The Mediating Role of Oxidative Stress on the Association Between Oxidative Balance Score and Cancer-Related Cognitive Impairment in Lung Cancer Patients: A Cross-Sectional Study

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Objectives: To explore the association between the oxidative balance score (OBS) and cancer-related cognitive impairment (CRCI) in patients with lung cancer, as well as the oxidative stress biomarkers involved. Methods: In this cross-sectional study, 315 lung cancer patients were recruited, from whom 142 blood samples were collected to determine oxidative stress biomarkers. Dietary intake was assessed using 3-day, 24 h dietary recalls. The OBS was calculated by summing up pro- and antioxidant factors from a diet and lifestyles assessment. CRCI was evaluated using the Montreal Cognitive Assessment (MoCA) test. Results: A total of 103 patients (32.7%) developed CRCI, with significantly lower OBS and dietary OBS and lower superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities than non-CRCI patients (p < 0.05). For every 1-point increase in OBS, the risk of CRCI was reduced by 10.6% (OR = 0.894; 95% CI 0.819, 0.977; p = 0.013). Both vitamin E (OR = 0.922; 95% CI 0.868, 0.980; p = 0.009) and dietary fiber (OR = 0.909; 95% CI 0.832, 0.992; p = 0.032) were significantly inversely related to CRCI. The association between the total OBS and CRCI was mediated by SOD (ACME = −0.0061; 95% CI −0.0170, −0.0004; p = 0.015) and GPx (ACME = −0.0069; 95% CI −0.0203, −0.0002; p = 0.032), respectively. Conclusions: Lung cancer patients with a greater balance of antioxidant to pro-oxidant diet, especially rich in dietary fiber and vitamin E, may decrease their CRCI in part by affecting SOD and GPx activities.

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