Integrating Sleep, Physical Activity, and Diet Quality to Estimate All-Cause Mortality Risk: A Combined Compositional Clustering and Survival Analysis of the National Health and Nutrition Examination Survey 2005-2006 Cycle

We aimed to compare all-cause mortality risk across clusters of adults ≥50 years of age (n = 1,035) with common lifestyle behaviors patterns, enrolled in the US National Health and Nutrition Examination Survey (2005-2006). Log-ratio coordinates of 24-hour movement pattern and z scores of diet quality were used as input into a model-based clustering analysis. A Cox regression model was fitted to ascertain the all-cause mortality risk associated with each cluster. Participants were clustered into 4 groups: 1) a group characterized by a better physical activity profile and longer sleep duration coupled with an average diet quality (cluster 1); 2) a group with the poorest activity profile and shortest sleep but also the best diet quality (cluster 2); 3) another group featuring lower levels of activity of either intensity and higher levels of sedentary behavior and also a poor diet quality score (cluster 3); and 4) a group with an average diet quality and the best activity profile in the sample (cluster 4). A combination of a poorer diet and activity profile increased the prospective risk of all-cause mortality. Our findings emphasize the importance of considering the combination of diet quality and 24-hour movement patterns when developing interventions to reduce the risk of premature mortality.