Association of Diet Quality and Physical Activity through Young Adulthood With Mid-Life Cardiovascular Health Trajectories: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
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Background
Young adulthood is a critical life course window during which cardiovascular pathophysiology develops, yet diet quality and physical activity (PA) are typically studied as separate, static exposures. We examined joint associations of diet and PA across young adulthood with midlife cardiovascular health (CVH) patterns.
Methods
Among 2,806 participants in the biracial Coronary Artery Risk Development in Young Adults (CARDIA) cohort, group-based dual-trajectory modeling identified latent classes of joint Dietary Approaches to Stop Hypertension (DASH) score and PA from exam Year 0 to Year 20 (mean age range at each exam 25–45 years). Group-based trajectory modeling defined midlife CVH trajectories using Life’s Essential 8 (LE8) scores (5 physiologic components) from Year 20 to Year 35 (mean age range at each exam 45–60 years). Multinomial logistic regression, adjusted for age, sex, race, and education, related young-adult behavioral groups to midlife CVH status (high ≥80, moderate 50–79, or low <50).
Results
Four joint diet/PA groups from young adulthood behaviors were identified: low DASH/very low PA (Group 1; 10.9%); low DASH/moderate-declining PA (Group 2; 25.6%); moderate DASH/high-declining PA (Group 3; 41.5%); and high DASH/high-declining PA (Group 4; 22.0%). Three non-overlapping midlife CVH trajectories (low, moderate, high) emerged. Compared with Group 1, participants in Groups 2, 3, and 4 had 4.8-, 8.6-, and 21.7-fold higher odds of high versus low CVH. The joint odds ratio (21.7) exceeded those for high diet quality (7.2) or high PA (10.3) individually. Associations persisted after adjustment for baseline LE8 score.
Conclusions
Sustained simultaneous adherence to high-quality diet and high PA through young adulthood was strongly and synergistically associated with high midlife CVH, supporting early, comprehensive, and sustained lifestyle prevention.
