Joint associations of diet and physical activity with incident type 2 diabetes and hypertension: an analysis of 144 288 UK Biobank participants

Studies examining the joint associations of lifestyle exposures can reveal novel synergistic and joint effects, but no study has examinedthe joint association of diet and physical activity (PA) with type 2 diabetes (T2D) and hypertension. The aim of this study is to examinethe joint associations of PA and diet with incidence of type T2D and hypertension, as a combined outcome and separately in a largesample of adults in the United Kingdom. This prospective cohort study included 144288 UK Biobank participants aged 40-69. Moderateto vigorous PA (MVPA) was measured using the International Physical Activity Questionnaire and a wrist accelerometer. We categorizedPA and diet indicators (diet quality score [DQS] and energy intake [EI]) based on tertiles and derived joint PA and diet variables. Outcomewas major cardiometabolic disease incidence (combination of T2D and hypertension). A total of 14003 (7.1%) participants developedT2D, 28075 (19.2%) developed hypertension, and 30529 (21.2%) developed T2D or hypertension over a mean follow-up of 10.9 (3.7)years. Participants with middle and high self-reported MVPA levels had lower risk of major cardiometabolic disease regardless of diet(eg, among high DQS group, hazard ratios [HRs] in middle and high MVPA group were 0.90; 95% CI, 0.86-0.94), and 0.88 (95% CI, 0.84-0.92), respectively. Participants with jointly high device-measured MVPA and high DQS levels had lower major cardiometabolic diseaserisk (HR, 0.84; 95% CI, 0.71-0.99). The equivalent joint device-measured MVPA and EI exposure analyses showed no clear pattern ofassociations with the outcomes. Higher PA is an important component in cardiometabolic disease prevention across all diet qualityand total EI groups. The observed lack of association between diet health outcomes may stem from a lower DQS.