Association of Physical Activity With All-Cause and CVD Mortality Across Metabolic and Obesity Phenotypes

To examine the independent and joint associations of metabolic status, obesity, and physical activity with all-cause and cardiovascular disease (CVD) mortality across metabolic-obesity phenotypes.

We analysed 442 666 adults from the Korean National Health Insurance Service health screening cohort (2009-2012). Metabolic status was defined using modified NCEP-ATP III criteria (elevated triglycerides, low HDL-C, elevated blood pressure or antihypertensive use, and elevated fasting glucose or antidiabetic use); ≥ 2 abnormalities indicated metabolically unhealthy. Obesity was defined as BMI ≥ 25 kg/m² (WHO Asia-Pacific), yielding four phenotypes: metabolically healthy lean (MHL), metabolically unhealthy lean (MUHL), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUHO). Physical activity was assessed by self-report and categorised by total MET-min/week (0, 1-499, 500-999, 1000-1499, ≥ 1500). Multivariable Cox proportional hazards models estimated hazard ratios (HRs) for all-cause and CVD mortality.

In the primary multivariable model (Model 2a), compared with MHL, MUHL had the highest all-cause mortality (HR 1.23, 95% CI 1.19-1.26), whereas MUHO was not significantly associated with all-cause mortality (HR 0.97, 95% CI 0.94-1.01), and MHO showed lower risk (HR 0.85, 95% CI 0.81-0.89). Higher physical activity was consistently associated with lower all-cause and CVD mortality in a dose-response manner, and joint analyses showed progressively lower mortality across all metabolic-obesity phenotypes with increasing activity levels.

Metabolic-obesity phenotypes were associated with differential mortality risk, and higher physical activity was associated with lower all-cause and CVD mortality across phenotypes.