Higher calorie intake with adequate exercise is associated with reduced mortality compared with low-calorie diet with equivalent exercise: An observational study from NHANES based on the 2020–2025 Dietary Guidelines for Americans

Object

To explore the effects of different combinations of calorie intake and exercise on all-cause, cardiovascular and cancer mortality.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) were analyzed. Weighted multivariate cox regression analyses were performed to assess the association between different combinations of calorie intake and exercise and mortality. Interaction effects were evaluated using the relative excess risk of interaction (RERI), attributable proportion of interaction (API), and synergy index (SI). Subgroup and sensitivity analyses were also conducted.

Results

A total of 21,618 participants (51 % female) were included, with 1957 all-cause deaths, 568 cardiovascular deaths, and 508 cancer deaths over a median follow-up of 6.75 years. Both higher- and low-calorie diet were associated with reduced all-cause mortality as long as the participants engaged in adequate exercise, with greater benefits in the former group (Higher-calorie diet: Hazard ratio (HR) [95%CI] 0.59 [0.48, 0.71]; low-calorie diet: 0.69 [0.56, 0.84]; both P < 0.001). Only higher-calorie diet with adequate exercise was associated with reduced cardiovascular mortality (HR 0.64 [0.43, 0.94], P = 0.022, P for trend = 0.085). No significant association about cancer mortality was observed (P > 0.05). There was no additive interaction between low-calorie diet and adequate exercise in reducing mortality (all P > 0.05). Subgroup and sensitivity analyses remained stable.

Conclusion

Adequate exercise with either higher- or low-calorie diet was associated with reduced all-cause mortality, with greater benefits in the former group. Moreover, only the former was associated with a reduction in cardiovascular mortality.