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a systematic review and meta-analysis

Our study also identified a unique clustered lifestyle characterized by physical activity. The results of multivariate adjusted model demonstrated no correlation with the beneficial cardio-renal-metabolic parameters in subjects with a high score of this pattern, except uric acid. Rather, these subjects had high AST and ALT levels. This is possibly because higher consumption of food could cancel the beneficial effects of habitual physical activity on cardio-renal metabolic parameters. These data suggest the presence of antagonistic effect of lifestyle patterns that tend to accumulate in real daily life on cardio-renal-metabolic parameters.

The present study has certain limitation. First, the cross-sectional design does not allow inference of causal relationship between lifestyle patterns and cardio-renal-metabolic parameters. Also, we could not exclude the possibility that subjects change their daily lifestyles at other periods. Second, we did not confirm the validity and reproducibility of the lifestyle patterns found in this study in a different Japanese population. In this regard, we assessed the validity and reproducibility of the lifestyle patterns in this study by the following steps: 1) Subjects data in this study were randomly divided into two datasets (test and validation groups) in half, 2) The lifestyle patterns were evaluated by factor analysis in each dataset, and 3) Steps 1) and 2) were repeated ten times. According to this analysis, the lifestyle patterns evaluated by factor analysis in test and validation groups were similar, and the results were almost identical to those in the whole population (data not shown), suggesting that validity and reproducibility of the lifestyle patterns were relatively high in an internal. Finally, there may be other lifestyle patterns that should be considered, although based on the results of previous reports, we chose the possible lifestyle factors related to cardio-renal—metabolic parameters such as sleep quality [10,39], morningness-eveningness trait [14,40,41], depression status [17,18], energy intake and physical activity [35], smoking [42] and alcohol consumption [43].