Associations between lifestyle, malnutrition, and health risks in a comprehensive population-based analysis

Obesity, lifestyle factors, and malnutrition increase the risk of cardiovascular events and mortality, however the interplay between lifestyle and malnutrition remains underexplored. We hypothesize that a healthier lifestyle score (lower LS)-reflecting favorable diet, higher physical activity, non-smoking, and low alcohol intake-is associated with lower cardiovascular risk (Framingham Risk Score, FRS) and reduced mortality in the LIFE-Adult-Study, and together may sharpen risk detection and prevention. We assessed the LS in 6073 participants of the LIFE-Adult-Study and analyzed associations with cardiometabolic biomarkers and FRS using multivariable linear regression (ANCOVA with post-hoc tests). All-cause mortality and malnutrition (CONUT, PNI, NRI) were analyzed across Lifestyle Score terciles using Cox models. LS categorization revealed 2038 individuals with low, 2140 with moderate, and 1895 with high lifestyle scores. Across LS terciles (higher LS = less healthy), BMI and triglycerides increased, while HDL decreased (ANCOVA; BMI adjusted for age and sex; lipids additionally for BMI; all p < 0.001). Malnutrition decreased with an increasing lifestyle score, while the FRS increased from 6.3 (LS ≤ 21) to 9.0% (LS > 32; p < 1 × 10⁻⁷). Participants with the unhealthiest LS had higher mortality, predominantly driven by smoking. The LS categorizes health status via metabolic parameters and identifies links to cardiovascular risk and malnutrition in the LIFE-Adult cohort, highlighting the value of integrating lifestyle factors into clinical diagnostics.