Wang Haozhe, Zhang Yike, Sun Meimei, Chen Zhou
College of Basic Medical Sciences of Naval Medical University, Shanghai, China.
Department of Nephrology, Gongli Hospital of Shanghai Pudong New Area, Shanghai, China.
BMC Public Health. 2025 May 28;25(1):1965. doi: 10.1186/s12889-025-23157-6.
Cardiovascular-kidney-metabolic (CKM) syndrome, a newly defined cluster of interrelated cardiometabolic disorders, poses a global health burden. While physical activity (PA) is a cornerstone of metabolic health, its relationship with early CKM progression remains unclear. This study aims to explore the nonlinear dose-response evidence between PA and early CKM syndrome and highlights the potential PA thresholds to maximise metabolic health benefits, providing theoretical support for personalized PA guidelines.
Using data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018, we analyzed 12,068 participants with early CKM (stages 0-2). Moderate-to-vigorous physical activity (MVPA) was quantified as metabolic equivalent of task (MET)*min/week. Restricted cubic splines, weighted logistic regression, and mediation analyses were employed to assess MVPA-CKM relationships and mediating roles of obesity-related indicators. Subgroup analyses evaluated heterogeneity across demographics and other core covariates.
A L-shaped association between MVPA and early CKM risk was identified (p-non-linear < 0.001). Before the lowest point (6872 METmin/week), any incremental increase in MVPA was associated with a reduction in early CKM risk, and moderate MVPA (600 - 12,600 METmin/week) exerts a protective effect. Up to the threshold of 12,600 METmin/week, MVPA continued to exhibit protective effects. The mediating effect of all the obesity-related indicators was not significant (p > 0.05). Protective effects of moderate PA were consistent across the majority subgroups, whereas an attenuation or even reversal of this protective effect was observed at excessive MVPA levels (> 12,600 METmin/week), where outcomes statistically indistinguishable from those observed at MVPA levels below 600 MET*min/week.
This study reveals an L-shaped association between MVPA and early CKM risk. The findings highlight the protective effects of moderate MVPA (600 - 12,600 METmin/week) while demonstrating that higher MVPA (> 12,600 METmin/week) may attenuate or even reverse these benefits.
心血管-肾脏-代谢（CKM）综合征是一种新定义的相互关联的心脏代谢紊乱集群，给全球健康带来负担。虽然身体活动（PA）是代谢健康的基石，但其与早期CKM进展的关系仍不清楚。本研究旨在探索PA与早期CKM综合征之间的非线性剂量反应证据，并突出潜在的PA阈值以最大化代谢健康益处，为个性化PA指南提供理论支持。
利用2007 - 2018年美国国家健康和营养检查调查（NHANES）的数据，我们分析了12,068名早期CKM（0 - 2期）参与者。中度至剧烈身体活动（MVPA）被量化为代谢当量任务（MET）*分钟/周。采用受限立方样条、加权逻辑回归和中介分析来评估MVPA与CKM的关系以及肥胖相关指标的中介作用。亚组分析评估了不同人口统计学和其他核心协变量的异质性。
确定了MVPA与早期CKM风险之间呈L形关联（p-非线性<0.001）。在最低点（6872 MET分钟/周）之前，MVPA的任何增量增加都与早期CKM风险的降低相关，且中度MVPA（600 - 12,600 MET分钟/周）具有保护作用。直至12,600 MET分钟/周的阈值，MVPA持续表现出保护作用。所有肥胖相关指标的中介作用均不显著（p>0.05）。中度PA的保护作用在大多数亚组中是一致的，而在过高MVPA水平（>12,600 MET分钟/周）时观察到这种保护作用减弱甚至逆转，此时的结果在统计学上与MVPA水平低于600 MET*分钟/周时观察到的结果无差异。
本研究揭示了MVPA与早期CKM风险之间的L形关联。研究结果突出了中度MVPA（600 - 12,600 MET分钟/周）的保护作用，同时表明更高的MVPA（>12,600 MET分钟/周）可能会减弱甚至逆转这些益处。
