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1Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
2Institute for Health and Society, Hanyang University, Seoul, Korea
3Department of Epidemiology and Health Statistics, Graduate School of Public Health, Hanyang University, Seoul, Korea
© 2024, Korean Society of Epidemiology
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflict of interest
The authors have no conflicts of interest to declare for this study. Mi Kyung Kim has been the associate editor of the Epidemiology and Health since 2021. She was not involved in the review process.
Funding
This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (grant No. RS-2023-00237863).
Author contributions
Both authors contributed equally to conceiving the study, analyzing the data, and writing this paper.
Characteristics | Total |
Healthy lifestyle score |
|||||
---|---|---|---|---|---|---|---|
0-1 (lowest) | 2 | 3 | 4 | 5 (highest) | p-value | ||
Toatl, n (%)1 | 10,693 | 564 (6.41) | 1,486 (15.5) | 3,439 (32.9) | 3,645 (31.7) | 1,559 (13.5) | 0.002 |
Male | 50.9 | 81.8 | 68.3 | 51.6 | 42.0 | 35.4 | <0.001 |
Age (yr) | 42.5±0.31 | 41.4±0.55 | 43.4±0.39 | 44.5±0.37 | 47.1±0.35 | 48.5±0.48 | <0.001 |
19-39 | 38.1 | 46.6 | 42.7 | 41.8 | 34.5 | 28.4 | <0.001 |
40-59 | 41.5 | 45.3 | 44.2 | 38.8 | 40.2 | 46.6 | |
60-79 | 20.3 | 8.1 | 13.1 | 19.4 | 25.3 | 25.1 | |
Education level | |||||||
≤Elementary school | 8.4 | 5.5 | 6.7 | 8.7 | 10.2 | 7.1 | <0.001 |
Middle school | 6.7 | 7.0 | 6.6 | 6.8 | 6.4 | 7.1 | |
High school | 37.2 | 47.7 | 37.5 | 38.4 | 35.1 | 33.9 | |
≥ College | 47.7 | 39.9 | 49.3 | 46.2 | 48.3 | 51.9 | |
Household income | |||||||
Low | 11.2 | 12.2 | 10.8 | 12.0 | 11.4 | 9.0 | 0.003 |
Low-middle | 22.3 | 22.4 | 22.7 | 22.6 | 22.9 | 19.9 | |
Middle-high | 30.3 | 35.6 | 31.7 | 30.1 | 29.0 | 29.5 | |
High | 36.1 | 29.8 | 34.7 | 35.3 | 36.7 | 41.6 | |
Marital status, married | 72.2 | 65.4 | 71.3 | 68.7 | 74.5 | 79.3 | <0.001 |
Healthy lifestyle factors | |||||||
Non-smoking | 81.0 | 16.7 | 56.3 | 82.7 | 96.0 | 100 | - |
Low alcohol consumption | 83.6 | 25.6 | 62.5 | 86.5 | 95.6 | 100 | - |
Healthy physical activity | 46.9 | 11.3 | 25.6 | 33.8 | 55.5 | 100 | - |
Healthy BMI status | 63.6 | 23.7 | 33.8 | 54.5 | 80.1 | 100 | - |
Favorable fruit and vegetable intakes | 54.4 | 6.8 | 21.7 | 42.4 | 72.8 | 100 | - |
Hypertension | 23.7 | 32.3 | 30.1 | 23.3 | 21.6 | 17.8 | <0.001 |
Dyslipidemia | 39.6 | 52.3 | 46.9 | 40.4 | 35.9 | 31.6 | <0.001 |
Blood pressure (mmHg) | |||||||
SBP | 117±0.21 | 123±0.70 | 120±0.43 | 117±0.32 | 116±0.32 | 114±0.45 | <0.001 |
DBP | 74.4±0.13 | 81.2±0.54 | 78.8±0.31 | 75.6±0.22 | 74.0±0.19 | 73.2±0.26 | <0.001 |
Lipid profile (mg/dL) | |||||||
TC | 189±0.39 | 198±2.01 | 196±1.09 | 193±0.78 | 191±0.72 | 193±1.10 | <0.001 |
TG | 126±1.06 | 192±6.46 | 162±3.78 | 129±1.97 | 111±1.54 | 103±2.25 | <0.001 |
LDL-C | 113±0.34 | 116±1.86 | 117±1.00 | 117±0.68 | 116±0.64 | 116±0.97 | 0.870 |
HDL-C | 52.2±0.14 | 48.8±0.60 | 50.4±0.41 | 51.7±0.27 | 53.6±0.26 | 55.9±0.36 | <0.001 |
BMI (kg/m2) | 23.3±0.05 | 26.6±0.17 | 26.2±0.13 | 24.6±0.09 | 23.0±0.06 | 21.9±0.07 | <0.001 |
Total energy intake (kcal/day) | 1,877±10.0 | 2,278±55.6 | 2,082±30.8 | 1,913±19.7 | 1,888±16.8 | 1,859±25.1 | <0.001 |
All values accounted for the complex sampling design effect of the national surveys using PROC SURVEY procedure, and values are presented as mean±standard error or %.
KNHANES, Korea National Health and Nutrition Examination Survey; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglyceride; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein.cholesterol
1 The unweighted sample size for each subgroup.
Values are presented as odds ratio (95% confidence interval).
1 Model 1: adjusted for age (years) and sex; Model 2: adjusted for age (years), sex, education status (≥12 years of school), household income status (≥3 times/wk and ≥30 min/session), marital status, energy intake (kcal/day), diagnosis of hypertension and/or dyslipidemia by physician, and family history of hypertension and/or dyslipidemia; Model 3 was adjusted for the covariates in model 2 and includes the other lifestyle factors.
Healthy lifestyle score |
Hypertension alone (n=1,127) |
Dyslipidemia alone (n=2,616) |
Hypertension and dyslipidemia (n=1,899) |
|||
---|---|---|---|---|---|---|
Age and sex-adjusted | Multivariable1 | Age and sex-adjusted | Multivariable1 | Age and sex-adjusted | Multivariable1 | |
0-1 (lowest) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
2 | 0.60 (0.40, 0.92) | 0.60 (0.37, 0.96) | 0.70 (0.52, 0.95) | 0.72 (0.52, 0.98) | 0.65 (0.47, 0.91) | 0.63 (0.42, 0.96) |
3 | 0.35 (0.23, 0.52) | 0.34 (0.22, 0.54) | 0.58 (0.44, 0.75) | 0.58 (0.44, 0.77) | 0.32 (0.24, 0.44) | 0.30 (0.20, 0.44) |
4 | 0.23 (0.16, 0.34) | 0.23 (0.15, 0.36) | 0.42 (0.32, 0.55) | 0.41 (0.31, 0.55) | 0.19 (0.14, 0.27) | 0.18 (0.12, 0.27) |
5 (highest) | 0.19 (0.12, 0.30) | 0.19 (0.11, 0.31) | 0.36 (0.26, 0.48) | 0.34 (0.25, 0.47) | 0.11 (0.08, 0.16) | 0.11 (0.07, 0.17) |
p for trend | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 |
Every 1-point increment | 0.66 (0.60, 0.72) | 0.65 (0.59, 0.72) | 0.78 (0.73, 0.82) | 0.76 (0.72, 0.81) | 0.57 (0.53, 0.61) | 0.56 (0.51, 0.62) |
Values are presented as odds ratio (95% confidence interval).
1 The multivariable model was adjusted for age (years), sex, education status (≥12 years of school), household income status (≥3 times/wk and ≥30 min/session), marital status, energy intake (kcal/day), diagnosis of hypertension and/or dyslipidemia by a physician, and family history of hypertension and/or dyslipidemia.
Lifestyle factor | Classification | Point | Description |
---|---|---|---|
Smoking | Smoking | 0 | Current smoker and ≥100 cigarettes in their lifetime |
Non-smoking | 1 | Never smoker, former smoker, or <100 cigarettes in their lifetime | |
Alcohol drinking | Unhealthy consumption | 0 | >2 drink/day for male and >1 drink/day for female |
Low consumption | 1 | No drinking or ≤2 drink/day for male and ≤1 drink/day for female | |
BMI status (kg/m2) | Obesity | 0 | ≥25 |
Non-obesity | 1 | <25 | |
Fruit and vegetable consumption | Unhealthy | 0 | Consumption of fruit and vegetables per day <median (3 times) |
Healthy | 1 | Consumption of fruit and vegetables per day ≥median (3 times) | |
PA | Unhealthy | 0 | Did not meet WHO guidelines on PA: <150 min of moderate-intensity aerobic PA or at least 75-150 min of vigorous-intensity aerobic PA; or an equivalent combination of moderate- and vigorous-intensity PA throughout the week |
Healthy | 1 | Meet WHO guidelines on PA: at least 150 min of moderate-intensity aerobic PA or at least 75-150 min of vigorous-intensity aerobic PA; or an equivalent combination of moderate- and vigorous-intensity PA throughout the week | |
Range | 0 (unhealthy) to 5 (healthy) |
Characteristics | Total | Healthy lifestyle score |
|||||
---|---|---|---|---|---|---|---|
0-1 (lowest) | 2 | 3 | 4 | 5 (highest) | p-value | ||
Toatl, n (%) |
10,693 | 564 (6.41) | 1,486 (15.5) | 3,439 (32.9) | 3,645 (31.7) | 1,559 (13.5) | 0.002 |
Male | 50.9 | 81.8 | 68.3 | 51.6 | 42.0 | 35.4 | <0.001 |
Age (yr) | 42.5±0.31 | 41.4±0.55 | 43.4±0.39 | 44.5±0.37 | 47.1±0.35 | 48.5±0.48 | <0.001 |
19-39 | 38.1 | 46.6 | 42.7 | 41.8 | 34.5 | 28.4 | <0.001 |
40-59 | 41.5 | 45.3 | 44.2 | 38.8 | 40.2 | 46.6 | |
60-79 | 20.3 | 8.1 | 13.1 | 19.4 | 25.3 | 25.1 | |
Education level | |||||||
≤Elementary school | 8.4 | 5.5 | 6.7 | 8.7 | 10.2 | 7.1 | <0.001 |
Middle school | 6.7 | 7.0 | 6.6 | 6.8 | 6.4 | 7.1 | |
High school | 37.2 | 47.7 | 37.5 | 38.4 | 35.1 | 33.9 | |
≥ College | 47.7 | 39.9 | 49.3 | 46.2 | 48.3 | 51.9 | |
Household income | |||||||
Low | 11.2 | 12.2 | 10.8 | 12.0 | 11.4 | 9.0 | 0.003 |
Low-middle | 22.3 | 22.4 | 22.7 | 22.6 | 22.9 | 19.9 | |
Middle-high | 30.3 | 35.6 | 31.7 | 30.1 | 29.0 | 29.5 | |
High | 36.1 | 29.8 | 34.7 | 35.3 | 36.7 | 41.6 | |
Marital status, married | 72.2 | 65.4 | 71.3 | 68.7 | 74.5 | 79.3 | <0.001 |
Healthy lifestyle factors | |||||||
Non-smoking | 81.0 | 16.7 | 56.3 | 82.7 | 96.0 | 100 | - |
Low alcohol consumption | 83.6 | 25.6 | 62.5 | 86.5 | 95.6 | 100 | - |
Healthy physical activity | 46.9 | 11.3 | 25.6 | 33.8 | 55.5 | 100 | - |
Healthy BMI status | 63.6 | 23.7 | 33.8 | 54.5 | 80.1 | 100 | - |
Favorable fruit and vegetable intakes | 54.4 | 6.8 | 21.7 | 42.4 | 72.8 | 100 | - |
Hypertension | 23.7 | 32.3 | 30.1 | 23.3 | 21.6 | 17.8 | <0.001 |
Dyslipidemia | 39.6 | 52.3 | 46.9 | 40.4 | 35.9 | 31.6 | <0.001 |
Blood pressure (mmHg) | |||||||
SBP | 117±0.21 | 123±0.70 | 120±0.43 | 117±0.32 | 116±0.32 | 114±0.45 | <0.001 |
DBP | 74.4±0.13 | 81.2±0.54 | 78.8±0.31 | 75.6±0.22 | 74.0±0.19 | 73.2±0.26 | <0.001 |
Lipid profile (mg/dL) | |||||||
TC | 189±0.39 | 198±2.01 | 196±1.09 | 193±0.78 | 191±0.72 | 193±1.10 | <0.001 |
TG | 126±1.06 | 192±6.46 | 162±3.78 | 129±1.97 | 111±1.54 | 103±2.25 | <0.001 |
LDL-C | 113±0.34 | 116±1.86 | 117±1.00 | 117±0.68 | 116±0.64 | 116±0.97 | 0.870 |
HDL-C | 52.2±0.14 | 48.8±0.60 | 50.4±0.41 | 51.7±0.27 | 53.6±0.26 | 55.9±0.36 | <0.001 |
BMI (kg/m2) | 23.3±0.05 | 26.6±0.17 | 26.2±0.13 | 24.6±0.09 | 23.0±0.06 | 21.9±0.07 | <0.001 |
Total energy intake (kcal/day) | 1,877±10.0 | 2,278±55.6 | 2,082±30.8 | 1,913±19.7 | 1,888±16.8 | 1,859±25.1 | <0.001 |
Variables | Hypertension alone | Dyslipidemia alone | Hypertension and dyslipidemia |
---|---|---|---|
Total (n) | 1,127 | 2,616 | 1,899 |
Non-smoking | |||
Model 1 | 0.77 (0.60, 0.98) | 0.67 (0.57, 0.78) | 0.64 (0.52, 0.79) |
Model 2 | 0.75 (0.56, 1.01) | 0.66 (0.56, 0.78) | 0.61 (0.45, 0.82) |
Model 3 | 0.77 (0.58, 1.02) | 0.51 (0.43, 0.60) | 0.51 (0.38, 0.68) |
Low alcohol consumption | |||
Model 1 | 0.46 (0.36, 0.59) | 1.03 (0.87, 1.23) | 0.60 (0.50, 0.72) |
Model 2 | 0.43 (0.32, 0.57) | 1.02 (0.85, 1.22) | 0.54 (0.42, 0.70) |
Model 3 | 0.46 (0.35, 0.61) | 1.10 (0.91, 1.33) | 0.57 (0.43, 0.74) |
Healthy body mass index status | |||
Model 1 | 0.33 (0.28, 0.39) | 0.40 (0.36, 0.46) | 0.18 (0.15, 0.21) |
Model 2 | 0.40 (0.33, 0.49) | 0.41 (0.36, 0.46) | 0.22 (0.18, 0.27) |
Model 3 | 0.37 (0.30, 0.46) | 0.36 (0.32, 0.41) | 0.20 (0.16, 0.24) |
Healthy fruit and vegetable consumption | |||
Model 1 | 0.78 (0.64, 0.94) | 0.93 (0.81, 1.05) | 0.82 (0.69, 0.98) |
Model 2 | 0.72 (0.57, 0.90) | 0.93 (0.81, 1.06) | 0.81 (0.63, 1.02) |
Model 3 | 0.79 (0.63, 0.99) | 0.96 (0.83, 1.11) | 0.91 (0.70, 1.16) |
Healthy physical activity | |||
Model 1 | 0.88 (0.75, 1.03) | 0.92 (0.82, 1.03) | 0.77 (0.66, 0.89) |
Model 2 | 0.83 (0.68, 1.01) | 0.88 (0.78, 1.00) | 0.67 (0.55, 0.81) |
Model 3 | 0.85 (0.70, 1.04) | 0.91 (0.81, 1.03) | 0.69 (0.56, 0.85) |
Healthy lifestyle score | Hypertension alone (n=1,127) |
Dyslipidemia alone (n=2,616) |
Hypertension and dyslipidemia (n=1,899) |
|||
---|---|---|---|---|---|---|
Age and sex-adjusted | Multivariable |
Age and sex-adjusted | Multivariable |
Age and sex-adjusted | Multivariable |
|
0-1 (lowest) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
2 | 0.60 (0.40, 0.92) | 0.60 (0.37, 0.96) | 0.70 (0.52, 0.95) | 0.72 (0.52, 0.98) | 0.65 (0.47, 0.91) | 0.63 (0.42, 0.96) |
3 | 0.35 (0.23, 0.52) | 0.34 (0.22, 0.54) | 0.58 (0.44, 0.75) | 0.58 (0.44, 0.77) | 0.32 (0.24, 0.44) | 0.30 (0.20, 0.44) |
4 | 0.23 (0.16, 0.34) | 0.23 (0.15, 0.36) | 0.42 (0.32, 0.55) | 0.41 (0.31, 0.55) | 0.19 (0.14, 0.27) | 0.18 (0.12, 0.27) |
5 (highest) | 0.19 (0.12, 0.30) | 0.19 (0.11, 0.31) | 0.36 (0.26, 0.48) | 0.34 (0.25, 0.47) | 0.11 (0.08, 0.16) | 0.11 (0.07, 0.17) |
p for trend | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 |
Every 1-point increment | 0.66 (0.60, 0.72) | 0.65 (0.59, 0.72) | 0.78 (0.73, 0.82) | 0.76 (0.72, 0.81) | 0.57 (0.53, 0.61) | 0.56 (0.51, 0.62) |
BMI, body mass index; PA, physical activity; WHO, World Health Organization.
All values accounted for the complex sampling design effect of the national surveys using PROC SURVEY procedure, and values are presented as mean±standard error or %. KNHANES, Korea National Health and Nutrition Examination Survey; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglyceride; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein.cholesterol The unweighted sample size for each subgroup.
Values are presented as odds ratio (95% confidence interval). Model 1: adjusted for age (years) and sex; Model 2: adjusted for age (years), sex, education status (≥12 years of school), household income status (≥3 times/wk and ≥30 min/session), marital status, energy intake (kcal/day), diagnosis of hypertension and/or dyslipidemia by physician, and family history of hypertension and/or dyslipidemia; Model 3 was adjusted for the covariates in model 2 and includes the other lifestyle factors.
Values are presented as odds ratio (95% confidence interval). The multivariable model was adjusted for age (years), sex, education status (≥12 years of school), household income status (≥3 times/wk and ≥30 min/session), marital status, energy intake (kcal/day), diagnosis of hypertension and/or dyslipidemia by a physician, and family history of hypertension and/or dyslipidemia.