Conjoint associations of adherence to physical activity and dietary guidelines with cardiometabolic health: The framingham heart study

BACKGROUND: The conjoint associations of adherence to the recent physical activity and dietary guidelines with the metabolic syndrome (MetS) are incompletely understood. METHODS AND RESULTS: We evaluated 2379 FHS (Framingham Heart Study) Third Generation participants (mean age, 47 years; 54.4% women) attending examination cycle 2. We examined the cross-sectional relations of adherence to the 2018 Physical Activity Guidelines for Americans (binary; moderate-to-vigorous physical activity ≥150 versus <150 min/wk) and 2015 Dietary Guidelines for Americans (binary; 2015 Dietary Guidelines for Americans Adherence Index ≥median versus <median [score, 62.1/100]) with prevalence of the MetS using generalized linear models. We also related adherence to guidelines with the incidence of MetS pro-spectively, using Cox proportional hazards regression with discrete time intervals. Adherence rates to the 2018 Physical Activity Guidelines for Americans (odds ratio [OR], 0.49; 95% CI, 0.40– 0.60) and 2015 Dietary Guidelines for Americans (OR, 0.67; 95% CI, 0.51– 0.90) were individually associated with lower odds of prevalent MetS, whereas conjoint adherence to both guidelines was associated with the lowest odds of MetS (OR, 0.35; 95% CI, 0.26– 0.47) compared with the referent group (nonadherence to both guidelines). Adherence rates to the 2018 Physical Activity Guidelines for Americans (hazard ratio [HR], 0.66; 95% CI, 0.50– 0.88) and 2015 Dietary Guidelines for Americans (HR, 0.68; 95% CI, 0.51– 0.90) were associated with lower risk of MetS, prospectively. In addition, we observed a 52% lower risk of MetS in individuals who adhered to both guidelines compared with the referent group. CONCLUSIONS: Maintaining both regular physical activity and a healthy diet in midlife may be required for optimal cardiometa-bolic health in later life.