Journal of Affective Disorders · Jul 28, 2025
Association between dietary oxidative balance score and cognitive function among older adults: A sex- and sex hormone-stratified analysis from the National Health and Nutrition Examination Surveys 2013-2014
By Zeng Y, Li H, Zi J et al.
BACKGROUND: Cognitive decline is associated with oxidative stress, which varies between males and females. Nevertheless, the sex- and sex hormone-stratified relevance of dietary oxidative balance score (DOBS) with cognitive function in older adults is unclear. METHODS: We analyzed 1094 participants aged 60 and older from the National Health and Nutrition Examination Surveys 2013-2014, assessed cognitive performance by animal fluency test (AFT), digit symbol substitution test (DSST), immediate recall tests (IRT) and delayed recall test (DRT), and created a total Z-score for impairment. DOBS was calculated from 16 dietary components, and relationships with cognitive function were explored using weighted generalized linear models, restricted cubic splines, and Quantile g-computation models, stratified by sex and sex hormones. RESULTS: We found high DOBS is negatively associated with low cognitive performance in AFT (OR: 0.473, 95 % CI: 0.233-0.963), more pronounced in males (OR: 0.402, 95 % CI: 0.166-0.971). Similarly, we found high DOBS is negatively associated with low cognitive performance in DSST (OR: 0.429, 95 % CI: 0.253-0.728) and global cognition (OR: 0.451, 95 % CI: 0.208-0.977). In males, the DOBS-cognition association is largely across testosterone, estradiol, and sex hormone-binding globulin SHBG normal levels, while significant in females only for the SHBG normal group in DSST (OR: 0.277, 95 % CI: 0.101-0.760). Magnesium had the highest positive weight in the DOBS-cognition association for DRT and DSST, and the DOBS-cognition association was non-linear (P < 0.01). CONCLUSIONS: We showed DOBS negatively and nonlinearly correlated with cognitive decline in older adults, particularly in males, providing a preventive basis for cognitive well-being.