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Accepted manuscript

Association between healthy lifestyle score and thyroid function biomarkers in adults: a cross-sectional analysis

Published online by Cambridge University Press:  04 February 2026

Xueqin Cheng
Affiliation:
Department of Thyroid and Breast Surgery, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
Xi Chen
Affiliation:
Department of Endocrinology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
Lijun Yan
Affiliation:
Department of Geriatric Gastroenterology, The First Affiliated Hospital with Nanjing Medical University, Nanjing Medical University, Nanjing, China
Jie Yang
Affiliation:
Department of Endocrinology, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
Yutao Zhao*
Affiliation:
Department of Thyroid and Breast Surgery, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China Department of Nursing, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
*
*Corresponding author: Yutao Zhao Email: 896576991@qq.com, cnh19811981@gmail.com Address: Department of Nursing, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
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Abstract

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The current study was designed to examine the association between a composite Healthy Lifestyle Score (HLS) and thyroid function biomarkers among American adults. This cross-sectional study utilized data from 5,693 adults aged ≥18 years in the NHANES 2007–2012 cycles. A HLS (range 0–6) was constructed based on six modifiable factors: non-smoking, no heavy alcohol intake, normal BMI (18.5–24.9 kg/m²), high physical activity (upper tertile of MET-min/week), adequate sleep (7–9 h/night), and appropriate energy intake. Serum concentrations of thyroid-stimulating hormone (TSH), free and total thyroxine (FT4, TT4), free and total triiodothyronine (FT3, TT3), thyroglobulin (Tg), and thyroid antibodies (TPOAb, TgAb) were measured. Multivariable linear regression adjusted for sociodemographic factors was used to assess associations. In fully adjusted models, each one-point increase in HLS was associated with lower serum FT4 (β = −0.07 ng/dL; 95% CI: −0.10, −0.03; p < 0.001) and TT4 (β = −0.11 µg/dL; 95% CI: −0.15, −0.06; p < 0.001). Compared with participants with an HLS of 0–1, those with HLS 4–6 had lower FT4 (β = −0.20; 95% CI: −0.30, −0.09; p < 0.001) and TT4 (β = −0.36; 95% CI: −0.49, −0.22; p < 0.001). Associations for other thyroid markers were not statistically significant after correction for multiple comparisons (p > 0.05). A healthier lifestyle is inversely associated with serum FT4 and TT4 levels, highlighting potential links between modifiable behaviors and thyroid physiology.

Information

Type
Research Article
Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of The Nutrition Society

Footnotes

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These authors contributed equally to this wor