Life's essential 8 health profiles and risk of incident neuropsychiatric diseases: a nationwide prospective cohort study.

BACKGROUND: Although previous studies have established associations between Life's Essential 8 (LE8) and neuropsychiatric diseases, they predominantly operationalised the LE8 as a composite score, assuming equal weighting and potentially obscuring heterogeneity in health behaviour patterns. Therefore, this study applied latent profile analysis (LPA) to identify distinct LE8 profiles and examined their associations with the incidence of neuropsychiatric diseases. METHODS: The sample comprised 242,947 UK Biobank participants without prevalent neuropsychiatric diseases. LE8 comprises eight components: healthy diet, physical activity, nicotine exposure, sleep health, glucose, blood lipid, blood pressure, and body mass index. LPA was utilized to identify distinct health patterns. Cox proportional hazards models were used to examine the associations between LE8 profiles and disease incidence. RESULTS: LPA identified five distinct profiles: Low LE8 score; Elevated adiposity, blood pressure, and glucose group; Low physical activity with poor sleep group; Elevated blood pressure and dyslipidaemia group; and High LE8 score group. Over a median follow-up of 13.8 years, 11,419 cases of anxiety, 341 cases of bipolar disorder, and 40 cases of schizophrenia were identified. Using the Low LE8 score group as a reference, all four comparison profiles exhibited significant protective associations for both anxiety (Hazard Ratio [HR] range: 0.65-0.78, all p < 0.001) and bipolar disorder (HR range: 0.37-0.51, all p < 0.001), with risk reductions of up to 35% and 63%, respectively. No significant associations were observed for schizophrenia, likely due to the small number of incident cases (n= 40), and these findings should be considered exploratory. CONCLUSIONS: Distinct LE8 profiles showed heterogeneous associations with neuropsychiatric disease risk, with healthier profiles linked to lower anxiety and bipolar disorder risk, while schizophrenia findings remained inconclusive. These results support person-centred, pattern-based approaches over composite scoring for neuropsychiatric risk stratification and hypothesis generation. CLINICAL TRIAL NUMBER: Not applicable.