Combined associations of physical activity, diet quality and their changes over time with mortality: findings from the EPIC-Norfolk study, United Kingdom.

Publisher: BioMed Central Country of Publication: England NLM ID: 101190723 Publication Model: Electronic Cited Medium: Internet ISSN: 1741-7015 (Electronic) Linking ISSN: 17417015 NLM ISO Abbreviation: BMC Med Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2003-

Exercise*/physiology ; Diet*; Humans ; Middle Aged ; Male ; Female ; Adult ; Aged ; Prospective Studies ; United Kingdom/epidemiology ; Mortality/trends ; Surveys and Questionnaires ; Diet, Mediterranean/statistics & numerical data

Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
(© 2024. The Author(s).)

PLoS Med. 2008 Jan 8;5(1):e12. (PMID: 18184033)
Int J Epidemiol. 2022 May 9;51(2):641-667. (PMID: 34480556)
BMC Public Health. 2020 Nov 16;20(1):1724. (PMID: 33198717)
Nutrients. 2017 Aug 26;9(9):. (PMID: 28846611)
Nutrients. 2023 Aug 07;15(15):. (PMID: 37571419)
Nutrients. 2021 Jan 28;13(2):. (PMID: 33525638)
J Physiol. 2013 Dec 15;591(24):6231-43. (PMID: 24167223)
BMC Med. 2016 Sep 29;14(1):135. (PMID: 27679997)
Stat Med. 2011 Feb 20;30(4):377-99. (PMID: 21225900)
JAMA Netw Open. 2019 Mar 1;2(3):e190355. (PMID: 30848809)
Br J Cancer. 1999 Jul;80 Suppl 1:95-103. (PMID: 10466767)
Lancet. 2020 Oct 17;396(10258):1223-1249. (PMID: 33069327)
Eur J Nutr. 2021 Apr;60(3):1561-1586. (PMID: 32770356)
BMJ. 2019 Jun 26;365:l2323. (PMID: 31243014)
Eur J Nutr. 2019 Feb;58(1):173-191. (PMID: 29177567)
Int J Epidemiol. 1997;26 Suppl 1:S137-51. (PMID: 9126542)
Br J Nutr. 1994 Oct;72(4):619-43. (PMID: 7986792)
Am J Kidney Dis. 2023 May;81(5):621-624. (PMID: 36455682)
Eur J Epidemiol. 2012 Jan;27(1):15-25. (PMID: 22089423)
Br J Nutr. 1995 Apr;73(4):531-50. (PMID: 7794870)
Public Health Nutr. 2011 Dec;14(12A):2274-84. (PMID: 22166184)
Crit Rev Food Sci Nutr. 2020;60(7):1207-1227. (PMID: 30676058)
Circulation. 2019 Sep 17;140(12):979-991. (PMID: 31401846)
Br J Sports Med. 2022 Jul 10;:. (PMID: 35811091)
Br J Sports Med. 2023 Aug;57(15):979-989. (PMID: 36854652)
Br J Nutr. 2018 Nov;120(10):1081-1097. (PMID: 30401007)
Int J Epidemiol. 2014 Aug;43(4):1063-72. (PMID: 23771720)
Eur J Epidemiol. 2005;20(7):575-9. (PMID: 16119429)
JAMA. 2003 May 14;289(18):2379-86. (PMID: 12746361)
BMC Public Health. 2019 Dec 26;19(1):1733. (PMID: 31878916)
Cancer Epidemiol Biomarkers Prev. 2010 Dec;19(12):3000-4. (PMID: 20978171)
Nutrients. 2017 Sep 26;9(10):. (PMID: 28954418)
Public Health Nutr. 2003 Jun;6(4):407-13. (PMID: 12795830)
J Nutr. 2020 Apr 1;150(4):663-671. (PMID: 31758189)
Eur J Nutr. 2019 Jun;58(4):1569-1578. (PMID: 29696401)
Prev Med. 2018 Jan;106:45-52. (PMID: 28964855)
N Engl J Med. 2017 Jul 13;377(2):143-153. (PMID: 28700845)
Eur J Nutr. 2022 Mar;61(2):925-933. (PMID: 34657186)
JAMA. 2004 Sep 22;292(12):1433-9. (PMID: 15383513)
Int J Behav Nutr Phys Act. 2004 Feb 3;1(1):2. (PMID: 15171787)
JAMA. 2020 Nov 24;324(20):2076-2094. (PMID: 33231669)

Keywords: Cancer mortality; Cardiovascular diseases mortality; Cohort studies; Diet quality; Mediterranean diet; Mortality; Physical activity; Prospective studies; Trajectories

Date Created: 20241014 Date Completed: 20241015 Latest Revision: 20241206

20241209

PMC11476187

10.1186/s12916-024-03668-6

39402526