# Joint association of dietary index for gut microbiota and weekend warrior physical activity pattern with mortality among hypertensive patients

## TL;DR

This study shows that combining a gut-friendly diet with weekend physical activity can significantly reduce mortality risk in people with hypertension.

## Contribution

The study is the first to examine the joint effect of a gut microbiota-friendly diet and weekend warrior activity on mortality in hypertensive patients.

## Key findings

- High DI-GM and weekend warrior activity reduced all-cause mortality risk by 55% in hypertensive patients.
- Weekend warriors had 47% lower CVD mortality risk compared to inactive individuals with low DI-GM.
- DI-GM was independently linked to a 6% lower all-cause mortality risk in hypertensive patients.

## Abstract

The Dietary Index for Gut Microbiota (DI-GM) is a dietary quality indicator of gut health, weekend warrior (WW) has grown increasingly prevalent in today’s fast-paced lifestyle. The association of DI-GM and WW with mortality in hypertensive populations is currently unclear. This study aimed to explore the independent and joint associations of DI-GM and WW physical activity pattern with mortality among hypertensive patients.

Utilizing data from 9082 hypertensive patients in the NHANES 2007–2018. The WW physical activity pattern was assessed using the self-reported Global Physical Activity Questionnaire, and DI-GM was estimated based on 24-hour dietary recalls. Kaplan–Meier (KM) curves and the Cox proportional hazard model were used to evaluate the associations between independent and joint prognostic effects of DI-GM and WW with mortality among hypertensive patients.

During a median follow-up of 6.8 years, 919 deaths were recorded. Analysis showed that DI-GM was associated with all-cause mortality in hypertensive patients (HR = 0.94, 95% CI [0.90, 0.99]). The all-cause (HR = 0.59, 95%CI 0.47 to 0.74) and cardiovascular disease (CVD) mortality (HR = 0.51, 95%CI 0.33 to 0.79) were significantly lower for weekend warriors compared with inactive individuals. The combined analysis demonstrated that, compared to individuals with low DI-GM and inactivity, those with high DI-GM and WW had a 55% lower risk of all-cause mortality, while those with low DI-GM and WW exhibited a 47% reduced risk of CVD mortality.

DI-GM demonstrated a significant inverse association with all-cause mortality risk among hypertensive patients. WW had similar benefits for all-cause mortality as regularly active. Our study revealed that the combination of high DI-GM diets with WW was robustly associated with reduced all-cause mortality risk in hypertensive patients.

The online version contains supplementary material available at 10.1186/s12986-025-01026-8.