Emerging healthy lifestyle factors and all-cause mortality among people with metabolic syndrome and metabolic syndrome-like characteristics in NHANES

Abstract

Background: The impact of integrated lifestyles on health has attracted a lot of attention. It remains unclear whether adherence to low-risk healthy lifestyle factors is protective in individuals with metabolic syndrome and metabolic syndrome-like characteristics. We aimed to explore whether and to what extent overall lifestyle scores mitigate the risk of all-cause mortality in individuals with metabolic syndrome and metabolic syndrome-like characteristics.

Methods: In total, 6934 participants from the 2007 to 2014 National Health and Nutrition Examination Survey (NHANES) were included. The weighted healthy lifestyle score was constructed based on smoking, alcohol consumption, physical activity, diet, sleep duration, and sedentary behavior information. Generalized linear regression models and restricted cubic splines were used to analyze the association between healthy lifestyle scores and all-cause mortality. ​ RESULTS: Compared to participants with relatively low healthy lifestyle scores, the risk ratio (RR) in the middle healthy lifestyle score group was 0.51 (RR = 0.51, 95% CI 0.30-0.88), and the high score group was 0.26 (RR = 0.26, 95% CI 0.15-0.48) in the population with metabolic syndrome. The difference in gender persists. In females, the RRs of the middle and high score groups were 0.47 (RR = 0.47, 95% CI 0.23-0.96) and 0.21 (RR = 0.21, 95% CI 0.09-0.46), respectively. In males, by contrast, the protective effect of a healthy lifestyle was more pronounced in the high score group (RR = 0.33, 95% CI 0.13-0.83) and in females, the protective effects were found to be more likely. The protective effect of a healthy lifestyle on mortality was more pronounced in those aged < 65 years. Higher lifestyle scores were associated with more prominent protective effects, regardless of the presence of one metabolic syndrome factor or a combination of several factors in 15 groups. What's more, the protective effect of an emerging healthy lifestyle was more pronounced than that of a conventional lifestyle.

Conclusions: Adherence to an emerging healthy lifestyle can reduce the risk of all-cause mortality in people with metabolic syndrome and metabolic syndrome-like characteristics; the higher the score, the more obvious the protective effect. Our study highlights lifestyle modification as a highly effective nonpharmacological approach that deserves further generalization.

Keywords: Healthy lifestyle; Metabolic syndrome; Mortality; NHANES.

Fig. 1

Flow chart of the screening of eligible participants

Fig. 2

Relationship between participants with metabolic syndrome-like characteristics and all-cause mortality in the middle score group. A RRs in all population; B RRs in males; C RRs in females; a represents the characteristics of central obesity, b represents the characteristics of dyslipidemia, c represents the characteristics of hypertension, and d represents the characteristics of hyperglycemia

Fig. 3

Relationship between participants with metabolic syndrome-like characteristics and all-cause mortality in the high score group. A RRs in all population; B RRs in males; C RRs in females; a represents the characteristics of central obesity, b represents the characteristics of dyslipidemia, c represents the characteristics of hypertension, and d represents the characteristics of hyperglycemia

Fig. 4

Dose–response relationship between weighted healthy lifestyle scores and all-cause mortality. The solid and dashed lines indicate the estimated RRs and their 95% confidence intervals

Fig. 5

Comparison of the conventional and emerging healthy lifestyle scores. A Comparison in the middle score group; B comparison in the high score group. Of the two groups represented by the same legend, the one on the left represents the emerging healthy lifestyle group, and the one on the right represents the conventional healthy lifestyle group