Key result
High DASH diet and physical activity in young adulthood linked to ~21.7-fold higher midlife cardiovascular health.
Why the study?
Young adulthood is a critical window for developing cardiovascular pathophysiology, yet diet quality and physical activity are typically studied as separate, static exposures rather than joint trajectories across young adulthood.
Does sustained simultaneous adherence to a high-quality DASH diet and high physical activity through young adulthood improve midlife cardiovascular health trajectories in biracial young adults?
Cohort (n=2,806)
Yes
Does sustained simultaneous adherence to a high-quality DASH diet and high physical activity through young adulthood improve midlife cardiovascular health trajectories in biracial young adults?
Sustained simultaneous adherence to both a high-quality diet and high physical activity throughout young adulthood is synergistically associated with 21.7-fold higher odds of achieving optimal cardiovascular health in midlife compared to poor adherence to both.
Supports combined diet-activity focus in young adulthood; extends prior evidence but leaves open causal effects on midlife CVH.
Background Young adulthood is a critical life course window during which cardiovascular pathophysiology develops, yet diet quality and physical activity (PA) are typically studied as separate, static exposures. We examined joint associations of diet and PA across young adulthood with midlife cardiovascular health (CVH) patterns. Methods Among 2,806 participants in the biracial Coronary Artery Risk Development in Young Adults (CARDIA) cohort, group-based dual-trajectory modeling identified latent classes of joint Dietary Approaches to Stop Hypertension (DASH) score and PA from exam Year 0 to Year 20 (mean age range at each exam 25–45 years). Group-based trajectory modeling defined midlife CVH trajectories using Life’s Essential 8 (LE8) scores (5 physiologic components) from Year 20 to Year 35 (mean age range at each exam 45–60 years). Multinomial logistic regression, adjusted for age, sex, race, and education, related young-adult behavioral groups to midlife CVH status (high ≥80, moderate 50–79, or low <50). Results Four joint diet/PA groups from young adulthood behaviors were identified: low DASH/very low PA (Group 1; 10.9%); low DASH/moderate-declining PA (Group 2; 25.6%); moderate DASH/high-declining PA (Group 3; 41.5%); and high DASH/high-declining PA (Group 4; 22.0%). Three non-overlapping midlife CVH trajectories (low, moderate, high) emerged. Compared with Group 1, participants in Groups 2, 3, and 4 had 4.8-, 8.6-, and 21.7-fold higher odds of high versus low CVH. The joint odds ratio (21.7) exceeded those for high diet quality (7.2) or high PA (10.3) individually. Associations persisted after adjustment for baseline LE8 score. Conclusions Sustained simultaneous adherence to high-quality diet and high PA through young adulthood was strongly and synergistically associated with high midlife CVH, supporting early, comprehensive, and sustained lifestyle prevention.
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Rai et al. (2026) conducted a cohort in Cardiovascular health trajectories in midlife (n=2,806). High DASH diet quality and high-declining physical activity trajectory (Group 4) vs. Low DASH diet quality and very low physical activity trajectory (Group 1) was evaluated on High versus low midlife cardiovascular health trajectory (defined by 5-component Life's Essential 8 score >=80 vs <50 from Year 20 to Year 35) (OR 21.7). Sustained high DASH diet quality and high physical activity through young adulthood was associated with 21.7-fold higher odds (OR 21.7) of high versus low midlife cardiovascular health.
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