体力活动（PA）和饮食质量均已被证明与死亡率呈负相关，但它们对寿命的综合影响却很少被探讨，特别是考虑到它们随时间的变化时。本研究旨在探讨 PA、饮食质量及其随时间的变化与死亡率结果的单独和组合关联。根据诺福克基于人群的欧洲癌症前瞻性调查，对 9349 名 40 至 79 岁的成年人进行了一项前瞻性队列研究研究重复测量 PA 和饮食（从 1993 年到 2004 年），并进行后续随访直至 2022 年（中位随访时间 18.8 年）。使用经过验证的问卷得出体力活动能量消耗 (PAEE) 作为总 PA 的代理，并遵守地中海饮食评分（MDS，范围 0-15 分）作为总体饮食质量的指标及其随时间的变化 (Δ PAEE 和 ΔMDS）。使用针对潜在混杂因素和中介因素进行调整的 Cox 回归模型来估计风险比 (HR) 和 95% CI。在 149,681 人年的随访中，有 3534 人死亡。在调整后的模型中，对于基线 PAEE（4.64 kJ/kg/天）、ΔPAEE（每年 0.65 kJ/kg/天）、基线 MDS（1.30 点）和 ΔMDS（每年 0.32 点）的每个 1-SD 差异全因死亡率的 HR（95% CI）分别为 0.90（0.86 至 0.94）、0.89（0.85 至 0.93）、0.95（0.91 至 0.99）和 0.93（0.90 至 0.97）。与持续低 PAEE（< 5 kJ/kg/day）和低 MDS（< 8.5 分）的参与者相比，持续高 PAEE 和高 MDS 的参与者的全因死亡率较低（HR 0.78；95% CI：0.68-0.91） ），那些同时改善 PAEE 和 MDS 的人也是如此（0.60；0.44-0.82）。没有证据表明 PA 和饮食质量暴露与死亡风险之间存在相互作用。人口影响估计表明，如果所有参与者始终保持高水平的 PA 和饮食质量，累积调整死亡率将降低 8.8%（95% CI：2.4 至 15.3%）。这些发现表明，采用并维持较高水平的 PA PA 和饮食质量与较低的死亡率相关。通过在成年期间保持积极的生活和健康的饮食，可以实现重大的公共健康效益。© 2024。作者。

Physical activity (PA) and diet quality have each been shown to be inversely associated with mortality but their combined impact on longevity has been less explored, particularly when considering their changes over time. This study aimed to examine the separate and combined associations of PA, diet quality and their changes over time with mortality outcomes.A prospective cohort study was performed on 9349 adults aged 40 to 79 years from the population-based European Prospective Investigation into Cancer in Norfolk Study, with repeated measurements of PA and diet (from 1993 till 2004) and subsequent follow-up till 2022 (median follow-up 18.8 years). Validated questionnaires were used to derive physical activity energy expenditure (PAEE) as a proxy of total PA and adherence to the Mediterranean diet score (MDS, range 0-15 points) as an indicator of overall diet quality, and their changes over time (∆PAEE and ∆MDS). Cox regression models adjusted for potential confounders and mediators were used to estimate hazard ratios (HRs) and 95% CIs.Over 149,681 person-years of follow-up, there were 3534 deaths. In adjusted models, for each 1-SD difference in baseline PAEE (4.64 kJ/kg/day), ∆PAEE (0.65 kJ/kg/day per year), baseline MDS (1.30 points) and ∆MDS (0.32 points per year), HRs (95% CI) for all-cause mortality were 0.90 (0.86 to 0.94), 0.89 (0.85 to 0.93), 0.95 (0.91 to 0.99) and 0.93 (0.90 to 0.97), respectively. Compared with participants with sustained low PAEE (< 5 kJ/kg/day) and low MDS (< 8.5 points), those with sustained high PAEE and high MDS had lower all-cause mortality (HR 0.78; 95% CI: 0.68-0.91), as did those who improved both PAEE and MDS (0.60; 0.44-0.82). There was no evidence of interaction between PA and diet quality exposures on mortality risk. Population impact estimates suggested that if all participants had maintained high levels of PA and diet quality consistently, cumulative adjusted mortality rate would have been 8.8% (95% CI: 2.4 to 15.3%) lower.These findings suggest that adopting and maintaining higher levels of PA and diet quality are associated with lower mortality. Significant public health benefits could be realised by enabling active living and healthy eating through adulthood.© 2024. The Author(s).