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

Q: What are the key findings of this study?

High physical activity combined with high diet quality was associated with lower risks of all-cause mortality (HR 0.64), CVD mortality (HR 0.61), and incident CVD (HR 0.83) across CKM stages.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular-kidney-metabolic (CKM) syndrome (stages 0 to 4) (n=339074). Intervention: High physical activity (≥150 min/wk of walking or moderate-to-vigorous activity) combined with high diet quality (healthy diet score 5-7) vs. Low physical activity (<150 min/wk) combined with low diet quality (healthy diet score 0-1). Primary outcome: All-cause mortality (co-primary with composite CVD mortality and incident composite CVD) (HR 0.64, 95% CI 0.60-0.68).

Q: What does this research mean for the field?

High physical activity combined with high diet quality is associated with substantial reductions in all-cause mortality, cardiovascular mortality, and incident cardiovascular disease across stages of cardiovascular-kidney-metabolic syndrome. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Haiyang Dong; Yunxin Wang; Yue Chen; Chuang Han; Wenying Gao; Zhicheng Zhang; Xinming Xu; 田芳; Feiyu Ma; Zidong Zhao; Xiang Gao; Liang Sun

doi:10.1016/j.jacadv.2026.103338

October 13, 2026JACC AdvancesOpen Access

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

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Key result

High physical activity plus healthy diet linked to ~36% lower mortality across CKM stages.

HR 0.64
95% CI 0.60-0.68
n=339,074

Graphical abstract published by JACC Advances — Graphical abstract · Published by JACC Advances · CC BY-NC-ND 4.0

Why the study?

The associations of physical activity and diet quality with mortality and cardiovascular disease within the cardiovascular-kidney-metabolic syndrome framework remain unexplored.

Does high physical activity independently and jointly with high diet quality reduce the risk of all-cause mortality, cardiovascular mortality, and incident cardiovascular disease across cardiovascular-kidney-metabolic (CKM) syndrome stages?

Key Points

To evaluate the independent and joint associations of physical activity and diet quality with mortality and incident cardiovascular disease across stages of cardiovascular-kidney-metabolic syndrome.
Prospective cohort study of 339,074 UK Biobank participants (51.3% women, mean age 56.4 years) across cardiovascular-kidney-metabolic syndrome stages 0 to 4.
Physical activity was categorized as high (≥150 min/wk of walking or moderate-to-vigorous activity) or low, and diet quality was classified as low, median, or high.
Multivariable Cox proportional hazards models assessed incident cardiovascular disease, cause-specific cardiovascular mortality, and all-cause mortality over a median follow-up of 13.5 years for mortality and 13.3 years for incident cardiovascular disease.
High physical activity was associated with lower risks of all-cause mortality (HR: 0.76 [95% CI: 0.74-0.79]), composite cardiovascular disease mortality (0.74 [0.70-0.77]), and incident composite cardiovascular disease (0.90 [0.88-0.92]).
High diet quality was associated with lower risks of all-cause mortality (HR: 0.81 [95% CI: 0.77-0.85]), composite cardiovascular disease mortality (0.81 [0.75-0.88]), and incident composite cardiovascular disease (0.87 [0.84-0.90]).
The combination of high physical activity and high diet quality showed the strongest reductions for all-cause mortality (HR: 0.64 [95% CI: 0.60-0.68]), composite cardiovascular mortality (0.61 [0.54-0.68]), and incident composite cardiovascular disease (0.83 [0.79-0.88]), with physical activity benefits plateauing at approximately 2,500 metabolic equivalent min/wk.

Study Design

Type

Cohort (n=339,074)

Multicenter

Yes

Structured PICO

Does high physical activity independently and jointly with high diet quality reduce the risk of all-cause mortality, cardiovascular mortality, and incident cardiovascular disease across cardiovascular-kidney-metabolic (CKM) syndrome stages?

P

Population

339,074 UK Biobank adults (mean age 56.4 years, 51.3% women) across cardiovascular-kidney-metabolic syndrome stages 0 to 4, followed for a median of 13.5 years for mortality and 13.3 years for incident CVD.

E

Exposure

High physical activity (meeting 2017 UK guidelines of ≥150 minutes/week of walking or moderate-to-vigorous physical activity or ≥75 minutes/week of vigorous activity via questionnaire or 7-day wrist-worn accelerometer) and/or high diet quality (healthy diet score 5-7 out of 7 based on food frequency questionnaire adherence to fruits, vegetables, fish, processed meat, red meat, whole grains, and refined grains)

C

Comparator

Low physical activity (<150 minutes/week of moderate-to-vigorous activity) and/or low diet quality (healthy diet score 0-1 out of 7)

O

Outcome

All-cause mortality, cause-specific composite CVD mortality, and incident composite CVD (heart failure, coronary heart disease, atrial fibrillation, stroke, and peripheral artery disease) over a median follow-up of 13.5 years for mortality and 13.3 years for incident CVDhard clinical

Main Result

Hazard Ratio: 0.64 (95% CI 0.6–0.68)

Limitations

Potential misclassification of CKM stage due to unavailability of certain clinical variables in the UK Biobank
Inclusion of CKM stage 0 participants resulted in an analytical sample closely resembling the general population rather than a strictly clinical CKM population
Self-reported dietary food frequency questionnaires and a simplified 7-component equal-weight diet score may introduce recall and measurement biases
Cardiometabolic biomarkers and exposures were assessed only once at baseline, precluding evaluation of CKM stage transitions over time
Limited generalizability as UK Biobank participants are generally healthier than the overall UK population
Inclusion of CKM stage 0 participants resulted in an analytical sample closely resembling the general population
Dietary data were collected using self-reported food frequency questionnaires and summarized using a simplified 7-group equal-weight diet score, which may introduce recall and measurement biases
Cardiometabolic biomarkers were assessed only once at baseline, precluding evaluation of changes or transitions in CKM stages during follow-up
Limited generalizability because UK Biobank participants are generally healthier than the overall UK population

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Answers are grounded in this paper and cite their sources.

Implication

Concurrent adherence to high physical activity and a high-quality diet is associated with substantial reductions in mortality and cardiovascular events across all CKM syndrome stages, with the strongest benefits observed in advanced CKM stages.

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.

Discussion

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Cite This Study

Dong et al. (2026) conducted a cohort in Cardiovascular-kidney-metabolic (CKM) syndrome (stages 0 to 4) (n=339,074). High physical activity (≥150 min/wk of walking or moderate-to-vigorous activity) combined with high diet quality (healthy diet score 5-7) vs. Low physical activity (<150 min/wk) combined with low diet quality (healthy diet score 0-1) was evaluated on All-cause mortality (co-primary with composite CVD mortality and incident composite CVD) (HR 0.64, 95% CI 0.60-0.68). High physical activity combined with high diet quality was associated with lower risks of all-cause mortality (HR 0.64), CVD mortality (HR 0.61), and incident CVD (HR 0.83) across CKM stages.

synapsesocial.com/papers/6ad0b8f43983294737c0c4d8 https://doi.org/10.1016/j.jacadv.2026.103338

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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