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Diet, physical activity, all-cause and cause-specific mortality: repeated measures considerations
Qianyan Zheng1,2, Yiwen Zhang1, Dong Hoon Lee1,3
1Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, USA.
European Journal of Epidemiology
|March 18, 2026
Summary
Adhering to a healthy diet and engaging in regular physical activity significantly lowers mortality risk. Repeated measures of diet and physical activity, unlike single baseline assessments, reveal the most substantial health benefits.
Area of Science:
- Epidemiology
- Public Health
- Nutrition Science
Background:
- Assessing the impact of lifestyle factors like diet and physical activity on mortality risk is crucial for public health.
- Previous studies often relied on single baseline measures, potentially underestimating the true associations with health outcomes.
- Understanding the interplay between diet and physical activity is key to developing effective prevention strategies.
Purpose of the Study:
- To compare the impact of single baseline versus repeated exposure measures on diet and physical activity associations with mortality.
- To examine the independent and joint effects of the Alternative Healthy Eating Index (AHEI) and moderate-to-vigorous physical activity (MVPA) on mortality risk.
- To analyze associations with all-cause, cardiovascular disease (CVD), and physical activity, diet, and adiposity-related (PDAR) cancer mortality.
Main Methods:
- Analysis of 106,387 adults from the Nurses' Health Study and Health Professionals Follow-up Study (1990-2020).
- Utilized multivariable Cox proportional hazards models with a 4-year lag between exposure assessment and mortality risk.
- Calculated cumulative averages of AHEI and MVPA from up to 15 repeated measures.
Main Results:
- Higher AHEI and MVPA were independently associated with significantly lower risks of all-cause, CVD, and PDAR cancer mortality.
- The greatest mortality risk reductions were observed when individuals met criteria for both high AHEI and high MVPA.
- Associations were substantially attenuated when using single baseline measures instead of cumulative averages, highlighting the importance of repeated assessments.
Conclusions:
- Both diet and physical activity are vital for reducing mortality risk, with combined adherence yielding the greatest benefits.
- Repeated exposure measures provide a more accurate assessment of the protective effects of diet and physical activity compared to single baseline measures.
- Findings underscore the importance of long-term lifestyle patterns in mitigating mortality from various causes.
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