Zhou Hongyin, Zhang Hui, Huang Yaxin, Hu Yonggang
Department of Clinical Laboratory, Zigong First People's Hospital, Zigong, Sichuan Province, China.
Department of Clinical Laboratory, Gaoxin Tumor Hospital, Zigong, Sichuan Province, China.
Medicine (Baltimore). 2025 Sep 12;104(37):e44555. doi: 10.1097/MD.0000000000044555.
Chronic low-grade inflammation contributes to the development of many chronic diseases, and both vitamin C intake and physical activity have individually been linked to reduced inflammatory responses; however, their combined effects on systemic inflammation and long-term survival in adults with chronic viral infections remain largely unknown. This study evaluated the individual and combined associations of dietary vitamin C intake and physical activity with inflammatory biomarkers and all-cause mortality in a nationally representative cohort of U.S. adults aged 20 years or older. Data from 33,590 participants in the National Health and Nutrition Examination Survey (NHANES 2005-2018) were analyzed, including 22,763 (67.8%) who were seropositive for at least 1 viral pathogen and 10,827 who were seronegative. Mortality status through 2019 was ascertained by probabilistic linkage of NHANES participants to the National Death Index (NDI) using a unique combination of identifiers provided by the National Center for Health Statistics. Higher vitamin C intake was associated with lower platelet count (PC), neutrophil count (NC), lymphocyte count (LC), platelet × neutrophil product (PPN), and systemic immune-inflammation index (SII) across the overall population, with consistent inverse associations in seronegative adults and those seropositive for hepatitis viruses, HSV, and HPV (e.g., PPN difference in the HSV subgroup, P < 1 × 10-9). Moderate-to-vigorous physical activity was linked to reduced PC, PLR, PPN, and SII, most prominently in seronegative and HSV-seropositive participants, while associations in the hepatitis, HPV, and HIV subgroups were weaker. Participants with both high vitamin C intake and higher activity demonstrated the most favorable inflammatory profiles, characterized by consistent reductions in platelet- and neutrophil-based indices. In HSV-seropositive adults (n = 10,306), elevated PC and PPN (above the median) were associated with significantly higher 10-year all-cause mortality (log-rank P < .05). These findings indicate that vitamin C intake and physical activity, individually and in combination, are associated with lower systemic inflammation and improved survival in adults with chronic viral infections, supporting the potential role of lifestyle interventions in reducing long-term mortality risk.
慢性低度炎症会促使许多慢性疾病的发展，维生素C摄入量和体育活动各自都与炎症反应减轻有关；然而，它们对慢性病毒感染成人的全身炎症和长期生存的联合影响在很大程度上仍不清楚。本研究评估了膳食维生素C摄入量和体育活动与炎症生物标志物及全因死亡率之间的个体关联和联合关联，研究对象为美国20岁及以上具有全国代表性的成年人队列。分析了来自国家健康与营养检查调查（NHANES 2005 - 2018）中33,590名参与者的数据，其中包括22,763名（67.8%）至少对一种病毒病原体血清学呈阳性的参与者和10,827名血清学呈阴性的参与者。通过使用国家卫生统计中心提供的唯一标识符组合，将NHANES参与者与国家死亡指数（NDI）进行概率性关联，确定了截至2019年的死亡状态。在总体人群中，较高的维生素C摄入量与较低的血小板计数（PC）、中性粒细胞计数（NC）、淋巴细胞计数（LC）、血小板×中性粒细胞产物（PPN）和全身免疫炎症指数（SII）相关，在血清学阴性的成年人以及对肝炎病毒、单纯疱疹病毒（HSV）和人乳头瘤病毒（HPV）血清学呈阳性的人群中存在一致的负相关（例如，HSV亚组的PPN差异，P < 1×10⁻⁹）。中度至剧烈的体育活动与PC、血小板淋巴细胞比值（PLR）、PPN和SII降低有关，在血清学阴性和HSV血清学呈阳性的参与者中最为显著，而在肝炎、HPV和人类免疫缺陷病毒（HIV）亚组中的关联较弱。维生素C摄入量高且活动量也高的参与者表现出最有利的炎症特征，其特点是基于血小板和中性粒细胞的指标持续降低。在HSV血清学呈阳性的成年人（n = 10,306）中，PC和PPN升高（高于中位数）与10年全因死亡率显著升高相关（对数秩检验P <.05）。这些发现表明，维生素C摄入量和体育活动，单独或联合起来，都与慢性病毒感染成人较低的全身炎症和改善的生存率相关，支持了生活方式干预在降低长期死亡风险方面的潜在作用。
