ArticleScientific reports2025
Insulin resistance mediates the association between physical activity and mortality in US adults with metabolic syndrome.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Physical activity, sedentary behaviour, and anthropometric profiles in women with and without insulin resistance: a cross-sectional study.BMC women's health · 2026Article
- Associations of cumulative exposure and dynamic trajectories of the triglyceride-total cholesterol-body weight index with new-onset cardiometabolic multimorbidity in middle-aged and older Chinese adults: evidence from a nationwide prospective cohort study.Cardiovascular diabetology · 2026Article
- Training gut and body: physical activity, diet, ASA and microbiota influence the outcome in gastrointestinal cancer survivors.Frontiers in nutrition · 2025Review
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Abstract
This study examines the associations between physical activity (PA) and all-cause mortality (ACM), cause-specific mortality (cancer, cardiovascular disease), and premature mortality, with a focus on the mediating role of insulin resistance. Data from the National Health and Nutrition Examination Survey (NHANES) were analyzed, including 8,460 participants. PA was quantified in metabolic equivalents (MET-h/week) and categorized into four groups: no physical activity (NOPA), low-level PA (LLPA), moderate-level PA (MLPA), and high-level PA (HLPA). Cox regression, restricted cubic splines, and Kaplan-Meier survival curves assessed the associations between PA and mortality risks. Mediation analysis evaluated the role of insulin resistance. With a median follow-up of 6.3 years, 1,147 all-cause deaths, 321 cardiovascular deaths, 274 cancer deaths, and 441 premature deaths. Compared to the NOPA group (0 MET-h/week), the LLPA (MET < 10 h/week), MLPA (10 ≤ MET < 50 h/week), and HLPA (≥ 50 MET-h/week) groups showed significant reductions in all-cause mortality risk by 39% (HR = 0.61, 95% CI: 0.51-0.73), 44% (HR = 0.56, 95% CI: 0.48-0.66), and 57% (HR = 0.43, 95% CI: 0.35-0.52), respectively. Similarly, for cardiovascular disease mortality, the risk reductions were 49% (HR = 0.51, 95% CI: 0.36-0.71), 51% (HR = 0.49, 95% CI: 0.37-0.64), and 52% (HR = 0.48, 95% CI: 0.35-0.66) across the three PA groups. In terms of cancer mortality risk, only the HLPA group showed a statistically significant 50% reduction (HR = 0.50, 95% CI: 0.34-0.74), while the LLPA and MLPA groups demonstrated non-significant reductions of 29% and 16%, respectively. A nonlinear dose-response relationship was observed for PA and mortality. Mediation analysis revealed that HOMA-IR mediated 22.1% (P = 0.022), 16.7% (P = 0.002), 15.7% (P = 0.030), and 10.1% (P = 0.058) of the association ACM, cause-specific mortality, and premature mortality, respectively. This study highlights the protective effects of PA in reducing the risks of ACM, cause-specific mortality, and premature mortality, particularly in patients with metabolic syndrome. Insulin resistance plays a significant mediating role in these relationships, underscoring the importance of targeting both PA and insulin resistance in interventions to reduce mortality risks in metabolic syndrome patients.
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