Synergistic Effects of Mediterranean Diet and Physical Activity in Mitigating CKD Risk: NHANES 2005‐2018 Insights

Lifestyle factors, including diet and physical activity (PA), influence chronic kidney disease (CKD) risk. Previous studies mainly examined single factors. This study assessed the individual and combined effects of Mediterranean diet (MD) adherence and PA on CKD.We analyzed 33,015 adults (≥20 years) from NHANES 2005 to 2018 (51.8% women). MD adherence was measured using the alternative Mediterranean Diet (aMED) score; PA was assessed via questionnaires. Weighted logistic regression estimated associations with CKD. Higher MD adherence was inversely associated with CKD (OR per unit = 0.957, 95% CI 0.927-0.988, p = 0.007). Compared to poor adherence (0-3), average (4-5), and high (6-9) adherence showed reduced CKD risk (OR = 0.856 and 0.815, respectively). PA independently lowered CKD risk (OR = 0.735, 95% CI 0.654-0.825, p < 0.001). Combined high MD adherence and PA yielded the greatest reduction (OR = 0.479, 95% CI 0.422-0.544, p < 0.001). Subgroup analysis indicated no benefit from MD in participants with PA < 500 MET-min/week.MD adherence and PA synergistically reduce CKD risk, but diet alone offers no benefit in physically inactive individuals.