Age-Varying Patterns of Total Cholesterol by Modifiable Lifestyle Factors Across Mid to Late Adulthood: Applying Time-Varying Effect Modeling

Objectives

Total cholesterol is a risk factor for cardiovascular disease, yet little is known about how its age-related trajectory differs by lifestyle factors across adulthood.

Methods

We analyzed data from 8758 adults aged 40–80 years using NHANES from 2011 to 2020. Total cholesterol was measured via enzymatic analysis of serum samples. Physical activity was assessed using the Global Physical Activity Questionnaire, with participants classified as meeting or not meeting physical activity guidelines (≥ 150 min/week of moderate-to-vigorous activity). Weight status was determined by body mass index (BMI), categorized as healthy BMI (18.5–24.9 kg/m²) or overweight BMI (≥ 25.0 kg/m²). Time-varying effect modeling (TVEM) was used to estimate total cholesterol across age, stratified by physical activity and BMI category.

Results

TVEM indicated that there were no significant differences in total cholesterol levels between physical activity groups across age. In contrast, individuals with an overweight BMI had higher total cholesterol levels than those with a normal BMI, with significant differences observed between ages 63 and 69.

Conclusions

These findings highlight late midlife as a turning point when excess body weight may exert a stronger influence on cholesterol regulation. Age-specific approaches to weight management may enhance cardiovascular disease prevention efforts.