Combined influence of healthy lifestyles, nutritional and inflammatory status on mortality among US adults with depression.

Objective: Healthy lifestyles, nutritional and inflammatory status are interrelated and influence mortality. This study aimed to evaluate their separate and combined effects on all-cause and cause-specific mortality in individuals exhibiting depression.

Methods: 6143 individuals with depression (median age 47) were recruited from the US National Health and Nutrition Examination Survey (NHANES 2005-2018), with mortality followed up through December 31, 2019. A healthy lifestyle score (0-5) was constructed based on current non-smoking, low-to-moderate alcohol consumption, adequate sleep, sufficient physical activity and healthy diet. Higher scores indicated healthier lifestyles. The Advanced Lung Cancer Inflammation Index (ALI), a composite marker of inflammation and nutritional status, was calculated as Body Mass Index (BMI) (kg/m) × albumin (g/dl)/Neutrophil-to-Lymphocyte Ratio (NLR). Higher ALI values denoted lower inflammation and better nutrition. Weighted Cox proportional-hazards models were used to estimate mortality hazard ratios.

Results: Healthier lifestyles significantly lowered all-cause (hazard ratio [HR] 0.72, 95 % confidence interval [CI] 0.66-0.78), cardiovascular (HR 0.70, 95 % CI 0.58-0.83), and non-cardiovascular mortality (HR 0.72, 95 % CI 0.64-0.81). High ALI reduced all-cause (HR 0.70, 95 % CI 0.54-0.91) and cardiovascular mortality (HR 0.46, 95 % CI 0.28-0.77) compared with low ALI. Joint analyses showed that individuals with both healthy lifestyle scores ≥3 and high ALI had the lowest risk of all-cause, cardiovascular, and non-cardiovascular mortality (HR 0.44, 95 % CI 0.33-0.60; 0.32, 95 % CI 0.16-0.63; 0.49, 95 % CI 0.35-0.68).

Conclusion: The joint presence of healthy lifestyles and high ALI was significantly associated with lower risk of mortality among individuals with depression.