Stamatakis Emmanuel, Koemel Nicholas A, Biswas Raaj K, Ahmadi Matthew N, Allman-Farinelli Margaret, Trost Stewart G, Inan-Eroglu Elif, Del Pozo Cruz Borja, Bin Yu Sun, Postnova Svetlana, Duncan Mitch J, Dumuid Dorothea, Brown Helen, Maher Carol, Fontana Luigi, Simpson Stephen, Cistulli Peter A
Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
BMC Med. 2025 Feb 26;23(1):111. doi: 10.1186/s12916-024-03833-x.
Sleep, physical activity, and nutrition (SPAN) are critical behaviours for health, although they have traditionally been studied separately. We examined the combined associations of SPAN and the minimum between-individual variations associated with meaningfully lower all-cause mortality risk.
This prospective cohort analysis included 59,078 participants from the UK Biobank (median age: 64.0 years; 45.4% male) who wore trackers for 7 days and self-reported dietary data. Wearable-measured sleep (hours/day) and moderate to vigorous physical activity (MVPA; mins/day) were calculated using a machine learning based schema. A 10-item diet quality score (DQS) assessed the intake of vegetables, fruits, fish, dairy, whole grains, vegetable oils, refined grains, processed and unprocessed meats, and sugary beverages (0-100 for all components with higher values indicating higher quality). Cox proportional hazards models were used to estimate hazard ratios (HR) for all-cause mortality risk across 27 separate joint tertile combinations of SPAN behaviours with the lowest tertile for all three as the referent group. For more granular clinical interpretations, we examined combined incremental dose-response changes of the SPAN behaviours using the 5th percentile of each behaviour as the referent point.
Over the 8.1-year median follow-up time, 2,458 mortality events occurred. Compared to the referent group of combined SPAN exposure (lowest tertiles for all three), the optimal SPAN combination involving moderate sleep duration (7.2-8.0 h/day), high MVPA (42-103 min/day), and a DQS between 57.5 and 72.5 was associated with an HR of 0.36 (95% CI: 0.26-0.50). Relative to the 5th percentile of sleep (5.5 h/day), physical activity (7.3 min/day), and nutrition (36.9 DQS), a theoretical minimum combined increase of 15 min/day of sleep, 1.6 min/day MVPA, and 5 DQS points (corresponding to e.g., extra 1/2 serving of vegetables per day or 1 less serving of processed meat per week) was associated with 10% lower all-cause mortality risk (0.90; 0.88-0.93). Combined increases of 75 min/day of sleep, 12.5 min/day MVPA, and 25 DQS points were associated with 50% lower all-cause mortality risk (0.50; 0.44-0.58).
This study highlights the potential health value of subtle combined SPAN modification in relation to mortality risk and expands opportunities for more holistic recommendations.
睡眠、身体活动和营养（SPAN）是对健康至关重要的行为，尽管传统上它们是分开研究的。我们研究了SPAN与个体间最小差异的综合关联，这些差异与显著降低全因死亡风险相关。
这项前瞻性队列分析纳入了来自英国生物银行的59,078名参与者（中位年龄：64.0岁；45.4%为男性），他们佩戴追踪器7天并自我报告饮食数据。使用基于机器学习的方案计算可穿戴设备测量的睡眠（小时/天）和中度至剧烈身体活动（MVPA；分钟/天）。一个10项饮食质量评分（DQS）评估蔬菜、水果、鱼类、乳制品、全谷物、植物油、精制谷物、加工和未加工肉类以及含糖饮料的摄入量（所有成分的评分为0 - 100，分数越高表明质量越高）。Cox比例风险模型用于估计SPAN行为的27种单独联合三分位数组合中全因死亡风险的风险比（HR），以所有三项均处于最低三分位数的组合作为参照组。为了进行更细致的临床解读，我们以每种行为的第5百分位数作为参照点，研究SPAN行为的联合增量剂量反应变化。
在8.1年的中位随访期内，发生了2458例死亡事件。与SPAN综合暴露的参照组（所有三项均处于最低三分位数）相比，最佳的SPAN组合包括适度睡眠时间（7.2 - 8.0小时/天）、高MVPA（42 - 103分钟/天）以及DQS在57.5至72.5之间，其HR为0.36（95%CI：0.26 - 0.50）。相对于睡眠的第5百分位数（5.5小时/天）、身体活动（7.3分钟/天）和营养（36.9 DQS），理论上睡眠每天最少增加15分钟、MVPA每天增加1.6分钟以及DQS增加5分（例如，相当于每天额外增加1/2份蔬菜或每周减少1份加工肉类）与全因死亡风险降低10%相关（0.90；0.88 - 0.93）。睡眠每天增加75分钟、MVPA每天增加12.5分钟以及DQS增加25分与全因死亡风险降低50%相关（0.50；0.44 - 0.58）。
本研究强调了在死亡率风险方面，对SPAN进行细微综合调整的潜在健康价值，并拓展了更全面建议的机会。
