003csup\u003e21\u003c/sup\u003e of the equilibrium between reducing agents and oxidants in a redox reaction\u003csup\u003e21\u003c/sup\u003e. In chemistry, this concept is frequently utilized to assess the state of equilibrium in a redox reaction\u003csup\u003e22\u003c/sup\u003e. It may be linked to a range of illnesses\u003csup\u003e23\u0026ndash;25\u003c/sup\u003e, including gynecological conditions, and previous research has indicated that the development of endometriosis is significantly influenced by oxidative stress.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEndometriosis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe diagnosis of Self-reported endometriosis is derived from the \u0026ldquo;rhq360\u0026rdquo; questionnaire in the MEC. The structured questionnaire included the question, \u0026ldquo;Has a doctor or other health professional ever told you that you have endometriosis?\u0026rdquo; Respondents indicating 'yes' to having endometriosis constituted the case group, whereas those indicating 'no' formed the control group, self-identifying their endometriosis status. \u003csup\u003e26\u003c/sup\u003e. Based on this information, we created a dichotomous variable on the history of endometriosis diagnosis\u003csup\u003e27\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCovariables\u003c/b\u003e \u003c/p\u003e \u003cp\u003eCovariates included age, race/ethnicity, education level, alcohol use, Hypertension, smoking, marriage, Family PIR and BMI, Hyperlipidemia, DM(Diabetes mellitus), and CVD( Cardiovascular disease).\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNHANES, with its sampling approach to mirror the general population, uses standard errors to illustrate the sample-population discrepancy. Baseline characteristics are reported with means and their standard errors for continuous data and counts with percentages for categorical data. The analysis of variance is applied to compare continuous variables among groups, while the chi-square test addresses categorical comparisons. Smoothing curve fitting was used to examine the nonlinear relationship between OBS and endometriosis. To evaluate the link between OBS and endometriosis. Following NHANES-recommended weights, a weighted analysis was employed for statistical rigor. We refined our findings through three models: Model 1, the baseline unadjusted model; Model 2, adjusted for significant univariate logistic regression variables; and Model 3, adjusted for all potential covariates. Analysis was conducted using R (version 4.2) or EmpowerStats (version 5.0), with statistical significance determined at a two-tailed p-value below 0.05.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristic\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInsert Table 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of3881 participants aged between 20 and 54 in our current study, consisting of 311(8.01%)with endometriosis. The distribution of participants across OBS quartiles is presented in Table 1: The average age of participants was 39.18 \u0026plusmn; 0.36years, and the adjusted overall incidence of endometriosis within the US population was recorded at 8.01%. Individuals in the highest tertile of the OBS demonstrated a tendency towards higher levels of education, greater wealth, reduced alcohol intake, and lower smoking prevalence, predominantly identifying as married and non-Hispanic White. However, statistical analysis revealed no significant disparities in the rates of hypertension and diabetes mellitus (DM) across different OBS tertiles (p\u0026gt;0.05). In addition, participants with higher OBS typically had lower BMI, and the prevalence of hyperlipidemia and CVD as well as reduced(Table 1)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between the different OBS and Endometriosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInsert Table 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the correlation between total OBS, OBS quartiles, dietary OBS, lifestyle OBS, and Endometriosis. By weighted logistic modeling, We found that higher OBS scores have a significant positive impact on endometriosis in\u0026nbsp;both the partial adjustment model [0.978(0.961,0.995)] and the comprehensive adjustment model[0.981(0.964,0.998)], After adjusting for total covariates, participants in the top quartile of OBS had a 29.1% lower prevalence rate of endometriosis than those in the bottom quartile [0.709 (0.480, 1.048)]. In model 2, when using the bottom quartile Dietary OBS group for comparison the prevalence rate of endometriosis in the top quartile Dietary OBS group was decreased by38.1% (95% CI 0.434\u0026ndash;0.881;p=0.009). Moreover, we examined the relationships in the partial adjustment model between OBS and dietary OBS with the vulnerability to endometriosis, the results are all remarkable(p-values \u0026lt;0.05). Furthermore, the analysis of the smoothed curve fitting has further confirmed the non-linear inverse trend between OBS scores and the prevalence of endometriosis (\u003cstrong\u003eInsert Figure 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInsert Table 3,4,5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe performed stratified subgroup analyses and interaction assessments by\u0026nbsp;age, BMI, Hypertension, Hyperlipidemia, DM, and CVD\u0026nbsp;to evaluate the uniformity of the association between OBS and endometriosis across the general population, as well as to uncover any distinct demographic patterns(Table 3 and Table 4 and Table5).\u0026nbsp;The study discovered\u0026nbsp;there are no significant differences in the association between OBS(including dietary OBS and lifestyle OBS) and endometriosis\u0026nbsp;Within every subgroup.\u0026nbsp;(P for interaction \u0026gt; 0.05). It reveals a significant inverse correlation between OBS and the incidence of endometriosis. Although the OR associated with did not exceed 1 among individuals aged 20 to 29 years (OR = 0.976, 95% CI (0.677\u0026ndash;1.406), 30\u0026ndash;39 years (OR = 0.970, 95% CI (0.796\u0026ndash;1.181), BMI\u0026lt;= (OR = 0.981, 95% CI 0.806\u0026ndash;1.195), the P value was not significant.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eUsing data from the NHANES spanning from 1999 to 2006, our research sheds fresh light on the correlation between the Oxidative Balance Score (OBS) and the susceptibility to endometriosis\u003csup\u003e28\u003c/sup\u003e. Our study finds that the Oxidative Balance Score (OBS) serves as a protective factor against endometriosis. The research indicated that overall OBS, as well as its dietary and lifestyle components\u003csup\u003e24\u003c/sup\u003e, exhibit a negative association with the incidence of endometriosis. Notably, individuals in the highest OBS bracket experienced a markedly lower endometriosis prevalence rate when contrasted with those in the lowest bracket. This association persisted after adjusting for various potential confounding influences. Additionally, The analysis demonstrated no substantial interactions among the various covariates considered and OBS (including dietary OBS and lifestyle OBS) (P for interaction\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating a strong negative association between OBS and the prevalence of endometriosis. In conclusion, higher levels of OBS are associated with a reduced incidence of endometriosis. Our study also emphasized the significance of adhering to a nutritious diet and lifestyle\u003csup\u003e29\u003c/sup\u003e, with significant implications for public healthcare. This suggests that the higher the OBS, the greater the exposure to antioxidants and the lower the indicators of pro-oxidant exposure. Endometriosis is a disorder associated with a general inflammatory response in the peritoneal cavity\u003csup\u003e30\u003c/sup\u003e. Studies have revealed that the global prevalence of endometriosis is approximately 10% among women of reproductive age, and can reach up to 40% among those experiencing pelvic pain or infertility symptoms\u003csup\u003e31,32\u003c/sup\u003e. The OBS aids in evaluating a person's oxidative stress index\u003csup\u003e33\u003c/sup\u003e by quantifying their anti-oxidant and pro-oxidant factors\u003csup\u003e34\u003c/sup\u003e. Oxidative stress is a potential factor\u003csup\u003e35\u003c/sup\u003einvolved in the pathophysiology\u003csup\u003e36\u003c/sup\u003e of endometriosis. Women with this disease show evidence of increased systemic oxidative stress expressed\u003csup\u003e28\u003c/sup\u003e, In recent years the correlation between oxidative stress(OS) and endometriosis has been of affinity\u003csup\u003e37\u003c/sup\u003e, and a theory has been suggested that OS may be a cause of endometriosis development. Recent studies have indicated that antioxidant vitamin\u003csup\u003e38\u003c/sup\u003esupplementation plays a pivotal role in mitigating oxidative stress in women with endometriosis. Specifically, the introduction of these vitamins has been associated with a significant reduction in Plasma malondialdehyde (MDA)\u003csup\u003e39\u003c/sup\u003e concentration in patients with endometriosis levels, a biomarker for lipid peroxidation and oxidative stress\u003csup\u003e40\u003c/sup\u003e. In a clinical setting, this supplementation strategy has demonstrated a positive correlation with the diminished plasma MDA concentrations, suggesting a beneficial effect on the overall health of endometriosis patients. The administration of antioxidant vitamins\u003csup\u003e41\u003c/sup\u003e, therefore, emerges as a promising therapeutic adjunct to support the standard treatment of endometriosis, potentially improving the quality of life for women\u003csup\u003e41\u003c/sup\u003e affected by this chronic condition\u003csup\u003e42\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur study's merits include lie in the utilization of a complex multi-stage probabilistic sampling framework, which improves the credibility and generalizability of our research outcomes. However, there exist several restrictions to our research. Firstly, given the study's cross-sectional design nature of the analysis, we cannot establish a causal link between OBS and endometriosis. Secondly, because of constraints in the database, we were unable to encompass data on every potential confounding variable that may impact endometriosis, as this would have compromised the size of our sample. Despite these limitations, the principal advantage of our study is rooted in the sampling framework of NHANES, which constitutes a representative sample of the civilian, non-hospitalized population in the United States. This helps to mitigate the effects of selection bias.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, the research, drawing from a sample that is representative of the US adult population, indicates a significant association between OBS and the occurrence of endometriosis, This finding suggests that elevated OBS may potentially reduce the odds of endometriosis prevalence, both lifestyle and antioxidant die, improvements are key factors in reducing odds of endometriosis prevalence. Further research is essential to offer further validation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOxidative Balance Score (OBS)\u003c/p\u003e\n\u003cp\u003eNational Health and Nutrition Examination Survey -- (NHANES)\u003c/p\u003e\n\u003cp\u003eCardiovascular disease (CVD)\u003c/p\u003e\n\u003cp\u003eBody mass index (BMI)\u003c/p\u003e\n\u003cp\u003eIncome-to-Poverty Ratio (PIR)\u003c/p\u003e\n\u003cp\u003eDiabetes mellitus (DM)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eWe would like to thank all participants in this study.\u003c/p\u003e\n\u003cp\u003eAuthor contributions:\u003c/p\u003e\n\u003cp\u003eSY: Formal analysis, Methodology, Software, Writing \u0026ndash; original draft\u003cstrong\u003e.\u003c/strong\u003eDQ\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eanalyzed the data, and drafted the manuscript.LL and XR revised the manuscript. All authors contributed to the article and approved the submitted version.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing financial interests.\u003c/p\u003e\n\u003cp\u003eEthical statement\u003c/p\u003e\n\u003cp\u003eThis study was conducted by the principles of the Declaration of Helsinki. The NHANES protocol was revised and approved by the Ethics Review Committee of the National Center for Health Statistics.\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe survey data are publicly available on the internet for data users and researchers throughout the world ( www.cdc.gov/nchs/nhanes/ ).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSaunders, P. T. 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Pyrroloquinoline-Quinone Is More Than an Antioxidant: A Vitamin-like Accessory Factor Important in Health and Disease Prevention. \u003cem\u003eBiomolecules\u003c/em\u003e 11, (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHabib, N. \u003cem\u003eet al.\u003c/em\u003e Impact of lifestyle and diet on endometriosis: a fresh look to a busy corner. Menopausal Review 21, 124\u0026ndash;132, (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 and 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Oxidative Balance Score, endometriosis, gynecological disease, Oxidative stress, NHANES","lastPublishedDoi":"10.21203/rs.3.rs-4625367/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4625367/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe Oxidative Balance Score (OBS) functions as a measure for gauging the oxidative stress condition, OBS has been utilized to assess the overall oxidants and antioxidants exposure status in various chronic disease studies, Growing evidence suggests that oxidative stress is involved in the pathophysiologic mechanisms of endometriosis, The purpose of this study was to investigate the association between OBS and endometriosis in women between the ages of 20 and 54.\u003c/p\u003e\u003ch2\u003eMethods and Results\u003c/h2\u003e \u003cp\u003eThe correlation between OBS and endometriosis was meticulously examined through a multifaceted approach, encompassing multivariate logistic regression, sensitivity analysis, and the application of smoothing techniques for curve fitting. This analysis was conducted utilizing the extensive dataset from the National Health and Nutrition Examination Survey (NHANES) spanning the years 1999 to 2006. To ascertain the stability of the observed relationship across diverse demographic segments, subgroup analysis, and interaction tests were meticulously implemented. Among the 3881 participants aged between 20 and 54 years, a significant inverse association was identified between OBS scores and the presence of endometriosis. Specifically, within the comprehensively adjusted model, for every 1 score increase in OBS, the odds of endometriosis prevalence decreased by 2.00%. The highest quartile of OBS demonstrated a 29.1% reduction in the prevalence of endometriosis when compared to those in the lowest quartile, with a confidence interval of [0.480, 1.048], underscoring the robustness of the observed trend.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOBS is related to endometriosis among American adults. Our results suggest that elevated OBS may potentially reduce the odds of endometriosis prevalence.\u003c/p\u003e","manuscriptTitle":"Association between oxidative balance score and endometriosis findings from NHANES 1999–2006","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-19 19:50:08","doi":"10.21203/rs.3.rs-4625367/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d630f5a5-ab84-4ad8-80de-a64cfeabc97e","owner":[],"postedDate":"July 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":34570328,"name":"Health sciences/Diseases"},{"id":34570329,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2024-12-03T18:53:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-19 19:50:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4625367","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4625367","identity":"rs-4625367","version":["v1"]},"buildId":"B-jG_2CBjPDmsCi4Wdhf-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}