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Healthy Lifestyle Characteristics and Their Joint Association With Cardiovascular Disease Biomarkers in US Adults

  • Paul D. Loprinzi
    Correspondence
    Correspondence: Address to Paul D. Loprinzi, PhD, Director of Research Engagement–Jackson Heart Study Vanguard Center of Oxford, Center for Health Behavior Research, Physical Activity Epidemiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, 229 Turner Center, University, MS 38677.
    Affiliations
    Director of Research Engagement–Jackson Heart Study Vanguard Center of Oxford, Center for Health Behavior Research, Physical Activity Epidemiology Laboratory, Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University
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  • Adam Branscum
    Affiliations
    Program in Biostatistics, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
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  • June Hanks
    Affiliations
    Department of Physical Therapy, The University of Tennessee–Chattanooga, Chattanooga
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  • Ellen Smit
    Affiliations
    Program in Epidemiology, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
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Published:February 21, 2016DOI:https://doi.org/10.1016/j.mayocp.2016.01.009

      Abstract

      Objective

      To estimate the prevalence of healthy lifestyle characteristics and to examine the association between different combinations of healthy lifestyle characteristics and cardiovascular disease biomarkers.

      Patients and Methods

      The prevalence of healthy lifestyle characteristics was estimated for the US adult population (N=4745) using 2003-2006 National Health and Nutrition Examination Survey data for the following parameters: being sufficiently active (accelerometer), eating a healthy diet (Healthy Eating Index based on 24-hour recalls), being a nonsmoker (serum cotinine level), and having a recommended body fat percentage (dual-energy X-ray absorptiometry). Cardiovascular biomarkers included mean arterial pressure, C-reactive protein, white blood cells (WBCs), total cholesterol, high-density lipoprotein cholesterol (HDL-C), total cholesterol to HDL-C ratio, fasting low-density lipoprotein cholesterol, fasting triglycerides, fasting glucose, fasting insulin, insulin resistance, hemoglobin A1c, and homocysteine. The study was conducted from August 15, 2013, through January 5, 2016.

      Results

      Only 2.7% (95% CI, 1.9%-3.4%) of all adults had all 4 healthy lifestyle characteristics. Participants with 3 or 4 compared with 0 healthy lifestyle characteristics had more favorable biomarker levels except for mean arterial blood pressure, fasting glucose, and hemoglobin A1c. Having at least 1 or 2 compared with 0 healthy lifestyle characteristics was favorably associated with C-reactive protein, WBCs, HDL-C, total cholesterol, and homocysteine. For HDL-C and total cholesterol, the strongest correlate was body fat percentage. For homocysteine, a healthy diet and not smoking were strong correlates; for WBCs, diet was not a strong correlate.

      Conclusion

      Although multiple healthy lifestyle characteristics are important, specific health characteristics may be more important for particular cardiovascular disease risk factors.

      Abbreviations and Acronyms:

      CRP (C-reactive protein), DXA (dual-energy X-ray absorptiometry), HbA1c (hemoglobin A1c), HDL-C (high-density lipoprotein cholesterol), HEI (Healthy Eating Index), HOMA (homeostasis model assessment), HR (hazard ratio), LDL-C (low-density lipoprotein cholesterol), MEC (mobile examination center), MVPA (moderate to vigorous physical activity), NCHS (National Center for Health Statistics), NHANES (National Health and Nutrition Examination Survey), PIR (income to poverty ratio), WBC (white blood cell)
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      Linked Article

      • In Reply—Body Fat Percentage Should Not Be Confused With Lifestyle Behaviors
        Mayo Clinic ProceedingsVol. 91Issue 6
        • Preview
          We appreciate the opportunity to respond to the letter submitted by Mr Kyle and Dr Stanford in reference to our recently published article in Mayo Clinic Proceedings.1 Kyle and Stanford raise several points that do not accurately represent our methods or study conclusions. As such, we appreciate having the opportunity to clarify and expound upon our differing opinions.
        • Full-Text
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      • Body Fat Percentage Should Not Be Confused With Lifestyle Behaviors
        Mayo Clinic ProceedingsVol. 91Issue 6
        • Preview
          In their article “Healthy lifestyle characteristics and their joint association with cardiovascular disease biomarkers in US adults,” Loprinzi et al1 conclude that “only 2.7% of all adults have the characteristics of a healthy lifestyle.” Unfortunately, their conclusion is undermined by their analysis, which categorizes body fat percentage as a “healthy lifestyle characteristic” and as a “positive health behavior.” Although the other 3 characteristics used as primary end points in this analysis—physical activity, a healthy diet, and nonsmoking status—are important health behaviors, body fat percentage is not.
        • Full-Text
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