Association of physical activity and sedentary behavior with stages of cardiovascular–kidney–metabolic syndrome among U.S. adults: NHANES 2007–2020

Figures

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  Fig. 1. Flowchart of participants included in analyses. Abbreviations: CKM: cardiovascular-kidney-metabolic; HEI-2015: Healthy Eating Index-2015; SB: sedentary behavior; PIR: poverty–income ratio; PA: physical activity.

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  Fig. 2. Methods for evaluating each CKM stage. Abbreviations: BMI: body mass index; MVPA: moderate-to-vigorous physical activity; CKD: chronic kidney disease; CKM: cardiovascular-kidney-metabolic; CVD: cardiovascular disease; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; HDL: high-density lipoprotein; KDIGO: The Kidney Disease: Improving Global Outcomes; SBP: systolic blood pressure; UACR: urinary albumin to creatinine ratio. Definition: Normal BMI: BMI <25 kg/m2 (or < 23 kg/m2 if Asian ancestry); normal waist circumference: waist circumference < 88/102 cm in female/male (or if Asian ancestry <80/90 cm in female/male); normoglycemia: fasting blood glucose <100 mg/dl and HbA1c < 5.7 % and without self-reported diagnosis of diabetes, use of insulin, or oral hypoglycemic agents; no hypertension: SBP <130 mmHg and DBP <80 mmHg without self-reported diagnosis of hypertension or use of antihypertensive medications; normal lipid profile: HDL cholesterol ≥50/40 mg/dl in female/male and triglycerides <150 mg/dl; low-risk CKD: Low-risk CKD in KDIGO classification according to eGFR and UACR: UACR <30 mg/g and eGFR ≥60 ml/min/1.73m2.* Asian was not listed as a separate…

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  Fig. 3. The relationship between MVPA and each CKM stage in different subgroups. Abbreviations: SB: sedentary behavior; MVPA: moderate-to-vigorous physical activity; PIR: poverty–income ratio. Results are expressed as multivariable-adjusted odds ratio after controlling covariates including age, sex, race/ethnicity, Healthy Eating Index-2015, educational level (above high school, high school or equivalent, under high school), marital status (married/cohabiting, never married, widowed/divorced/separated), tobacco use (current, former, and never), alcohol use (heavy, mild, moderate, and never), PIR [high (>3.49), low (≤1.49), medium (>1.49, < 3.49)], and sedentary behavior(<5 h/day, 5–8 h/day, or ≥ 8 h/day).

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  Fig. 4. Restricted cubic splines (RCS) analysis investigating the relationship between MET-MVPA and each CKM stage. Abbreviations: RCS: Restricted cubic splines; PIR: poverty–income ratio; MET: metabolic equivalent; MVPA: moderate-to-vigorous physical activity. Adjustment include age, race/ethnicity, Healthy Eating Index-2015, educational level (above high school, high school or equivalent, under high school), marital status (married/cohabiting, never married, widowed/divorced/separated), tobacco use (current, former, and never), alcohol use (heavy, mild, moderate, and never), PIR [high (>3.49), low (≤1.49), medium (>1.49, < 3.49)], and sedentary behavior. The orange lines correspond to the central estimates, and the shaded regions indicate the 95 % confidence interval.