Gao Kedi, Lin Youliang
School of Physical Education, Wuhan University of Technology, South Lake Campus, Xiongchu Avenue 258, Hongshan District, Wuhan, 430000, Hubei, China.
Sci Rep. 2025 May 29;15(1):18872. doi: 10.1038/s41598-025-02921-z.
This study examines the associations between physical activity (PA) and all-cause mortality (ACM), cause-specific mortality (cancer, cardiovascular disease), and premature mortality, with a focus on the mediating role of insulin resistance. Data from the National Health and Nutrition Examination Survey (NHANES) were analyzed, including 8,460 participants. PA was quantified in metabolic equivalents (MET-h/week) and categorized into four groups: no physical activity (NOPA), low-level PA (LLPA), moderate-level PA (MLPA), and high-level PA (HLPA). Cox regression, restricted cubic splines, and Kaplan-Meier survival curves assessed the associations between PA and mortality risks. Mediation analysis evaluated the role of insulin resistance. With a median follow-up of 6.3 years, 1,147 all-cause deaths, 321 cardiovascular deaths, 274 cancer deaths, and 441 premature deaths. Compared to the NOPA group (0 MET-h/week), the LLPA (MET < 10 h/week), MLPA (10 ≤ MET < 50 h/week), and HLPA (≥ 50 MET-h/week) groups showed significant reductions in all-cause mortality risk by 39% (HR = 0.61, 95% CI: 0.51-0.73), 44% (HR = 0.56, 95% CI: 0.48-0.66), and 57% (HR = 0.43, 95% CI: 0.35-0.52), respectively. Similarly, for cardiovascular disease mortality, the risk reductions were 49% (HR = 0.51, 95% CI: 0.36-0.71), 51% (HR = 0.49, 95% CI: 0.37-0.64), and 52% (HR = 0.48, 95% CI: 0.35-0.66) across the three PA groups. In terms of cancer mortality risk, only the HLPA group showed a statistically significant 50% reduction (HR = 0.50, 95% CI: 0.34-0.74), while the LLPA and MLPA groups demonstrated non-significant reductions of 29% and 16%, respectively. A nonlinear dose-response relationship was observed for PA and mortality. Mediation analysis revealed that HOMA-IR mediated 22.1% (P = 0.022), 16.7% (P = 0.002), 15.7% (P = 0.030), and 10.1% (P = 0.058) of the association ACM, cause-specific mortality, and premature mortality, respectively. This study highlights the protective effects of PA in reducing the risks of ACM, cause-specific mortality, and premature mortality, particularly in patients with metabolic syndrome. Insulin resistance plays a significant mediating role in these relationships, underscoring the importance of targeting both PA and insulin resistance in interventions to reduce mortality risks in metabolic syndrome patients.
本研究探讨身体活动（PA）与全因死亡率（ACM）、特定病因死亡率（癌症、心血管疾病）和过早死亡率之间的关联，重点关注胰岛素抵抗的中介作用。对来自国家健康与营养检查调查（NHANES）的数据进行了分析，包括8460名参与者。PA以代谢当量（MET-h/周）进行量化，并分为四组：无身体活动（NOPA）、低水平PA（LLPA）、中等水平PA（MLPA）和高水平PA（HLPA）。采用Cox回归、受限立方样条和Kaplan-Meier生存曲线评估PA与死亡风险之间的关联。中介分析评估了胰岛素抵抗的作用。中位随访6.3年，有1147例全因死亡、321例心血管死亡、274例癌症死亡和441例过早死亡。与NOPA组（0 MET-h/周）相比，LLPA组（MET＜10 h/周）、MLPA组（10≤MET＜50 h/周）和HLPA组（≥50 MET-h/周）的全因死亡风险分别显著降低39%（HR = 0.61，95%CI：0.51 - 0.73）、44%（HR = 0.56，95%CI：0.48 - 0.66）和57%（HR = 0.43，95%CI：0.35 - 0.52）。同样，对于心血管疾病死亡率，三组PA组的风险降低分别为49%（HR = 0.51，95%CI：0.36 - 0.71）、51%（HR = 0.49，95%CI：0.37 - 0.64）和52%（HR = 0.48，95%CI：0.35 - 0.66）。就癌症死亡风险而言，只有HLPA组显示出统计学上显著的50%降低（HR = 0.50，95%CI：0.34 - 0.74），而LLPA组和MLPA组分别显示出29%和16%的非显著降低。观察到PA与死亡率之间存在非线性剂量反应关系。中介分析显示，HOMA-IR分别介导了ACM、特定病因死亡率和过早死亡率关联的22.1%（P = 0.022）、16.7%（P = 0.002）、15.7%（P = 0.030）和10.1%（P = 0.058）。本研究强调了PA在降低ACM、特定病因死亡率和过早死亡率风险方面的保护作用，尤其是在代谢综合征患者中。胰岛素抵抗在这些关系中起显著的中介作用，强调了在干预措施中同时针对PA和胰岛素抵抗以降低代谢综合征患者死亡风险的重要性。
