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Peer-reviewedCC BY-NC-NDJACC. Advances

Associations of Physical Activity and Diet Quality With Mortality and Cardiovascular Disease in Cardiovascular-Kidney-Metabolic Syndrome.

  • Haiyang Dong1
  • Yunxin Wang1
  • Yue Chen1
  • Chuang Han1
  • Wenying Gao2
  • Zhicheng Zhang2
  • Xinming Xu2
  • Fang Tian3
  • Feiyu Ma2
  • Zidong Zhao1
  • Xiang Gao4
  • Liang Sun5
5 affiliations
  1. 1Shanghai Stomatological Hospital & School of Stomatology, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China.
  2. 2Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China.
  3. 3Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China; Department of Clinical Nutrition, Huashan Hospital, Fudan University, Shanghai, China.
  4. 4Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China. Electronic address: [email protected].
  5. 5Shanghai Stomatological Hospital & School of Stomatology, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China. Electronic address: [email protected].
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Abstract

Background

Physical activity (PA) and diet are cornerstones for cardiovascular disease (CVD) prevention, yet their associations with CVD within the cardiovascular-kidney-metabolic (CKM) framework remain unexplored.Objectives

This study aims to evaluate the independent and joint associations of PA and/or diet quality with mortality and incident CVD across CKM stages.Methods

Our study included 339,074 UK Biobank participants (51.3% women, mean age 56.4 years) with CKM syndrome stage 0 to 4. PA was categorized as high (≥150 min/wk of walking or moderate-to-vigorous activity) or low using self-reported and accelerometer-measured data. Diet quality was classified as low/median/high. Cox proportional hazards models assessed associations with incident CVD, cause-specific CVD mortality, and all-cause mortality across CKM stages.Results

High PA was associated with lower risks of all-cause mortality (HR: 0.76 [95% CI: 0.74-0.79]), composite CVD mortality (0.74 [0.70-0.77]), and incident composite CVD (0.90 [0.88-0.92]); for high diet quality, corresponding HRs (95% CIs) were 0.81 (0.77-0.85), 0.81 (0.75-0.88), and 0.87 (0.84-0.90). PA showed nonlinear associations with these outcomes, plateauing at approximately 2,500 metabolic equivalent min/wk. High PA combined with high diet quality showed stronger inverse associations with all-cause mortality (0.64 [0.60-0.68]), composite CVD mortality (0.61 [0.54-0.68]), and incident composite CVD (0.83 [0.79-0.88]). Significant multiplicative interactions between PA and diet quality were observed for stroke mortality, composite CVD, and heart failure. The joint associations with these outcomes were stronger at more advanced CKM syndrome stages.Conclusions

Beyond individual benefits, joint PA-diet modification was associated with lower risk of mortality and CVD across CKM stages, highlighting the value of integrated behavioral strategies.

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Cite

BibTeXRIS
BibTeX
@article{dong2026associations,
  title = {{Associations of Physical Activity and Diet Quality With Mortality and Cardiovascular Disease in Cardiovascular-Kidney-Metabolic Syndrome.}},
  author = {Haiyang Dong and Yunxin Wang and Yue Chen and Chuang Han and Wenying Gao and Zhicheng Zhang and Xinming Xu and Fang Tian and Feiyu Ma and Zidong Zhao and Xiang Gao and Liang Sun},
  journal = {JACC. Advances},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jacadv.2026.103338},
  url = {https://europepmc.org/article/MED/42868966},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Associations of Physical Activity and Diet Quality With Mortality and Cardiovascular Disease in Cardiovascular-Kidney-Metabolic Syndrome.
AU  - Haiyang Dong
AU  - Yunxin Wang
AU  - Yue Chen
AU  - Chuang Han
AU  - Wenying Gao
AU  - Zhicheng Zhang
AU  - Xinming Xu
AU  - Fang Tian
AU  - Feiyu Ma
AU  - Zidong Zhao
AU  - Xiang Gao
AU  - Liang Sun
PY  - 2026
DA  - 2026/10/13
JO  - JACC. Advances
DO  - 10.1016/j.jacadv.2026.103338
UR  - https://europepmc.org/article/MED/42868966
AB  - Background  Physical activity (PA) and diet are cornerstones for cardiovascular disease (CVD) prevention, yet their associations with CVD within the cardiovascular-kidney-metabolic (CKM) framework remain unexplored.Objectives  This study aims to evaluate the independent and joint associations of PA and/or diet quality with mortality and incident CVD across CKM stages.Methods  Our study included 339,074 UK Biobank participants (51.3% women, mean age 56.4 years) with CKM syndrome stage 0 to 4. PA was categorized as high (≥150 min/wk of walking or moderate-to-vigorous activity) or low using self-reported and accelerometer-measured data. Diet quality was classified as low/median/high. Cox proportional hazards models assessed associations with incident CVD, cause-specific CVD mortality, and all-cause mortality across CKM stages.Results  High PA was associated with lower risks of all-cause mortality (HR: 0.76 [95% CI: 0.74-0.79]), composite CVD mortality (0.74 [0.70-0.77]), and incident composite CVD (0.90 [0.88-0.92]); for high diet quality, corresponding HRs (95% CIs) were 0.81 (0.77-0.85), 0.81 (0.75-0.88), and 0.87 (0.84-0.90). PA showed nonlinear associations with these outcomes, plateauing at approximately 2,500 metabolic equivalent min/wk. High PA combined with high diet quality showed stronger inverse associations with all-cause mortality (0.64 [0.60-0.68]), composite CVD mortality (0.61 [0.54-0.68]), and incident composite CVD (0.83 [0.79-0.88]). Significant multiplicative interactions between PA and diet quality were observed for stroke mortality, composite CVD, and heart failure. The joint associations with these outcomes were stronger at more advanced CKM syndrome stages.Conclusions  Beyond individual benefits, joint PA-diet modification was associated with lower risk of mortality and CVD across CKM stages, highlighting the value of integrated behavioral strategies.
SN  - 2772-963X
ER  -