Minimum and optimal combined variations in sleep, physical activity, and nutrition in relation to all-cause mortality risk | BMC Medicine

Chaput JP, Dutil C, Featherstone R, Ross R, Giangregorio L, Saunders TJ, Janssen I, Poitras VJ, Kho ME, Ross-White A, et al. Sleep duration and health in adults: an overview of systematic reviews. Appl Physiol Nutr Metab. 2020;45(10 (Suppl. 2)):S218–s231.
Google Scholar
Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput J-P, Chastin S, Chou R. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–62.
Google Scholar
World Cancer Research Fund International: Diet, activity and cancer. In.; 2023.
Sharma S, Kavuru M. Sleep and metabolism: an overview. Int J Endocrinol. 2010;2010:270832.
Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33(5):585–92.
Google Scholar
Ekelund U, Tarp J, Steene-Johannessen J, Hansen BH, Jefferis B, Fagerland MW, Whincup P, Diaz KM, Hooker SP, Chernofsky A, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. 2019;366:l4570.
Google Scholar
Stamatakis E, Lee I-M, Bennie J, Freeston J, Hamer M, O’Donovan G, Ding D, Bauman A, Mavros Y. Does Strength-Promoting Exercise Confer Unique Health Benefits? A Pooled Analysis of Data on 11 Population Cohorts With All-Cause, Cancer, and Cardiovascular Mortality Endpoints. Am J Epidemiol. 2017;187(5):1102–12.
Google Scholar
Wang P, Song M, Eliassen AH, Wang M, Fung TT, Clinton SK, Rimm EB, Hu FB, Willett WC, Tabung FK, et al. Optimal dietary patterns for prevention of chronic disease. Nat Med. 2023;29(3):719–28.
Google Scholar
Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol. 2013;9(1):13–27.
Google Scholar
Fadnes LT, Celis-Morales C, Økland J-M, Parra-Soto S, Livingstone KM, Ho FK, Pell JP, Balakrishna R, Javadi Arjmand E, Johansson KA, et al. Life expectancy can increase by up to 10 years following sustained shifts towards healthier diets in the United Kingdom. Nature Food. 2023;4(11):961–5.
Google Scholar
Green CL, Lamming DW, Fontana L. Molecular mechanisms of dietary restriction promoting health and longevity. Nat Rev Mol Cell Biol. 2022;23(1):56–73.
Google Scholar
Fontana L, Partridge L, Longo VD. Extending healthy life span—from yeast to humans. Science. 2010;328(5976):321–6.
Google Scholar
Meader N, King K, Moe-Byrne T, Wright K, Graham H, Petticrew M, Power C, White M, Sowden AJ. A systematic review on the clustering and co-occurrence of multiple risk behaviours. BMC Public Health. 2016;16(1):1–9.
Google Scholar
Verswijveren SJJM, Dingle S, Donnelly AE, Dowd KP, Ridgers ND, Carson BP, Kearney PM, Harrington JM, Chappel SE, Powell C. How are different clusters of physical activity, sedentary, sleep, smoking, alcohol, and dietary behaviors associated with cardiometabolic health in older adults? A cross-sectional latent class analysis. J Act Sedentary Sleep Behav. 2023;2(1):16.
Google Scholar
Huang BH, Hamer M, Duncan MJ, Cistulli PA, Stamatakis E. The bidirectional association between sleep and physical activity: A 6.9 years longitudinal analysis of 38,601 UK Biobank participants. Preventive Medicine. 2021;143:106315.
Google Scholar
Sampasa-Kanyinga H, Chaput JP, Huang BH, Duncan MJ, Hamer M, Stamatakis E. Bidirectional associations of sleep and discretionary screen time in adults: Longitudinal analysis of the UK biobank. J Sleep Res. 2023;32(2):e13727.
Google Scholar
Grandner MA, Fernandez FX. The translational neuroscience of sleep: A contextual framework. Science. 2021;374(6567):568–73.
Google Scholar
Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007;11(3):163–78.
Google Scholar
Godos J, Grosso G, Castellano S, Galvano F, Caraci F, Ferri R. Association between diet and sleep quality: A systematic review. Sleep Med Rev. 2021;57:101430.
Google Scholar
Ding D, Van Buskirk J, Nguyen B, Stamatakis E, Elbarbary M, Veronese N, et al. Physical activity, diet quality and all-cause cardiovascular disease and cancer mortality: a prospective study of 346 627 UK Biobank participants. Br J Sports Med. 2022;56(20):1148–56.
Google Scholar
Nicola V, Yanping L, JoAnn EM, Walter CW, Luigi F, Frank BH. Combined associations of body weight and lifestyle factors with all cause and cause specific mortality in men and women: prospective cohort study. BMJ. 2016;355:i5855.
Liang YY, Feng H, Chen Y, Jin X, Xue H, Zhou M, Ma H, Ai S, Wing YK, Geng Q, et al. Joint association of physical activity and sleep duration with risk of all-cause and cause-specific mortality: a population-based cohort study using accelerometry. Eur J Prev Cardiol. 2023;30(9):832–43.
Google Scholar
Huang B-H, Duncan MJ, Cistulli PA, Nassar N, Hamer M, Stamatakis E. Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk. Br J Sports Med. 2022;56(13):718–24.
Google Scholar
del Pozo CB, McGregor DE, del Pozo CJ, Buman MP, Palarea-Albaladejo J, Alfonso-Rosa RM, Chastin SFM. Integrating Sleep, Physical Activity, and Diet Quality to Estimate All-Cause Mortality Risk: A Combined Compositional Clustering and Survival Analysis of the National Health and Nutrition Examination Survey 2005–2006 Cycle. Am J Epidemiol. 2020;189(10):1057–64.
Google Scholar
Sudlow C, Gallacher J, Allen N, Beral V, Burton P, Danesh J, Downey P, Elliott P, Green J, Landray M, et al. UK Biobank: An Open Access Resource for Identifying the Causes of a Wide Range of Complex Diseases of Middle and Old Age. PLoS Med. 2015;12(3):e1001779.
Google Scholar
Doherty A, Jackson D, Hammerla N, Plötz T, Olivier P, Granat MH, White T, van Hees VT, Trenell MI, Owen CG, et al. Large Scale Population Assessment of Physical Activity Using Wrist Worn Accelerometers: The UK Biobank Study. PLoS ONE. 2017;12(2):e0169649.
Google Scholar
Ahmadi MN, Clare PJ, Katzmarzyk PT, del Pozo CB, Lee IM, Stamatakis E. Vigorous physical activity, incident heart disease, and cancer: how little is enough? Eur Heart J. 2022;43(46):4801–14.
Google Scholar
Ahmadi MN, Hamer M, Gill JM, Murphy M, Sanders JP, Doherty A, Stamatakis E. Brief bouts of device-measured intermittent lifestyle physical activity and its association with major adverse cardiovascular events and mortality in people who do not exercise: a prospective cohort study. The Lancet Public Health. 2023;8(10):e800–10.
Google Scholar
Stamatakis E, Ahmadi MN, Friedenreich CM, Blodgett JM, Koster A, Holtermann A, Atkin A, Rangul V, Sherar LB, Teixeira-Pinto A. Vigorous intermittent lifestyle physical activity and cancer incidence among nonexercising adults: The UK Biobank Accelerometry Study. JAMA Oncol. 2023;9(9):1255–9.
Google Scholar
del Pozo CB, Ahmadi MN, Lee I-M, Stamatakis E. Prospective Associations of Daily Step Counts and Intensity With Cancer and Cardiovascular Disease Incidence and Mortality and All-Cause Mortality. JAMA Intern Med. 2022;182(11):1139–48.
Google Scholar
Koemel NA, Ahmadi MN, Biswas RK, Koster A, Atkin AJ, Sabag A, et al. Can incidental physical activity offset the deleterious associations of sedentary behaviour with major adverse cardiovascular events? Eur J of Prev Cardiol. 2025;32(1):77–85.
Google Scholar
van Hees VT, Sabia S, Jones SE, Wood AR, Anderson KN, Kivimäki M, et al. Estimating sleep parameters using an accelerometer without sleep diary. Sci Rep. 2018;8(1):12975.
Google Scholar
Ahmadi MN, Nathan N, Sutherland R, Wolfenden L, Trost SG. Non-wear or sleep? Evaluation of five non-wear detection algorithms for raw accelerometer data. J Sports Sci. 2020;38(4):399–404.
Google Scholar
Pavey TG, Gilson ND, Gomersall SR, Clark B, Trost SG. Field evaluation of a random forest activity classifier for wrist-worn accelerometer data. J Sci Med Sport. 2017;20(1):75–80.
Google Scholar
Stamatakis E, Ahmadi MN, Gill JMR, Thøgersen-Ntoumani C, Gibala MJ, Doherty A, Hamer M. Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality. Nat Med. 2022;28(12):2521–9.
Google Scholar
Bradbury KE, Young HJ, Guo W, Key TJ. Dietary assessment in UK Biobank: an evaluation of the performance of the touchscreen dietary questionnaire. Journal of Nutritional Science. 2018;7:e6.
Google Scholar
Greenwood DC, Hardie LJ, Frost GS, Alwan NA, Bradbury KE, Carter M, Elliott P, Evans CEL, Ford HE, Hancock N, et al. Validation of the Oxford WebQ Online 24-Hour Dietary Questionnaire Using Biomarkers. Am J Epidemiol. 2019;188(10):1858–67.
Google Scholar
Carter JL, Lewington S, Piernas C, Bradbury K, Key TJ, Jebb SA, Arnold M, Bennett D, Clarke R. Reproducibility of dietary intakes of macronutrients, specific food groups, and dietary patterns in 211 050 adults in the UK Biobank study. Journal of Nutritional Science. 2019;8:e34.
Google Scholar
Zhuang P, Liu X, Li Y, Wan X, Wu Y, Wu F, Zhang Y, Jiao J. Effect of Diet Quality and Genetic Predisposition on Hemoglobin A(1c) and Type 2 Diabetes Risk: Gene-Diet Interaction Analysis of 357,419 Individuals. Diabetes Care. 2021;44(11):2470–9.
Google Scholar
Bohlscheid-Thomas S, Hoting I, Boeing H, Wahrendorf J. Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the German part of the EPIC project. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol. 1997;26(suppl_1)(1):S59.
Google Scholar
Kaaks R, Slimani N, Riboli E. Pilot phase studies on the accuracy of dietary intake measurements in the EPIC project: overall evaluation of results. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol. 1997;26 Suppl 1:S26–36.
Google Scholar
Ocké MC, Bueno-de-Mesquita HB, Goddijn HE, Jansen A, Pols MA, van Staveren WA, Kromhout D. The Dutch EPIC food frequency questionnaire. I. Description of the questionnaire, and relative validity and reproducibility for food groups. Int J Epidemiol. 1997;26:S37–48.
Google Scholar
Erceg-Hurn DM, Mirosevich VM. Modern robust statistical methods: an easy way to maximize the accuracy and power of your research. Am Psychol. 2008;63(7):591.
Google Scholar
Abrams D, Montesi SB, Moore SKL, Manson DK, Klipper KM, Case MA, Brodie D, Beitler JR. Powering Bias and Clinically Important Treatment Effects in Randomized Trials of Critical Illness. Crit Care Med. 2020;48(12):1710–9.
Google Scholar
Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Adams Hillard PJ, Katz ES, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health. 2015;1(4):233–43.
Google Scholar
Chastin SF, Palarea-Albaladejo J, Dontje ML, Skelton DA. Combined Effects of Time Spent in Physical Activity, Sedentary Behaviors and Sleep on Obesity and Cardio-Metabolic Health Markers: A Novel Compositional Data Analysis Approach. PLoS ONE. 2015;10(10):e0139984.
Google Scholar
Gupta N, Korshøj M, Dumuid D, Coenen P, Allesøe K, Holtermann A. Daily domain-specific time-use composition of physical behaviors and blood pressure. Int J Behav Nutr Phys Act. 2019;16(1):4.
Google Scholar
Kim JH. Multicollinearity and misleading statistical results. Korean J Anesthesiol. 2019;72(6):558–69.
Google Scholar
Andersson T, Alfredsson L, Källberg H, Zdravkovic S, Ahlbom A. Calculating measures of biological interaction. Eur J Epidemiol. 2005;20(7):575–9.
Google Scholar
Chang K, Gunter MJ, Rauber F, Levy RB, Huybrechts I, Kliemann N, Millett C, Vamos EP: Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank. eClinicalMedicine 2023, 56.
Monteiro CA, Cannon G, Levy RB, Moubarac JC, Louzada ML, Rauber F, Khandpur N, Cediel G, Neri D, Martinez-Steele E, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936–41.
Google Scholar
Arnold M, Bennett D, Bradbury K, Carter JL, Clarke R, Jebb SA, Key TJ, Lewington S, Piernas C. Reproducibility of dietary intakes of macronutrients, specific food groups, and dietary patterns in 211 050 adults in the UK Biobank study. Journal of Nutritional Science. 2019;8:e34.
Google Scholar
Perez-Cornago A, Pollard Z, Young H, van Uden M, Andrews C, Piernas C, Key TJ, Mulligan A, Lentjes M. Description of the updated nutrition calculation of the Oxford WebQ questionnaire and comparison with the previous version among 207,144 participants in UK Biobank. Eur J Nutr. 2021;60(7):4019–30.
Google Scholar
Lu Y, Hajifathalian K, Ezzati M, Woodward M, Rimm EB, Danaei G, D’Este C: Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. 2014.
Quail DF, Dannenberg AJ. The obese adipose tissue microenvironment in cancer development and progression. Nat Rev Endocrinol. 2019;15(3):139–54.
Google Scholar
Wang Y, Fan H, Ren Z, Liu X, Niu X. Sleep disorder, Mediterranean diet, and all-cause and cause-specific mortality: a prospective cohort study. BMC Public Health. 2023;23(1):1–12.
Ding D, Rogers K, van der Ploeg H, Stamatakis E, Bauman AE. Traditional and Emerging Lifestyle Risk Behaviors and All-Cause Mortality in Middle-Aged and Older Adults: Evidence from a Large Population-Based Australian Cohort. PLoS Med. 2015;12(12):e1001917.
Google Scholar
Krokstad S, Ding D, Grunseit AC, Sund ER, Holmen TL, Rangul V, Bauman A. Multiple lifestyle behaviours and mortality, findings from a large population-based Norwegian cohort study – The HUNT Study. BMC Public Health. 2017;17(1):58.
Google Scholar
Fenton S, Burrows TL, Collins CE, Rayward AT, Murawski B, Duncan MJ: Efficacy of a Multi-Component m-Health Diet, Physical Activity, and Sleep Intervention on Dietary Intake in Adults with Overweight and Obesity: A Randomised Controlled Trial. Nutrients 2021, 13(7).
Taylor RW, Gray AR, Heath A-LM, Galland BC, Lawrence J, Sayers R, Healey D, Tannock GW, Meredith-Jones KA, Hanna M, et al. Sleep, nutrition, and physical activity interventions to prevent obesity in infancy: follow-up of the Prevention of Overweight in Infancy (POI) randomized controlled trial at ages 35 and 5 y. Am J Clin Nutr. 2018;108(2):228–36.
Google Scholar
Ulf E, Knut Eirik D, Jakob T, Lee IM. Physical activity and mortality: what is the dose response and how big is the effect? Br J Sports Med. 2020;54(19):1125.
Google Scholar
Chaput J-P, Biswas RK, Ahmadi M, Cistulli PA, Rajaratnam SMW, Bian W, St-Onge M-P, Stamatakis E: Sleep regularity and major adverse cardiovascular events: a device-based prospective study in 72 269 UK adults. J Epidemiol Community Health. 2024.
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