MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK.
Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Medical Drive, Brenner Centre for Molecular Medicine, Singapore, 117609, Republic of Singapore.
BMC Med. 2024 Oct 14;22(1):464. doi: 10.1186/s12916-024-03668-6.
Physical activity (PA) and diet quality have each been shown to be inversely associated with mortality but their combined impact on longevity has been less explored, particularly when considering their changes over time. This study aimed to examine the separate and combined associations of PA, diet quality and their changes over time with mortality outcomes.
A prospective cohort study was performed on 9349 adults aged 40 to 79 years from the population-based European Prospective Investigation into Cancer in Norfolk Study, with repeated measurements of PA and diet (from 1993 till 2004) and subsequent follow-up till 2022 (median follow-up 18.8 years). Validated questionnaires were used to derive physical activity energy expenditure (PAEE) as a proxy of total PA and adherence to the Mediterranean diet score (MDS, range 0-15 points) as an indicator of overall diet quality, and their changes over time (∆PAEE and ∆MDS). Cox regression models adjusted for potential confounders and mediators were used to estimate hazard ratios (HRs) and 95% CIs.
Over 149,681 person-years of follow-up, there were 3534 deaths. In adjusted models, for each 1-SD difference in baseline PAEE (4.64 kJ/kg/day), ∆PAEE (0.65 kJ/kg/day per year), baseline MDS (1.30 points) and ∆MDS (0.32 points per year), HRs (95% CI) for all-cause mortality were 0.90 (0.86 to 0.94), 0.89 (0.85 to 0.93), 0.95 (0.91 to 0.99) and 0.93 (0.90 to 0.97), respectively. Compared with participants with sustained low PAEE (< 5 kJ/kg/day) and low MDS (< 8.5 points), those with sustained high PAEE and high MDS had lower all-cause mortality (HR 0.78; 95% CI: 0.68-0.91), as did those who improved both PAEE and MDS (0.60; 0.44-0.82). There was no evidence of interaction between PA and diet quality exposures on mortality risk. Population impact estimates suggested that if all participants had maintained high levels of PA and diet quality consistently, cumulative adjusted mortality rate would have been 8.8% (95% CI: 2.4 to 15.3%) lower.
These findings suggest that adopting and maintaining higher levels of PA and diet quality are associated with lower mortality. Significant public health benefits could be realised by enabling active living and healthy eating through adulthood.
体力活动（PA）和饮食质量都与死亡率呈负相关，但它们对长寿的综合影响研究较少，尤其是考虑到它们随时间的变化。本研究旨在探讨 PA、饮食质量及其随时间变化对死亡结局的单独和综合关联。
这项前瞻性队列研究纳入了来自基于人群的英国诺福克郡癌症前瞻性研究（European Prospective Investigation into Cancer in Norfolk Study）中的 9349 名年龄在 40 至 79 岁的成年人，对他们的 PA 和饮食进行了重复测量（从 1993 年至 2004 年），并随后进行了随访直至 2022 年（中位随访时间为 18.8 年）。使用经过验证的问卷来推算体力活动能量消耗（PAEE）作为总 PA 的替代指标，以及采用地中海饮食评分（MDS，范围为 0 至 15 分）作为整体饮食质量的指标，并推算其随时间的变化（∆PAEE 和 ∆MDS）。使用调整了潜在混杂因素和中介因素的 Cox 回归模型来估计危险比（HRs）和 95%置信区间（CIs）。
在超过 149681 人年的随访中，有 3534 人死亡。在调整后的模型中，与基线 PAEE（4.64 kJ/kg/天）每 1-SD 差异、∆PAEE（每年 0.65 kJ/kg/天）、基线 MDS（1.30 分）和 ∆MDS（每年 0.32 分）相比，全因死亡率的 HR（95%CI）分别为 0.90（0.86 至 0.94）、0.89（0.85 至 0.93）、0.95（0.91 至 0.99）和 0.93（0.90 至 0.97）。与持续低 PAEE（<5 kJ/kg/天）和低 MDS（<8.5 分）的参与者相比，持续高 PAEE 和高 MDS 的参与者全因死亡率较低（HR 0.78；95%CI：0.68-0.91），PAEE 和 MDS 均改善的参与者也是如此（0.60；0.44-0.82）。PA 和饮食质量暴露对死亡率风险之间没有交互作用的证据。人群影响估计表明，如果所有参与者一直保持高水平的 PA 和饮食质量，累积调整死亡率将降低 8.8%（95%CI：2.4 至 15.3%）。
这些发现表明，采用和保持较高水平的 PA 和饮食质量与较低的死亡率相关。通过促进成年人的积极生活和健康饮食，可能会带来显著的公共卫生效益。
