Healthy Lifestyle Characteristics and Their Joint Association With Cardiovascular Disease Biomarkers in US Adults.
Level 4 - case-series / case-control
Cross-sectional observational survey (NHANES)
PubMed 26906650 · doi:10.1016/j.mayocp.2016.01.009
What was done
Analyzed 2003–2006 National Health and Nutrition Examination Survey (NHANES) data from 4,745 US adults. Four healthy lifestyle characteristics were evaluated: physical activity (accelerometer), healthy diet (Healthy Eating Index via 24-hour recalls), nonsmoking (serum cotinine), and recommended body fat percentage (dual-energy X-ray absorptiometry). These characteristics were analyzed individually and in combination for associations with cardiovascular biomarkers, including blood pressure, C-reactive protein, white blood cells, lipid panels, fasting glucose, insulin resistance, HbA1c, and homocysteine.
What was found
Only 2.7% (95% CI, 1.9%-3.4%) of US adults possessed all 4 healthy lifestyle characteristics. Having 3 or 4 characteristics compared with 0 was associated with more favorable biomarker profiles, with the exception of mean arterial blood pressure, fasting glucose, and HbA1c. Having 1 or 2 characteristics compared with 0 was favorably associated with C-reactive protein, white blood cells, HDL-C, total cholesterol, and homocysteine. Body fat percentage was the strongest correlate for HDL-C and total cholesterol; healthy diet and nonsmoking were strongest for homocysteine; diet was not strongly correlated with white blood cell count. Specific numerical effect sizes for biomarker levels were not reported in the abstract.
Why it matters
Achieving multiple healthy lifestyle behaviors is exceptionally rare among US adults, and different lifestyle characteristics appear to exert distinct influences on specific cardiovascular risk factors.
Limits
The cross-sectional design cannot establish causality or temporal direction. Diet was assessed using 24-hour recalls subject to recall error. The abstract omits effect sizes, variance estimates, and p-values for individual biomarker associations.
Cited by
- supports Fewer than 3% of the United States population meets four core low-risk lifestyle characteristics: non-smoking, 150 minutes of weekly exercise, diet in the top two quintiles of whole foods, and a healthy body fat percentage.