| BackgroundCardiovascular disease(CVD)is estimated to claim 17 million lives annually.Despite implementing and promoting the management of traditional CVD risk factors,the burden of CVD continues to steadily rise,highlighting the importance of exploring preventive strategies beyond traditional risk factors.Sedentary behaviour(SB)has emerged as an independent risk factor for CVD and all-cause mortality,however,the optimal intervention level to improve CVD and all-cause mortality risk remains to be studied.Ultra-processed food(UPF),characterized by deep processing,is replacing traditional diets,but few studies have evaluated its relationship with CVD incidence and all-cause mortality risk in the general population.In addition,there is no literature reporting on the joint effect of UPF and SB on the risk of CVD and all-cause mortality.Study ObjectivesThis study aims to investigate the associations and dose-response relationships between SB,UPF intake,and the risks of CVD and all-cause mortality,respectively.as well as to analyze the joint effects of UPF intake and SB on the incidence of CVD and all-cause mortality.Studying the optimal intervention levels for sedentary behavior and ultraprocessed food intake can provide a theoretical basis for health promotion.The study of SB and UPF intake may provide a new perspective on prevention to reduce the occurrence of CVD and delay death,providing a theoretical basis for future public health promotion.Participants and methodsThe data used in this study were obtained from the UK Biobank,a large prospective cohort of over 500,000 UK residents aged 37-73 years old,which began collecting genetic and health information in 2006 to provide new perspective for improving human health and advancing modern medical treatment strategies.For the analysis of the association between SB and the risk of CVD and all-cause mortality,462,795 participants were included.For the analysis of the association between UPF intake and the risk of CVD and all-cause mortality,as well as the joint effects of SB and UPF intake,60,298 participants were included.Sitting time was defined as time spent watching TV,using a computer,and driving.UPF intake data were derived from dietary data and assessed using the NOVA classification system.The baseline time was the time of the dietary/SB survey of the study participants,and the outcome events were new-onset CVD or all-cause mortality.Participants were divided into four groups based on their sitting time:<4 hours,4-6 hours,6-8 hours,and>8 hours;Participants were also divided into four groups based on the quartiles of the energy contribution of UPF:<20.8%,20.8%-31.3%,31.3%-43.0%,and>43.0%.The participants were further categorized into four groups based on their UPF intake and sitting time:low UPF intake combined with low SB,low UPF intake combined with high SB,high UPF intake combined with low SB,and high UPF intake combined with high SB;where high UPF intake was defined as an energy contribution of>31.3%and high SB was defined as a sedentary time of ≥6 hours/day.Descriptive statistics used median(P25-P75)or mean±standard deviation to describe numerical variables and frequency(%)to describe categorical variables,and analysis of variance,Kruskal-Wallis test and chi-square test were used to compare the differences between different types of variables across groups.Kaplan-Meier survival curves were used to describe the cumulative probability of survival of CVD and all-cause mortality among the four groups.Cox proportional hazards regression models were used to analyze the association between SB,UPF intake,and the risk of CVD and all-cause mortality,with the lowest group(the first group)as the reference group.Hazard ratios(HRs)and 95%confidence intervals(CIs)were calculated.Restricted cubic splines(RCS)were used to study the dose-response relationships between SB,UPF intake,and the risk of CVD and allcause mortality,in order to explore potential intervention levels that could guide population health promotion.Identification of combinations of UPF intake,SB and increased risk of CVD and all-cause mortality through a joint effects analysis.A series of sensitivity analyses and subgroup analyses were conducted to assess the robustness of the findings.Results1.The association between sedentary behavior and the risk of new-onset cardiovascular disease and all-cause mortality.A total of 462,795 participants(43.9%male)with a median baseline age of 57(50-63)years were included in this study on the independent association between SB and CVD and all-cause mortality.During the follow-up period,56,899 participants(12.3%)experienced a CVD event(50,199 participants experienced coronary heart disease events and 15,272 participants experienced cerebrovascular disease),and 27,450 deaths occurred(4,543 due to CVD and 7,108 due to cancer).In a multivariate Cox regression model,SB was positively associated with the incidence of CVD and all-cause mortality.Compared with the reference group,the highest level of SB was associated with a significantly higher risk of incident CVD(HR=1.14,95%CI:1.10-1.18),as well as coronary heart disease(HR=1.13,95%CI:1.10-1.17),cerebrovascular diseases(HR=1.18,95%CI:1.11-1.26),all-cause mortality(HR=1.21,95%CI:1.15-1.26),and cancer mortality(HR=1.22,95%CI:1.11-1.33).Similar results were also found in our subgroup and sensitivity analyses.There was a significant non-linear U-shaped relationship between SB and the risk of CVD incidence and all-cause mortality.As sitting time increased,the risk of CVD and all-cause mortality initially decreased,reached a threshold time,and then gradually increased.Combining the curve fits for both outcomes,the inflection point at which sedentary time significantly alter the risk of CVD and all-cause mortality is 2.5-3.5 hours/day(Pnonlinear<0.05).2.The association between ultra-processed food intake and new-onset cardiovascular disease and all-cause mortality.In this examining the independent association between UPF intake and CVD and allcause mortality,60,298 participants(55.6%female)with a median age of 57(49-62)years were included.A total of 6,048 participants developed CVD event(5,327 participants experienced coronary heart disease events and 1,519 participants experienced cerebrovascular disease),and 2,590 deaths occurred(384 due to CVD).In the multivariable Cox regression models,UPF intake was positively associated with both incidence of CVD and all-cause mortality.Participants in the highest intake group had a significantly higher risk of incident CVD compared to the reference group.(HR=1.15,95%CI:1.07-1.24).Similar evidence was found for coronary heart disease(HR=1.18,95%CI:1.08-1.28),cerebrovascular diseases(HR=1.29,95%CI:1.10-1.51),and all-cause mortality(HR=1.22,95%CI:1.08-1.38).The association between UPF intake and risk of CVD and all-cause mortality was generally consistent in subgroup and sensitivity analyses.The RCS analyses revealed a linear positive association between UPF intake and CVD incidence and all-cause mortality risk(all Plinear<0.05).As the intake of UPF increased,the risk of incident CVD and all-cause mortality gradually increased among the participants.3.The joint association of ultra-processed food consumption and sedentary behavior with cardiovascular disease incidence and all-cause mortality.The study population in this section was the same as that in section 2.In a multivariable Cox-adjusted model,participants with high UPF intake combined with high SB had a higher incidence of CVD(HR=1.18,95%CI:1.10-1.27)and its subtypes(coronary heart disease:HR=1.29,95%CI:1.11-1.49;cerebrovascular diseases:HR=1.15,95%CI:1.06-1.24)compared to the first group.They also had a higher risk of all-cause mortality(HR=1.27,95%CI:1.13-1.43).A positive association was found for cancer mortality(HR=1.44,95%CI:1.16-1.78),while no association was found for CVD mortality(HR=0.99,95%CI:0.75-1.32).The results of the stratified analysis and sensitivity analysis showed further confirmation of the stability of the study results.Conclusion1.Sedentary behavior is associated with increased risk of future cardiovascular disease,coronary heart disease,cerebrovascular disease,all-cause mortality,and cancer mortality.Sedentary behavior is positively and non-linearly associated with the risk of CVD and allcause mortality,and limiting sedentary time to between 2.5-3.5 hours/day for the public is recommended as an intervention target to reduce the risk of cardiovascular disease and allcause mortality,but further validation in randomized controlled trials is needed in the future.2.Ultra-processed food intake is associated with increased risk of future cardiovascular disease,coronary heart disease,cerebrovascular disease,and all-cause mortality.This study provides new observational evidence for future dietary guidelines.3.The comprehensive risks of cardiovascular disease and all-cause mortality in the population was highest when the sitting time was≥6 hours/day and the energy intake from ultra-processed foods was higher than 31.3%.Our results support interventions for sedentary behavior and ultra-processed food intake to improve the burden of new-onset cardiovascular disease and premature death. |
PDF Full Text Request