Combined influence of healthy lifestyles, nutritional and inflammatory status on mortality among US adults with depression

Abstract

Objective

Healthy lifestyles, nutritional and inflammatory status are interrelated and influence mortality. This study aimed to evaluate their separate and combined effects on all-cause and cause-specific mortality in individuals exhibiting depression.

Methods

6143 individuals with depression (median age 47) were recruited from the US National Health and Nutrition Examination Survey (NHANES 2005–2018), with mortality followed up through December 31, 2019. A healthy lifestyle score (0–5) was constructed based on current non-smoking, low-to-moderate alcohol consumption, adequate sleep, sufficient physical activity and healthy diet. Higher scores indicated healthier lifestyles. The Advanced Lung Cancer Inflammation Index (ALI), a composite marker of inflammation and nutritional status, was calculated as Body Mass Index (BMI) (kg/m²) × albumin (g/dl)/Neutrophil-to-Lymphocyte Ratio (NLR). Higher ALI values denoted lower inflammation and better nutrition. Weighted Cox proportional-hazards models were used to estimate mortality hazard ratios.

Results

Healthier lifestyles significantly lowered all-cause (hazard ratio [HR] 0.72, 95 % confidence interval [CI] 0.66–0.78), cardiovascular (HR 0.70, 95 % CI 0.58–0.83), and non-cardiovascular mortality (HR 0.72, 95 % CI 0.64–0.81). High ALI reduced all-cause (HR 0.70, 95 % CI 0.54–0.91) and cardiovascular mortality (HR 0.46, 95 % CI 0.28–0.77) compared with low ALI. Joint analyses showed that individuals with both healthy lifestyle scores ≥3 and high ALI had the lowest risk of all-cause, cardiovascular, and non-cardiovascular mortality (HR 0.44, 95 % CI 0.33–0.60; 0.32, 95 % CI 0.16–0.63; 0.49, 95 % CI 0.35–0.68).

Conclusion

The joint presence of healthy lifestyles and high ALI was significantly associated with lower risk of mortality among individuals with depression.