Beyond Energy Balance, Quantifying the Mortality Consequences of Chronic Energy Surplus: A Nationally Representative Cohort Study using NHANES Data (2007~2014)

Abstract

Objective: This study aims to evaluate the association of energy balance with all-cause, cardiovascular and cancer mortality based on the ratio of energy intake to total daily energy expenditure (EI/TDEE). Methods: Participants in the NHANES from 2007 to 2014 were analyzed. We calculated each individual's energy intake (EI) according to dietary interview questionnaires and total daily energy expenditure (TDEE) according to physical activity questionnaires and physical examination data. EI/TDEE is divided into three quartiles. The mortality data were linked to the National Death Index through the end of 2019. Cox proportional hazards models were used to compare the mortality among different groups. Results: Among 17,562 participants, 1,981 (11.3%) died over a mean follow-up of 8.66±2.63 years. The energy surplus group was associated with a higher all-cause mortality risk(HR 1.21, 95%CI 1.07-1.36, P<0.05) compared with the reference group after adjustment for relevant factors. But energy intake tertiles were not associated with cardiovascular mortality and cancer mortality in the fully adjusted model. Moreover, it has some robustness after subgroup analysis and sensitivity analysis. Conclusion: Energy excess is associated with an increased risk of all-cause mortality.