Combined healthy lifestyles and osteoarthritis among middle-aged and older adults: A cross-sectional study in US adults
Pengfei Shi, Jinmin ZhaoObjective
This cross-sectional study aimed to examine the association between combined healthy lifestyle factors and the prevalence of osteoarthritis (OA) among middle-aged and older U.S. adults using nationally representative data from the National Health and Nutrition Examination Survey (NHANES).
Methods
Data were collected from 15,617 adults participating in NHANES (2005–2020). A healthy lifestyle score (range 0-6) was constructed based on six modifiable factors: smoking status, alcohol consumption, physical activity, diet quality, waist circumference, and sleep duration. Weighted multivariable logistic regression models were utilized to analyze the relationships between healthy lifestyle scores and the prevalence of OA, controlling for demographic, socioeconomic, and health-related variables. Robustness was assessed through stratified, interaction, and sensitivity analyses, including propensity score adjustment, E-value analysis, and restricted cubic spline modeling.
Results
Among 15,617 participants, OA was present in 2,275 individuals. In the crude model, the association between the healthy lifestyle score and OA was not statistically significant for the per-factor trend. After adjustment for covariates, a higher healthy lifestyle score was significantly associated with lower odds of OA. Participants with 5–6 healthy lifestyle factors had 31% lower odds of OA, and each additional factor was associated with 7% lower odds of OA. Key factors associated with lower odds of OA included non-smoking, optimal waist circumference, and adequate sleep. The association was more pronounced in adults under 60 years. Sensitivity analyses confirmed a consistent inverse association between the lifestyle score and OA odds.
Conclusions
Our findings suggest that adherence to a greater number of healthy lifestyle factors may be associated with lower odds of OA, particularly among younger adults. Notably, smoking avoidance, maintaining optimal waist circumference, and adequate sleep duration demonstrated particularly robust inverse associations. These results highlight the potential of integrated lifestyle modifications for OA-related public health strategies at both individual and population levels.