Higher calorie intake with adequate exercise is associated with reduced mortality compared with low-calorie diet with equivalent exercise: An observational study from NHANES based on the 2020–2025 Dietary Guidelines for Americans
Object: To explore the effects of different combinations of calorie intake and exercise on all-cause, cardiovascular and cancer mortality. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) were analyzed. Weighted multivariate cox regression analyses were performed to a...
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Elsevier
2025-09-01
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| Series: | Experimental Gerontology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0531556525001342 |
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| author | Hanghang Gan Yu Yan Shanshan Jia Yingqiang Guo Gonggong Lu |
| author_facet | Hanghang Gan Yu Yan Shanshan Jia Yingqiang Guo Gonggong Lu |
| author_sort | Hanghang Gan |
| collection | DOAJ |
| description | Object: To explore the effects of different combinations of calorie intake and exercise on all-cause, cardiovascular and cancer mortality. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) were analyzed. Weighted multivariate cox regression analyses were performed to assess the association between different combinations of calorie intake and exercise and mortality. Interaction effects were evaluated using the relative excess risk of interaction (RERI), attributable proportion of interaction (API), and synergy index (SI). Subgroup and sensitivity analyses were also conducted. Results: A total of 21,618 participants (51 % female) were included, with 1957 all-cause deaths, 568 cardiovascular deaths, and 508 cancer deaths over a median follow-up of 6.75 years. Both higher- and low-calorie diet were associated with reduced all-cause mortality as long as the participants engaged in adequate exercise, with greater benefits in the former group (Higher-calorie diet: Hazard ratio (HR) [95%CI] 0.59 [0.48, 0.71]; low-calorie diet: 0.69 [0.56, 0.84]; both P < 0.001). Only higher-calorie diet with adequate exercise was associated with reduced cardiovascular mortality (HR 0.64 [0.43, 0.94], P = 0.022, P for trend = 0.085). No significant association about cancer mortality was observed (P > 0.05). There was no additive interaction between low-calorie diet and adequate exercise in reducing mortality (all P > 0.05). Subgroup and sensitivity analyses remained stable. Conclusion: Adequate exercise with either higher- or low-calorie diet was associated with reduced all-cause mortality, with greater benefits in the former group. Moreover, only the former was associated with a reduction in cardiovascular mortality. |
| format | Article |
| id | doaj-art-01805c4feb2945d99c5c38179131c8ea |
| institution | DOAJ |
| issn | 1873-6815 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Experimental Gerontology |
| spelling | doaj-art-01805c4feb2945d99c5c38179131c8ea2025-08-20T02:39:28ZengElsevierExperimental Gerontology1873-68152025-09-0120811280510.1016/j.exger.2025.112805Higher calorie intake with adequate exercise is associated with reduced mortality compared with low-calorie diet with equivalent exercise: An observational study from NHANES based on the 2020–2025 Dietary Guidelines for AmericansHanghang Gan0Yu Yan1Shanshan Jia2Yingqiang Guo3Gonggong Lu4Department of Cardiovascular Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiovascular Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Corresponding authors at: Department of Cardiovascular Surgery, West China School of Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, Sichuan, China.Department of Cardiovascular Surgery, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Corresponding authors at: Department of Cardiovascular Surgery, West China School of Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, Sichuan, China.Object: To explore the effects of different combinations of calorie intake and exercise on all-cause, cardiovascular and cancer mortality. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) were analyzed. Weighted multivariate cox regression analyses were performed to assess the association between different combinations of calorie intake and exercise and mortality. Interaction effects were evaluated using the relative excess risk of interaction (RERI), attributable proportion of interaction (API), and synergy index (SI). Subgroup and sensitivity analyses were also conducted. Results: A total of 21,618 participants (51 % female) were included, with 1957 all-cause deaths, 568 cardiovascular deaths, and 508 cancer deaths over a median follow-up of 6.75 years. Both higher- and low-calorie diet were associated with reduced all-cause mortality as long as the participants engaged in adequate exercise, with greater benefits in the former group (Higher-calorie diet: Hazard ratio (HR) [95%CI] 0.59 [0.48, 0.71]; low-calorie diet: 0.69 [0.56, 0.84]; both P < 0.001). Only higher-calorie diet with adequate exercise was associated with reduced cardiovascular mortality (HR 0.64 [0.43, 0.94], P = 0.022, P for trend = 0.085). No significant association about cancer mortality was observed (P > 0.05). There was no additive interaction between low-calorie diet and adequate exercise in reducing mortality (all P > 0.05). Subgroup and sensitivity analyses remained stable. Conclusion: Adequate exercise with either higher- or low-calorie diet was associated with reduced all-cause mortality, with greater benefits in the former group. Moreover, only the former was associated with a reduction in cardiovascular mortality.http://www.sciencedirect.com/science/article/pii/S0531556525001342Calorie intakeDietExerciseAll-cause mortalityAmericansNHANES |
| spellingShingle | Hanghang Gan Yu Yan Shanshan Jia Yingqiang Guo Gonggong Lu Higher calorie intake with adequate exercise is associated with reduced mortality compared with low-calorie diet with equivalent exercise: An observational study from NHANES based on the 2020–2025 Dietary Guidelines for Americans Experimental Gerontology Calorie intake Diet Exercise All-cause mortality Americans NHANES |
| title | Higher calorie intake with adequate exercise is associated with reduced mortality compared with low-calorie diet with equivalent exercise: An observational study from NHANES based on the 2020–2025 Dietary Guidelines for Americans |
| title_full | Higher calorie intake with adequate exercise is associated with reduced mortality compared with low-calorie diet with equivalent exercise: An observational study from NHANES based on the 2020–2025 Dietary Guidelines for Americans |
| title_fullStr | Higher calorie intake with adequate exercise is associated with reduced mortality compared with low-calorie diet with equivalent exercise: An observational study from NHANES based on the 2020–2025 Dietary Guidelines for Americans |
| title_full_unstemmed | Higher calorie intake with adequate exercise is associated with reduced mortality compared with low-calorie diet with equivalent exercise: An observational study from NHANES based on the 2020–2025 Dietary Guidelines for Americans |
| title_short | Higher calorie intake with adequate exercise is associated with reduced mortality compared with low-calorie diet with equivalent exercise: An observational study from NHANES based on the 2020–2025 Dietary Guidelines for Americans |
| title_sort | higher calorie intake with adequate exercise is associated with reduced mortality compared with low calorie diet with equivalent exercise an observational study from nhanes based on the 2020 2025 dietary guidelines for americans |
| topic | Calorie intake Diet Exercise All-cause mortality Americans NHANES |
| url | http://www.sciencedirect.com/science/article/pii/S0531556525001342 |
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