Lai Chong, Fu Ruiyi, Huang Changzhen, Wang Lu, Ren Haiqing, Zhu Yimin, Zhang Xuhui
Department of Urology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Epidemiology & Biostatistics, School of Public Health, Zhejiang University, Hangzhou 310058, Zhejiang, China.
J Nutr Health Aging. 2024 Mar;28(3):100164. doi: 10.1016/j.jnha.2024.100164. Epub 2024 Feb 1.
To identify the influence of healthy lifestyles on the incidence of the first NCD (FNCD), multiple chronic conditions (MCCs), and the progression from FNCD to MCCs.
cohort study.
Zhejiang, China PARTICIPANTS: 10566 subjects (55.5 ± 13.5 years, 43.1% male) free of NCDs at baseline from the Zhejiang Metabolic Syndrome prospective cohort.
Healthy lifestyle score (HLS) was developed by 6 common healthy lifestyle factors as smoking, alcohol drinking, physical activity, body mass index (BMI) and waist-to-hip ratio (WHR). Healthy lifestyle data and metabolic biomarkers collected via a face-to-face questionnaire-based interview, clinical health examination and routine biochemical determination. Biochemical variables were determined using biochemical auto-analyzer. Participants were stratified into four group based on the levels of HLS as ≤2, 3, 4 and ≥5. Multiple Cox proportional hazards model was applied to examine the relationship between HLS and the risk of FNCD, MCCs and the progression from FNCD to MCCs. The population-attributable fractions (PAF) were used to assess the attributable role of HLS. Mediating effect was examined by mediation package in R.
After a median of 9.92 years of follow-up, 1572 participants (14.9%) developed FNCD, and 149 (1.4%) developed MCCs. In the fully adjusted model, the higher HLS group (≥5) was associated with lower risk of FNCD (HR = 0.68 and 95% CI: 0.56-0.82), MCCs (HR = 0.31 and 95%CI: 0.14-0.69); and the progression from FNCD to MCCs (HR = 0.39 and 95%CI: 0.18-0.85). Metabolic components (TC, TG, HDL-C, LDC-C, FPG, and UA) played the mediating roles with the proportion ranging from 5.02% to 22.2% for FNCD and 5.94% to 20.1% for MCCs. PAFs (95%CI) for poor adherence to the overall healthy lifestyle (HLS ≤ 3) were 17.5% (11.2%, 23.7%) for FNCD, 42.9% (23.4%, 61.0%) for MCCs, and 37.0% (15.5%, 56.3%) for the progression from FNCD to MCCs.
High HLS decreases the risk of FNCD, MCCs, and the progression from FNCD to MCCs. These effects are partially mediated by metabolic components. Maintaining healthy lifestyles might reduce the disease burden of common chronic diseases.
确定健康生活方式对首发非传染性疾病（FNCD）、多种慢性病（MCC）发病率以及从FNCD进展到MCC的影响。
队列研究。
中国浙江
来自浙江代谢综合征前瞻性队列的10566名基线时无NCD的受试者（55.5±13.5岁，43.1%为男性）。
健康生活方式评分（HLS）由吸烟、饮酒、身体活动、体重指数（BMI）和腰臀比（WHR）这6个常见的健康生活方式因素构成。通过基于面对面问卷调查的访谈、临床健康检查和常规生化测定收集健康生活方式数据和代谢生物标志物。使用生化自动分析仪测定生化变量。根据HLS水平将参与者分为四组，即≤2、3、4和≥5。应用多因素Cox比例风险模型来检验HLS与FNCD、MCC风险以及从FNCD进展到MCC之间的关系。采用人群归因分数（PAF）来评估HLS的归因作用。通过R语言中的中介效应包检验中介效应。
经过中位9.92年的随访，1572名参与者（14.9%）发生了FNCD，149名（1.4%）发生了MCC。在完全调整模型中，较高HLS组（≥5）与较低的FNCD风险（HR = 0.68，95%CI：0.56 - 0.82）、MCC风险（HR = 0.31，95%CI：0.14 - 0.69）以及从FNCD进展到MCC的风险（HR = 0.39，95%CI：0.18 - 0.85）相关。代谢成分（总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹血糖和尿酸）起到了中介作用，对于FNCD，中介比例范围为5.02%至22.2%，对于MCC，中介比例范围为5.94%至20.1%。总体健康生活方式依从性差（HLS≤3）的PAF（95%CI）对于FNCD为17.5%（11.2%，23.7%），对于MCC为42.9%（23.4%，61.0%），对于从FNCD进展到MCC为37.0%（15.5%，56.3%）。
高HLS可降低FNCD、MCC的风险以及从FNCD进展到MCC的风险。这些效应部分由代谢成分介导。保持健康的生活方式可能会减轻常见慢性病的疾病负担。
