Can Vitamin C Intake and Physical Activity Individually and Jointly Lower Inflammation in Chronically Infected Populations? Insights from NHANES 2005–2018

Can Vitamin C Intake and Physical Activity Individually and Jointly Lower Inflammation in Chronically Infected Populations? 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Insights from NHANES 2005–2018 Hongyin Zhou, Hui Zhang, Yaxin Huang, Yonggang Hu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6641016/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Systemic immune-inflammation is a key contributor to chronic disease pathogenesis. Whether vitamin C intake and physical activity influence inflammatory status in individuals with latent viral infections remains unclear. Methods: We conducted a cross-sectional analysis of 33,590 U.S. adults from NHANES 2005–2018. Vitamin C intake was assessed by two 24-hour dietary recalls; physical activity was self-reported. The primary outcome was the systemic immune-inflammation index (SII), with secondary outcomes including NLR, PLR, PPN, PC, NC, and LC. Multivariable linear regression models adjusted for sociodemographic and behavioral covariates. Analyses were stratified by serostatus to hepatitis viruses, HIV, HPV, and HSV. Results: Higher vitamin C intake was associated with lower SII, PC, NC, and PPN, particularly among HSV-seropositive and seronegative individuals. Moderate/vigorous physical activity was independently associated with lower inflammatory markers in these same subgroups. Joint exposure to high vitamin C intake and higher activity showed the most consistent anti-inflammatory profiles. Conclusions: Higher vitamin C intake and physical activity were independently and jointly associated with lower systemic inflammation, with pronounced effects among those with HSV infection or no viral exposure. These findings support the role of lifestyle modification in mitigating inflammation, particularly in populations with chronic immune activation. Health sciences/Diseases/Infectious diseases Health sciences/Medical research/Epidemiology Health sciences/Pathogenesis/Infection Health sciences/Pathogenesis/Inflammation Vitamin C intake Physical activity Systemic immune-inflammation index Chronic viral infection NHANES Inflammatory biomarkers Herpes simplex virus Neutrophil-to-lymphocyte ratio Lifestyle factors Population health Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Chronic low-grade inflammation plays a central role in the development and progression of numerous noncommunicable diseases, including cardiovascular disease, diabetes, cancer, and neurodegeneration 1 – 5 . In recent years, hematologic biomarkers derived from routine complete blood counts—such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and particularly the systemic immune-inflammation index (SII)—have emerged as accessible, integrative markers of systemic immune activation 6 – 8 . These indices reflect the dynamic balance between innate and adaptive immunity, and higher values have been consistently linked with increased morbidity and mortality in both clinical and community settings 6 , 9 – 12 . Modifiable lifestyle factors such as diet and physical activity have been widely studied as potential modulators of systemic inflammation. Vitamin C, a potent dietary antioxidant and cofactor in multiple immune processes, has been shown to attenuate oxidative stress and inflammatory signaling 13 – 18 . Regular physical activity is similarly associated with reduced levels of proinflammatory cytokines and improved leukocyte function through mechanisms involving adipokine modulation, reduced visceral adiposity, and neuroendocrine regulation 19 – 21 . While each of these factors has been independently linked to inflammatory outcomes, limited evidence exists on their combined effect—and, critically, whether such associations are consistent across individuals with varying infectious exposures. Chronic or latent viral infections, such as those caused by hepatitis viruses (HAV, HBV, HCV, HDV, HEV), human papillomavirus (HPV), herpes simplex virus (HSV), and human immunodeficiency virus (HIV), are highly prevalent in adult populations and are known to induce sustained immune perturbations, even in the absence of overt disease 22 – 25 . These infections may alter leukocyte distribution and amplify systemic inflammation through persistent antigenic stimulation, immune exhaustion, and epigenetic remodeling 26 – 29 . However, individuals harboring these infections have been largely overlooked in studies linking lifestyle exposures to inflammatory status. To address this gap, we conducted a cross-sectional analysis of 33,590 U.S. adults participating in the National Health and Nutrition Examination Survey (NHANES) from 2005 through 2018. Our aim was to evaluate the independent and joint associations of dietary vitamin C intake and physical activity with multiple systemic inflammatory markers, including SII, PLR, NLR, and their component cell counts. Uniquely, we stratified all analyses by serostatus to four major classes of infectious pathogens to assess whether the associations differed in the context of chronic viral exposure. By integrating nationally representative data on diet, behavior, immunity, and infection, this study offers novel insights into modifiable determinants of systemic immune-inflammation across both healthy and immunologically vulnerable populations. Methods Study Sample Selection We conducted a cross-sectional analysis using data from adults participating in the NHANES from 2005 through 2018 to investigate associations between vitamin C intake, physical activity, and systemic immune-inflammation. NHANES is a nationally representative survey of the U.S. population that employs a complex, stratified, multistage probability sampling design and includes both interviews and physical examinations. Detailed information is publicly available from the Centers for Disease Control and Prevention (CDC) ( https://www.cdc.gov/nchs/nhanes/index.htm ). A total of 70,427 participants were initially enrolled. We excluded 25,332 individuals who were not adults, 214 with missing data on physical activity, 9,786 without vitamin C intake data, and 1,505 without SII values, resulting in 33,590 eligible adult participants (Fig. 1 ). Among them, subgroups were identified based on seropositivity to various infectious pathogens, including hepatitis viruses (HAV, HBV, HCV, HDV, HEV; n = 16,544), human immunodeficiency virus (HIV; n = 82), human papillomavirus (HPV; n = 2,200), and herpes simplex virus (HSV; n = 10,306). All data collection was conducted by the CDC with informed consent obtained from participants under protocols approved by the National Center for Health Statistics Ethics Review Board. Assessment of Vitamin C Intake The primary exposure of interest in this study was dietary vitamin C intake, assessed through two 24-hour dietary recalls conducted as part of NHANES. The first dietary recall was administered in person at a mobile examination center, and the second was conducted by telephone 3 to 10 days later. The average daily intake of vitamin C was calculated based on data from both recalls, using the Food and Nutrient Database for Dietary Studies (FNDDS) developed by the United States Department of Agriculture (USDA). Assessment of Physical Activity Physical activity was assessed using self-reported data collected through standardized physical activity questionnaires administered during the NHANES interview. Participants were asked to report the frequency and duration of moderate and vigorous physical activities performed during a typical week, including both recreational and transportation-related activities. Based on established NHANES coding protocols, physical activity levels were classified into two categories: mild/light and moderate/vigorous. This classification reflected both the intensity and duration of reported activity, in accordance with national physical activity guidelines. Assessment of Seropositivity to Infectious Pathogens We included viruses that were consistently assessed across multiple NHANES cycles from 2005 to 2018 to ensure sufficient sample size and statistical power. Viruses evaluated in only a single cycle, such as cytomegalovirus (CMV), were excluded due to limited data availability. Seropositivity to HAV, HBV, HCV, HDV, and HEV was determined using a solid-phase competitive immunoassay. HIV antibodies were detected using a synthetic peptide enzyme immunoassay (Bio-Rad Laboratories, Redmond, WA). For HPV, purified DNA was analyzed using multiplex polymerase chain reaction (PCR). Seropositivity to herpes simplex virus types 1 and 2 (HSV-1, HSV-2) was assessed with a solid-phase enzymatic immunoassay. Detailed descriptions of the laboratory procedures are available on the NHANES website. Measurement of Immunoinflammatory Indices The primary outcome was the SII, calculated as platelet count (PC) × neutrophil count (NC) / lymphocyte count (LC), based on values obtained from the complete blood count 30 , 31 . All hematologic parameters were measured in units of 1,000 cells/mL, following standardized laboratory protocols available on the NHANES website. Secondary outcomes included other inflammatory biomarkers derived from the same components: PLR, NLR, PPN, as well as PC, NC, and LC individually. To comprehensively evaluate the associations between nutrient intake and systemic inflammation, we examined both SII and these related markers in dose–response analyses. Assessment of Covariates The data collected by the NHANES personnel during the household interview included information on the age, sex, poverty income ratio (PIR), education attainment, alcohol consumption, cigarette-smoking status, and body mass index (BMI) of the participants. The age of the participant was calculated in years at the time of screening (variable name prefix RIDAGEYR). Sex was categorized by NHANES personnel as either male or female (variable name prefix RIAGENDR). PIR was defined as the ratio of family income to poverty guidelines (variable name prefix INDFMPIR). The education level was determined by the question (variable name prefix DMDEDUC2). The question posed was as follows: "Please indicate the highest grade or level of school you have completed or the highest degree you have received." The Alcohol Use Questionnaire (variable name prefix ALQ) focused on both lifetime and current use (past 12 months). The questions do not distinguish between the types of alcohol consumed. For adults aged 18 years or older, the Cigarette Use Questionnaire (variable name prefix SMQ) was administered in the home by trained interviewers utilizing the Computer Assisted Personal Interview (CAPI) system. The BMI was collected, in the Mobile Examination Center (MEC), by trained health technicians. The health technician was assisted by a recorder during the body measures examination. Data Analysis All analyses were performed in accordance with the NHANES analytic guidelines, incorporating appropriate sampling weights to account for the complex, multistage, stratified survey design, thereby ensuring nationally representative estimates of the U.S. adult population. Descriptive statistics were presented as means with standard deviations (SD) for continuous variables and as frequencies with percentages for categorical variables. Group comparisons were conducted using two-sample t-tests. To evaluate the associations between vitamin C intake, physical activity, and inflammatory markers, multivariable linear regression models were applied, adjusting for total energy intake, age, sex, PIR, educational attainment, alcohol consumption, smoking status, and BMI. Missing covariate data (excluding exposure and outcome variables) were addressed using random forest-based multiple imputation techniques. Statistical significance was defined as a two-sided P -value less than 0.05. Analyses were conducted using SAS software, version 9.4 (SAS Institute, Cary, NC, USA), and R software, version 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria). Results Study population characteristics A total of 33,590 adult participants aged 20 years or older were included in the final analytic sample. Baseline characteristics are presented in Table 1 , stratified by serostatus for various infectious pathogens. Among these participants, 10,827 were seronegative, and 22,763 were seropositive for at least one pathogen. Subgroups included those seropositive for hepatitis viruses (HAV, HBV, HCV, HDV, or HEV; n = 16,544), HIV ( n = 82), HPV ( n = 2,200), and HSV ( n = 10,306). Table 1 Baseline Characteristics of the Study Population Variables Seronegative individuals a Seropositivity to infectious pathogens a N = 10,827 Hepatitis N = 16,544 HIV N = 82 HPV N = 2,200 HSV N = 10,306 Any pathogens N = 22,763 Age, years, mean (SD) 52.07 (17.62) 53.01 (18.01) 40.38 (9.57) 39.98 (11.52) 35.60 (8.44) 48.34 (17.80) PIR, mean (SD) 2.90 (1.63) 2.30 (1.56) 1.97 (1.39) 2.29 (1.62) 2.25 (1.58) 2.34 (1.58) BMI, kg/m 2 , mean (SD) 2.68 (0.23) 2.65 (0.24) 2.45 (0.23) 2.68 (0.23) 2.68 (0.23) 2.66 (0.24) SII, mean (SD) 2.38 (0.12) 2.37 (0.12) 2.34 (0.10) 2.41 (0.12) 2.40 (0.11) 2.38 (0.12) PC, mean (SD) 0.61 (0.16) 0.60 (0.17) 0.41 (0.19) 0.62 (0.18) 0.62 (0.17) 0.61 (0.17) NC, mean (SD) 0.32 (0.15) 0.33 (0.14) 0.30 (0.15) 0.35 (0.13) 0.36 (0.13) 0.34 (0.14) LC, mean (SD) 2.08 (0.17) 2.06 (0.17) 2.06 (0.17) 2.07 (0.16) 2.07 (0.15) 2.07 (0.16) PLR, mean (SD) 0.33 (0.19) 0.31 (0.19) 0.15 (0.21) 0.30 (0.18) 0.30 (0.18) 0.31 (0.19) NLR, mean (SD) 2.98 (0.22) 2.96 (0.23) 2.73 (0.21) 3.02 (0.24) 3.01 (0.23) 2.98 (0.23) PPN, mean (SD) 52.07 (17.62) 53.01 (18.01) 40.38 (9.57) 39.98 (11.52) 35.60 (8.44) 48.34 (17.80) Sex, n (%) Men 5,283 (48.8%) 8,443 (51.0%) 18 (22.0%) 1,524 (69.3%) 5,712 (55.4%) 12,033 (52.9%) Women 5,544 (51.2%) 8,101 (49.0%) 64 (78.0%) 676 (30.7%) 4,594 (44.6%) 10,730 (47.1%) Education, n (%) b ≤ High school 6,806 (62.9%) 7,277 (44.0%) 44 (53.7%) 1,086 (49.4%) 5,108 (49.6%) 10,822 (47.5%) College or above 4,021 (37.1%) 9,267 (56.0%) 38 (46.3%) 1,114 (50.6%) 5,198 (50.4%) 11,941 (52.5%) Drinking, n (%) b Yes 2,941 (27.2%) 5,997 (36.2%) 13 (15.9%) 529 (24.0%) 2,822 (27.4%) 7,378 (32.4%) No 7,886 (72.8%) 10,547 (63.8%) 69 (84.1%) 1,671 (76.0%) 7,484 (72.6%) 15,385 (67.6%) Smoking, n (%) b Yes 5,662 (52.3%) 9,742 (58.9%) 38 (46.3%) 1,067 (48.5%) 6,047 (58.7%) 12,949 (56.9%) No 5,165 (47.7%) 6,802 (41.1%) 44 (53.7%) 1,133 (51.5%) 4,259 (41.3%) 9,814 (43.1%) Vitamin C intake, n (%) Low 5,503 (50.8%) 7,830 (47.3%) 36 (43.9%) 1,147 (52.1%) 5,306 (51.5%) 11,292 (49.6%) High 5,324 (49.2%) 8,714 (52.7%) 46 (56.1%) 1,053 (47.9%) 5,000 (48.5%) 11,471 (50.4%) Physical activity, n (%) Mild/Light 6,561 (60.6%) 11,290 (68.2%) 46 (56.1%) 1,369 (62.2%) 6,413 (62.2%) 14,999 (65.9%) Moderate/Vigorous 4,266 (39.4%) 5,254 (31.8%) 36 (43.9%) 831 (37.8%) 3,893 (37.8%) 7,764 (34.1%) Physical activity + Vitamin C intake, n (%) Mild/Light + Low 3,306 (30.5%) 5,357 (32.4%) 22 (26.8%) 717 (32.6%) 3,273 (31.8%) 7,417 (32.6%) Moderate/Vigorous + High 7,521 (69.5%) 11,187 (67.6%) 60 (73.2%) 1,483 (67.4%) 7,033 (68.2%) 15,346 (67.4%) a Data shown are either frequency (%) or mean (SD). b Missing values were imputed with random forest imputation. Abbreviations: BMI, body mass index; HIV, human immunodeficiency virus; HPV, human papillomavirus; HSV, herpes simplex virus; LC, lymphocyte count; NC, neutrophil count; NLR, neutrophil-to-lymphocyte ratio; PC, plate count; PIR, poverty income ratio; PLR, platelet-to-lymphocyte ratio; PPN, the product of platelet and neutrophil count; SD, standard deviation; SII, systemic immune-inflammation index. The mean age ranged from 35.6 years in the HPV group to 53.0 years in the hepatitis group. Participants seropositive for any pathogen tended to have lower socioeconomic status, as indicated by lower poverty income ratios (mean PIR: 2.34 vs. 2.90 in seronegative individuals), and a slightly lower proportion of participants with a college education or higher (52.5% vs. 62.9%). The mean SII was generally comparable across groups, with values ranging from 2.34 to 2.41. Similar patterns were observed for related biomarkers, including PC, NC, LC, PLR, NLR, and PPN. Sex distribution varied substantially by infection type. For example, 78.0% of the HIV-seropositive group were women, whereas the majority of HPV-positive participants were men (69.3%). Lifestyle factors also differed: current smoking was more prevalent among pathogen-positive individuals (e.g., 58.7% in the HSV group vs. 52.3% among seronegative participants), while alcohol use was less common among those with HIV (15.9%) compared to other groups. Regarding exposure variables, low vitamin C intake was reported in approximately half of the study population, with minimal variation across groups. Mild or light physical activity was more common than moderate or vigorous activity, particularly among participants seropositive for hepatitis (68.2%). In joint exposure categories, approximately two-thirds of participants in all groups fell into the favorable category of high vitamin C intake and moderate/vigorous physical activity. Differences in Inflammatory Biomarkers by Vitamin C Intake Across Pathogen Exposure Subgroups Figure 2 illustrates differences in inflammatory biomarkers between participants with low and high vitamin C intake across subgroups defined by seropositivity to infectious pathogens. Among participants seropositive for hepatitis viruses ( n = 16,544), higher vitamin C intake was significantly associated with lower levels of LC, NC, PC, PPN, and SII (all P < 0.05), whereas no significant differences were observed for PLR and NLR. In the HSV subgroup ( n = 10,306), participants with higher vitamin C intake had significantly lower LC, NC, PC, NLR, PPN, and SII values compared with those with lower intake ( P < 0.05 for all), with the most pronounced difference observed for PPN ( P < 1×10⁻⁹). Similar but slightly weaker patterns were observed in the HPV subgroup ( n = 2,200), where higher vitamin C intake was associated with reduced LC, NC, and PPN ( P < 0.05), although differences in SII and other markers were not statistically significant. Among individuals seropositive for any of the evaluated pathogens (HPV, HIV, HSV, hepatitis; n = 22,763), high vitamin C intake was consistently associated with lower levels of NC, LC, PC, NLR, PPN, and SII (all P < 0.05), indicating a broadly inverse relationship between vitamin C intake and systemic immune-inflammation in infected populations. In contrast, among HIV-positive participants ( n = 82), no statistically significant differences in biomarker levels were observed between intake groups, likely due to the small sample size and limited statistical power. Among seronegative individuals ( n = 10,827), similar inverse associations were observed for LC, NC, PC, and PPN ( P < 0.01 for all), although SII and NLR values did not differ significantly between the vitamin C intake groups. Overall, the findings suggest that higher dietary vitamin C intake is associated with lower systemic inflammation, particularly among individuals with viral infections, with the most consistent differences observed in innate immune markers such as neutrophil count and PPN. Differences in Inflammatory Biomarkers by Physical Activity Levels Across Pathogen Exposure Subgroups Figure 3 illustrates the associations between physical activity levels and systemic inflammatory markers across pathogen exposure subgroups. Significant differences by activity level were observed primarily in seronegative individuals and those seropositive for HSV. In seronegative participants ( n = 10,827), moderate to vigorous physical activity was associated with lower PC ( P = 0.006), PLR ( P < 0.001), and SII ( P = 0.006), along with a modest increase in LC ( P = 0.027). Among participants seropositive for HSV ( n = 10,306), those engaging in moderate/vigorous physical activity had significantly lower PC ( P < 0.001), PLR ( P = 0.004), PPN ( P < 0.001), and SII ( P = 0.001), suggesting a beneficial immune-inflammatory profile associated with greater activity. In contrast, no statistically significant differences in inflammatory markers were observed between activity groups in the hepatitis, HIV, or HPV subpopulations, nor in the overall virus-positive group ( n = 22,763), potentially due to heterogeneity in infection status and smaller subgroup sizes. These findings suggest that the anti-inflammatory effects of physical activity may be more prominent in individuals without chronic viral exposure or in those infected with HSV, particularly in relation to platelet- and neutrophil-related indices. Combined Effects of Vitamin C Intake and Physical Activity on Inflammatory Biomarkers Across Pathogen Exposure Subgroups Figure 4 depicts the differences in systemic inflammatory markers between individuals with low vitamin C intake and mild/light physical activity versus those with high vitamin C intake and moderate/vigorous physical activity, stratified by serostatus. Among participants seropositive for HSV ( n = 10,306), the combined high-exposure group demonstrated significantly lower levels of PC ( P < 0.001), NC ( P = 0.002), PPN ( P < 0.001), and SII ( P = 0.001), as well as a modest reduction in LC ( P < 0.001). In the overall virus-positive group ( n = 22,763), individuals with high vitamin C intake and moderate/vigorous physical activity had significantly lower NC ( P < 0.001), PC ( P < 0.001), PPN ( P < 0.001), and SII ( P < 0.001), along with a small but significant decrease in LC ( P = 0.015), compared with the reference group. Among seronegative participants ( n = 10,827), similar patterns were observed, with significantly lower PC ( P = 0.001), NC ( P = 0.020), PPN ( P < 0.001), and SII ( P = 0.020) in the high-exposure group. In contrast, no statistically significant differences were observed in the HPV subgroup ( n = 2,200), although a trend toward lower inflammatory marker levels was noted. Data for the HIV subgroup were limited and not presented due to small sample size. These results suggest that the combination of high vitamin C intake and greater physical activity is associated with a more favorable inflammatory profile, particularly among HSV-seropositive and seronegative individuals, with the most consistent reductions observed in neutrophil-related and platelet-based indices. Associations Between Vitamin C Intake, Physical Activity, and Inflammatory Biomarkers Table 2 summarizes the associations of vitamin C intake, physical activity, and their joint effects with seven inflammatory biomarkers, stratified by pathogen serostatus. Among individuals seropositive for any infectious pathogen ( n = 22,763), higher vitamin C intake was significantly associated with lower levels of PC, NC, LC, SII, and PPN, with β estimates ranging from − 0.004 to − 0.015 ( P < 0.05 for all). Table 2 Associations of Vitamin C Intake, Physical Activity, and Their Joint Effects with Seven Inflammatory Biomarkers Among Seronegative Individuals and Those Seropositive to Infectious Pathogens Independent variables Seronegative individuals a Seropositivity to infectious pathogens a N = 10,827 Hepatitis N = 16,544 HIV N = 82 HPV N = 2,200 HSV N = 10,306 Any pathogens N = 22,763 Dependent variable: PC, β ( P ) a Vitamin C intake Low Reference Reference Reference Reference Reference Reference High -0.003 (0.169) -0.004 (0.035) 0.026 (0.261) -0.004 (0.422) -0.008 (< 0.001) -0.006 (< 0.001) Physical activity Mild/Light Reference Reference Reference Reference Reference Reference Moderate/Vigorous -0.006 (0.009) 0.000 (0.797) 0.002 (0.938) -0.002 (0.723) -0.005 (0.018) -0.002 (0.259) Physical activity + Vitamin C intake Mild/Light + Low Reference Reference Reference Reference Reference Reference Moderate/Vigorous + High -0.006 (0.014) -0.003 (0.086) 0.023 (0.367) -0.006 (0.280) -0.010 (< 0.001) -0.006 (< 0.001) Dependent variable: NC , β ( P ) a Vitamin C intake Low Reference Reference Reference Reference Reference Reference High -0.008 (0.013) -0.006 (0.026) 0.055 (0.235) -0.005 (0.530) -0.011 (0.002) -0.009 (< 0.001) Physical activity Mild/Light Reference Reference Reference Reference Reference Reference Moderate/Vigorous -0.001 (0.696) -0.004 (0.171) -0.008 (0.855) -0.011 (0.166) -0.006 (0.109) -0.004 (0.128) Physical activity + Vitamin C intake Mild/Light + Low Reference Reference Reference Reference Reference Reference Moderate/Vigorous + High -0.005 (0.131) -0.003 (0.275) 0.037 (0.471) -0.002 (0.805) -0.006 (0.117) -0.005 (0.040) Dependent variable: LC , β ( P ) a Vitamin C intake Low Reference Reference Reference Reference Reference Reference High -0.006 (0.020) -0.002 (0.275) -0.004 (0.909) -0.005 (0.355) -0.006 (0.010) -0.004 (0.032) Physical activity Mild/Light Reference Reference Reference Reference Reference Reference Moderate/Vigorous 0.001 (0.670) -0.002 (0.455) -0.007 (0.834) -0.008 (0.163) -0.002 (0.411) -0.002 (0.268) Physical activity + Vitamin C intake Mild/Light + Low Reference Reference Reference Reference Reference Reference Moderate/Vigorous + High -0.003 (0.364) -0.002 (0.354) -0.023 (0.554) -0.005 (0.425) -0.008 (0.002) -0.004 (0.021) Dependent variable: SII , β ( P ) a Vitamin C intake Low Reference Reference Reference Reference Reference Reference High -0.004 (0.342) -0.007 (0.006) 0.088 (0.114) -0.003 (0.736) -0.012 (0.006) -0.011 (0.001) Physical activity Mild/Light Reference Reference Reference Reference Reference Reference Moderate/Vigorous -0.008 (0.074) -0.003 (0.521) 0.001 (0.984) -0.005 (0.656) -0.009 (0.058) -0.003 (0.327) Physical activity + Vitamin C intake Mild/Light + Low Reference Reference Reference Reference Reference Reference Moderate/Vigorous + High -0.008 (0.093) -0.004 (0.296) 0.086 (0.160) -0.003 (0.771) -0.008 (0.109) -0.007 (0.044) Dependent variable: PLR , β ( P ) a Vitamin C intake Low Reference Reference Reference Reference Reference Reference High 0.004 (0.259) -0.001 (0.603) 0.029 (0.457) 0.001 (0.847) -0.001 (0.654) -0.002 (0.406) Physical activity Mild/Light Reference Reference Reference Reference Reference Reference Moderate/Vigorous -0.007 (0.034) 0.001 (0.634) 0.008 (0.830) 0.007 (0.347) -0.003 (0.314) 0.000 (0.857) Physical activity + Vitamin C intake Mild/Light + Low Reference Reference Reference Reference Reference Reference Moderate/Vigorous + High -0.003 (0.392) -0.001 (0.689) 0.045 (0.290) -0.001 (0.892) -0.002 (0.536) -0.002 (0.434) Dependent variable: NLR , β ( P ) a Vitamin C intake Low Reference Reference Reference Reference Reference Reference High -0.001 (0.779) -0.003 (0.269) 0.055 (0.284) 0.001 (0.949) -0.004 (0.270) -0.005 (0.054) Physical activity Mild/Light Reference Reference Reference Reference Reference Reference Moderate/Vigorous -0.002 (0.518) -0.002 (0.539) 0.000 (0.994) -0.002 (0.773) -0.003 (0.375) -0.001 (0.597) Physical activity + Vitamin C intake Mild/Light + Low Reference Reference Reference Reference Reference Reference Moderate/Vigorous + High -0.002 (0.579) -0.001 (0.776) 0.057 (0.318) 0.003 (0.737) 0.003 (0.509) 0.000 (0.882) Dependent variable: PPN , β ( P ) a Vitamin C intake Low Reference Reference Reference Reference Reference Reference High -0.011 (0.010) -0.010 (0.007) 0.085 (0.103) -0.009 (0.388) -0.019 (< 0.001) -0.015 (< 0.001) Physical activity Mild/Light Reference Reference Reference Reference Reference Reference Moderate/Vigorous -0.007 (0.107) -0.004 (0.246) -0.005 (0.916) -0.013 (0.213) -0.010 (0.018) -0.006 (0.087) Physical activity + Vitamin C intake Mild/Light + Low Reference Reference Reference Reference Reference Reference Moderate/Vigorous + High -0.011 (0.017) -0.006 (0.092) 0.064 (0.266) -0.008 (0.462) -0.016 (0.001) -0.011 (< 0.001) a Multivariable linear regression models accounted for key demographic and behavioral covariates, including age, sex, level of education, alcohol use, smoking behavior, body mass index (BMI), and the poverty income ratio (PIR). Statistically significant associations ( P < 0.05) are indicated in boldface. In the seronegative population ( n = 10,827), moderate to vigorous physical activity was modestly associated with reduced PC (β = − 0.006, P = 0.009) and PLR (β = − 0.007, P = 0.034), although associations with other markers were not statistically significant. Among pathogen-positive individuals, the associations of physical activity with inflammatory markers were generally weaker and less consistent. Joint exposure to high vitamin C intake and moderate/vigorous physical activity was more consistently associated with reduced inflammatory marker levels. In particular, participants seropositive for any pathogen who reported both high vitamin C intake and higher physical activity exhibited significantly lower SII (β = − 0.007, P = 0.044), PC (β = − 0.006, P < 0.001), and PPN (β = − 0.011, P < 0.001) compared with the low intake/low activity reference group. Associations in the HIV and HPV subgroups were less robust and generally nonsignificant, likely reflecting limited sample sizes. Collectively, these findings suggest that vitamin C intake and physical activity, particularly when combined, are associated with lower levels of systemic inflammation and related hematologic indices. Discussion In this nationally representative sample of U.S. adults, higher dietary vitamin C intake and moderate to vigorous physical activity were independently and jointly associated with lower levels of systemic immune-inflammation, as assessed by SII and related hematologic markers. Notably, these associations were most consistent and pronounced among individuals seropositive for HSV and those without evidence of chronic viral exposure. Our findings underscore the potential of modifiable lifestyle factors to mitigate chronic inflammation, even in the context of latent or persistent viral infection. The SII has emerged as a robust marker of immune system activation, integrating components of both the innate (neutrophils and platelets) and adaptive (lymphocytes) immune responses 32 – 36 . Elevated SII has been linked to adverse outcomes in cardiovascular disease, cancer, and all-cause mortality, even in community-based settings 37 – 39 . The observed inverse associations between vitamin C intake and SII—particularly in HSV-positive and seronegative individuals—support the anti-inflammatory role of this micronutrient. Mechanistically, vitamin C may reduce oxidative stress, stabilize neutrophil function, and preserve lymphocyte viability, thereby shifting the immune balance toward a less inflammatory phenotype 18 , 40 – 42 . Similarly, physical activity was modestly but significantly associated with lower levels of PC, PLR, and SII in seronegative individuals and those with HSV seropositivity. While these associations were weaker in pathogen-positive groups overall, the consistency of effects in HSV-positive individuals is notable, given the immunologic burden of herpesviruses. Exercise has been shown to reduce inflammatory cytokines, enhance regulatory immune cell function, and modulate hematologic parameters, including platelet activation and leukocyte distribution 43 – 46 . Our findings extend this evidence to a nationally representative infected population, suggesting that regular physical activity may partially offset chronic viral-driven immune activation. The biologic plausibility of our findings is supported by established immunologic mechanisms through which vitamin C and physical activity influence inflammatory tone and leukocyte dynamics. Vitamin C serves not only as a potent antioxidant but also plays critical roles in leukocyte trafficking, phagocytosis, and the regulation of cytokine production 41 , 47 . By scavenging reactive oxygen species (ROS), vitamin C limits NF-κB–dependent transcription of pro-inflammatory cytokines (e.g., IL-6, TNF-α), thus dampening chronic immune activation 48 – 51 . Physical activity, in turn, has been shown to activate the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system, both of which exert immunoregulatory effects 52 – 58 . Acute bouts of moderate exercise transiently increase circulating immune cells, while regular physical activity downregulates toll-like receptor expression on monocytes and reduces systemic IL-1β and CRP levels 46 , 59 . Exercise also upregulates anti-inflammatory cytokines such as IL-10 and promotes the expansion of regulatory T cells (Tregs), supporting a shift toward immune homeostasis 60 , 61 . In the context of chronic viral infections, such as HSV or hepatitis viruses, the immune system is often skewed toward persistent activation, with heightened neutrophil and platelet activity and reduced lymphocyte surveillance 22 , 62 – 65 . Our observation that vitamin C and physical activity ameliorated inflammation particularly in HSV-seropositive individuals suggests that these exposures may blunt virus-induced immune dysregulation. HSV latency is known to induce intermittent reactivation and low-level systemic immune engagement; thus, interventions that reduce oxidative stress and support lymphocyte resilience may be especially effective in this context. These mechanistic pathways offer a coherent framework for interpreting our epidemiologic findings and support the hypothesis that lifestyle factors can exert immunomodulatory effects even under conditions of latent viral challenge. The novelty of our study lies in its focus on infection-stratified populations—a frequently overlooked group in epidemiologic research on inflammation. Most prior studies have treated chronic viral exposure as a confounder or exclusion criterion, rather than an effect modifier. Yet persistent infections such as HSV, HPV, HIV, and hepatitis viruses are common in adults and may interact with nutritional and behavioral factors in shaping immune function 66 . By explicitly stratifying analyses by serostatus, we provide new insight into the heterogeneity of lifestyle-inflammation associations across immunologic contexts. Our findings also suggest that the joint effects of high vitamin C intake and moderate/vigorous physical activity may be more than additive. Individuals reporting both favorable exposures consistently exhibited lower SII, PC, NC, and PPN levels, especially in HSV-positive and seronegative groups. This convergence reinforces the hypothesis that combined lifestyle optimization may confer synergistic benefits in attenuating systemic inflammation 67 , 68 . Despite the strengths of our study—including its large, diverse sample and standardized data collection—several limitations merit consideration. First, the cross-sectional design precludes causal inference. Second, vitamin C intake and physical activity were based on self-report, which is subject to measurement error and recall bias. Third, serostatus does not reflect active viral replication or disease stage, and we cannot assess whether the observed associations differ by viral load or immune suppression. Finally, while we adjusted for key sociodemographic and behavioral confounders, residual confounding by unmeasured factors such as medication use or other dietary components cannot be ruled out. In conclusion, higher vitamin C intake and moderate to vigorous physical activity were independently and jointly associated with lower systemic immune-inflammation, particularly among HSV-seropositive and seronegative individuals. These findings support the relevance of lifestyle-based strategies in mitigating chronic inflammation, even in populations with latent viral exposure. Future longitudinal and mechanistic studies are warranted to clarify causality and inform targeted interventions in at-risk subgroups. Declarations Acknowledgments We thank the Director and staff of the Department of Clinical Laboratory, People's Hospital of Naxi District, for their valuable assistance and full support during the conduct of this study. Author contributions The authors’ responsibilities were as follows—Hongyin Zhou and Yonggang Hu contributed to data curation, formal analysis, writing – original draft, and project administration; Hui Zhang and Yaxin Huang were responsible for conceptualization, visualization and methodology. Hongyin Zhou, Hui Zhang and Yonggang Hu were responsible for funding acquisition and investigation. Yonggang Hu and Hongyin Zhou were responsible for supervision, validation and writing – review & editing. All authors declare that they have read and approved the final version of the manuscript. Funding This research was financially supported by the Luzhou City People's Hospital of Naxi District. The findings and conclusions presented in this article are solely those of the authors and do not necessarily reflect the official views of the Centers for Disease Control and Prevention (CDC) or the U.S. Department of Health and Human Services. No commercial sponsors were involved in the design of the study, data collection, data analysis, data interpretation, manuscript preparation, or the decision to submit the manuscript for publication. Conflict of interest The authors declare no competing interest. Consent for publication Not applicable. Ethics approval and consent to participate The National Health and Nutrition Examination Survey (NHANES) is conducted by the National Center for Health Statistics (NCHS) and has received approval from the NCHS Research Ethics Review Board. All participants provided written informed consent at the time of data collection. The present study utilized publicly available, de-identified NHANES data and was conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its subsequent revisions. As a secondary analysis of anonymized data, this study was deemed exempt from institutional review board (IRB) oversight. References Alur, İ. Low-Grade Inflammation: A Familiar Factor in Cardiovascular Diseases. JACC Basic Transl Sci 8 , 1475, doi:10.1016/j.jacbts.2023.09.010 (2023). Doi, T., Langsted, A. & Nordestgaard, B. G. Dual elevated remnant cholesterol and C-reactive protein in myocardial infarction, atherosclerotic cardiovascular disease, and mortality. Atherosclerosis 379 , 117141, doi:10.1016/j.atherosclerosis.2023.05.010 (2023). Alshuweishi, Y. et al. Platelet/High-Density Lipoprotein Ratio (PHR) Predicts Type 2 Diabetes in Obese Patients: A Retrospective Study. Healthcare (Basel) 12 , doi:10.3390/healthcare12151540 (2024). Laouali, N. et al. Dietary inflammatory index and type 2 diabetes risk in a prospective cohort of 70,991 women followed for 20 years: the mediating role of BMI. Diabetologia 62 , 2222-2232, doi:10.1007/s00125-019-04972-0 (2019). Stuart, C. M. et al. Mild Systemic Inflammation Increases Erythrocyte Fragility. Int. J. Mol. Sci. 25 , doi:10.3390/ijms25137027 (2024). Carpio-Orantes, L. D., García-Méndez, S. & Hernández-Hernández, S. N. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index in patients with COVID-19-associated pneumonia. Gac. Med. Mex. 156 , 527-531, doi:10.24875/gmm.M21000480 (2020). Zhong, Y., Zhong, L., Zhou, Y., Liao, Y. & Deng, J. Dynamic neutrophil-to-lymphocyte-platelet ratio trajectories predict 30-day and 1-year mortality in sepsis: a retrospective cohort study based on MIMIC-IV 2.2. BMC Infect. Dis. 25 , 594, doi:10.1186/s12879-025-10987-3 (2025). Liao, S. et al. Neutrophil-to-lymphocyte ratio-based prognostic score can predict outcomes in patients with advanced non-small cell lung cancer treated with immunotherapy plus chemotherapy. BMC Cancer 25 , 697, doi:10.1186/s12885-025-13811-y (2025). Sambataro, G. et al. The Model for Early COvid-19 Recognition (MECOR) Score: A Proof-of-Concept for a Simple and Low-Cost Tool to Recognize a Possible Viral Etiology in Community-Acquired Pneumonia Patients during COVID-19 Outbreak. Diagnostics (Basel) 10 , doi:10.3390/diagnostics10090619 (2020). Liu, Y. et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J. Infect. 81 , e6-e12, doi:10.1016/j.jinf.2020.04.002 (2020). Fois, A. G. et al. The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients. Molecules 25 , doi:10.3390/molecules25235725 (2020). Buonacera, A., Stancanelli, B., Colaci, M. & Malatino, L. Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. Int. J. Mol. Sci. 23 , doi:10.3390/ijms23073636 (2022). Ellulu, M. S., Rahmat, A., Patimah, I., Khaza'ai, H. & Abed, Y. Effect of vitamin C on inflammation and metabolic markers in hypertensive and/or diabetic obese adults: a randomized controlled trial. Drug Des. Devel. Ther. 9 , 3405-3412, doi:10.2147/dddt.S83144 (2015). Upritchard, J. E., Sutherland, W. H. & Mann, J. I. Effect of supplementation with tomato juice, vitamin E, and vitamin C on LDL oxidation and products of inflammatory activity in type 2 diabetes. Diabetes Care 23 , 733-738, doi:10.2337/diacare.23.6.733 (2000). Murer, S. B. et al. Antioxidant supplements reduced oxidative stress and stabilized liver function tests but did not reduce inflammation in a randomized controlled trial in obese children and adolescents. J. Nutr. 144 , 193-201, doi:10.3945/jn.113.185561 (2014). Popovic, L. M. et al. Influence of vitamin C supplementation on oxidative stress and neutrophil inflammatory response in acute and regular exercise. Oxid. Med. Cell. Longev. 2015 , 295497, doi:10.1155/2015/295497 (2015). Wawrzyniak-Gramacka, E. et al. The Association of Anti-Inflammatory Diet Ingredients and Lifestyle Exercise with Inflammaging. Nutrients 13 , doi:10.3390/nu13113696 (2021). Alberts, A., Moldoveanu, E. T., Niculescu, A. G. & Grumezescu, A. M. Vitamin C: A Comprehensive Review of Its Role in Health, Disease Prevention, and Therapeutic Potential. Molecules 30 , doi:10.3390/molecules30030748 (2025). Clemente-Suárez, V. J. et al. The Role of Adipokines in Health and Disease. Biomedicines 11 , doi:10.3390/biomedicines11051290 (2023). Taherkhani, S., Suzuki, K. & Castell, L. A Short Overview of Changes in Inflammatory Cytokines and Oxidative Stress in Response to Physical Activity and Antioxidant Supplementation. Antioxidants (Basel) 9 , doi:10.3390/antiox9090886 (2020). Moldoveanu, A. I., Shephard, R. J. & Shek, P. N. The cytokine response to physical activity and training. Sports Med. 31 , 115-144, doi:10.2165/00007256-200131020-00004 (2001). Zuniga, E. I., Macal, M., Lewis, G. M. & Harker, J. A. Innate and Adaptive Immune Regulation During Chronic Viral Infections. Annu Rev Virol 2 , 573-597, doi:10.1146/annurev-virology-100114-055226 (2015). Quirino, A. et al. Viral Hepatitis: Host Immune Interaction, Pathogenesis and New Therapeutic Strategies. Pathogens 13 , doi:10.3390/pathogens13090766 (2024). Wilson, E. M. & Sereti, I. Immune restoration after antiretroviral therapy: the pitfalls of hasty or incomplete repairs. Immunol. Rev. 254 , 343-354, doi:10.1111/imr.12064 (2013). Brüggemann, Y., Klöhn, M., Wedemeyer, H. & Steinmann, E. Hepatitis E virus: from innate sensing to adaptive immune responses. Nat. Rev. Gastroenterol. Hepatol. 21 , 710-725, doi:10.1038/s41575-024-00950-z (2024). Belk, J. A., Daniel, B. & Satpathy, A. T. Epigenetic regulation of T cell exhaustion. Nat. Immunol. 23 , 848-860, doi:10.1038/s41590-022-01224-z (2022). Abdel-Hakeem, M. S. et al. Epigenetic scarring of exhausted T cells hinders memory differentiation upon eliminating chronic antigenic stimulation. Nat. Immunol. 22 , 1008-1019, doi:10.1038/s41590-021-00975-5 (2021). Pascutti, M. F., Erkelens, M. N. & Nolte, M. A. Impact of Viral Infections on Hematopoiesis: From Beneficial to Detrimental Effects on Bone Marrow Output. Front. Immunol. 7 , 364, doi:10.3389/fimmu.2016.00364 (2016). Faist, A. et al. Virus Infection and Systemic Inflammation: Lessons Learnt from COVID-19 and Beyond. Cells 11 , doi:10.3390/cells11142198 (2022). Hu, B. et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin. Cancer Res. 20 , 6212-6222, doi:10.1158/1078-0432.Ccr-14-0442 (2014). Qin, Z. et al. Systemic Immune-Inflammation Index Is Associated With Increased Urinary Albumin Excretion: A Population-Based Study. Front. Immunol. 13 , 863640, doi:10.3389/fimmu.2022.863640 (2022). Nascimento, M. A. L., Ferreira, L. G. R., Alves, T. V. G. & Rios, D. R. A. Inflammatory Hematological Indices, Cardiovascular Disease and Mortality: A Narrative Review. Arq. Bras. Cardiol. 121 , e20230752, doi:10.36660/abc.20230752 (2024). Yan, Q. et al. Systemic immune-inflammation index (SII): A More Promising Inflammation-Based Prognostic Marker for Patients with synchronic colorectal peritoneal carcinomatosis. J. Cancer 11 , 5264-5272, doi:10.7150/jca.46446 (2020). Okutan, İ., Aci, R., Keskin, Â., Bilgin, M. & Kızılet, H. New inflammatory markers associated with disease activity in rheumatoid arthritis: pan-immune-inflammation value, systemic immune-inflammation index, and systemic inflammation response index. Reumatologia 62 , 439-446, doi:10.5114/reum/196066 (2024). Dervisevic, A. et al. Systemic Immune-inflammation Index in Evaluation of Inflammation in Rheumatoid Arthritis Patients. Medeni Med J 39 , 183-191, doi:10.4274/MMJ.galenos.2024.60533 (2024). Jiang, Y. et al. Associations between folate intake, serum folate, and stroke risk: The mediating role of dietary inflammatory index from NHANES 2007-2018. J. Stroke Cerebrovasc. Dis. 34 , 108318, doi:10.1016/j.jstrokecerebrovasdis.2025.108318 (2025). Wang, H., Nie, H., Bu, G., Tong, X. & Bai, X. Systemic immune-inflammation index (SII) and the risk of all-cause, cardiovascular, and cardio-cerebrovascular mortality in the general population. Eur. J. Med. Res. 28 , 575, doi:10.1186/s40001-023-01529-1 (2023). Uzun, M., Gokcek, S., Kaya, E. & Semiz, H. S. The prognostic role of systemic immune-inflammation index, SII, in Metastatic Castration-Resistant Prostate Cancer patients. Discov Oncol 16 , 317, doi:10.1007/s12672-025-02084-3 (2025). Li, C. X. et al. Pan-immune-inflammatory value and systemic immune-inflammatory index in relation to osteoradionecrosis of the jaws: a single institutional experience over 15 years. Odontology , doi:10.1007/s10266-025-01101-9 (2025). Liugan, M. & Carr, A. C. Vitamin C and Neutrophil Function: Findings from Randomized Controlled Trials. Nutrients 11 , doi:10.3390/nu11092102 (2019). Mousavi, S., Bereswill, S. & Heimesaat, M. M. Immunomodulatory and Antimicrobial Effects of Vitamin C. Eur. J. Microbiol. Immunol. (Bp) 9 , 73-79, doi:10.1556/1886.2019.00016 (2019). De la Fuente, M. et al. Vitamin C and vitamin C plus E improve the immune function in the elderly. Exp. Gerontol. 142 , 111118, doi:10.1016/j.exger.2020.111118 (2020). Guo, L. et al. Associations of lifestyle characteristics with circulating immune markers in the general population based on NHANES 1999 to 2014. Sci. Rep. 14 , 13444, doi:10.1038/s41598-024-63875-2 (2024). Kohut, M. L., Thompson, J. R., Lee, W. & Cunnick, J. E. Exercise training-induced adaptations of immune response are mediated by beta-adrenergic receptors in aged but not young mice. J Appl Physiol (1985) 96 , 1312-1322, doi:10.1152/japplphysiol.00792.2003 (2004). Lin, D. et al. Associations Between Leisure-Time Physical Activity Level and Peripheral Immune Cell Populations in the US General Population, Analysis of the National Health and Nutrition Examination Survey Data, 1999-2018. Sports Med Open 9 , 101, doi:10.1186/s40798-023-00643-y (2023). Cerqueira, É., Marinho, D. A., Neiva, H. P. & Lourenço, O. Inflammatory Effects of High and Moderate Intensity Exercise-A Systematic Review. Front. Physiol. 10 , 1550, doi:10.3389/fphys.2019.01550 (2019). Tan, Y. et al. Vitamin B12, Folate, Homocysteine, Inflammatory Mediators (Interleukin-6, Tumor Necrosis Factor-α and C-Reactive Protein) Levels in Adolescents with Anxiety or Depressive Symptoms. Neuropsychiatr. Dis. Treat. 19 , 785-800, doi:10.2147/ndt.S399378 (2023). Dragičević Tomičić, D. et al. Effects of Vitamin D, Melatonin, and Omega-3 Fatty Acids on Periodontal Health: A Narrative Review. Dent J (Basel) 13 , doi:10.3390/dj13040178 (2025). Choi, S., Lee, J., Park, J. H. & Kim, G. Inhibitory effects of AptaminC320 targeting vitamin C on LPS-induced inflammation in RAW264.7 cells. Biochem Biophys Rep 41 , 101951, doi:10.1016/j.bbrep.2025.101951 (2025). Kumar, S. et al. The Interplay of Oxidative Stress and ROS Scavenging: Antioxidants as a Therapeutic Potential in Sepsis. Vaccines (Basel) 10 , doi:10.3390/vaccines10101575 (2022). Liu, Z. et al. Role of ROS and Nutritional Antioxidants in Human Diseases. Front. Physiol. 9 , 477, doi:10.3389/fphys.2018.00477 (2018). Taddei, S., Virdis, A., Ghiadoni, L., Magagna, A. & Salvetti, A. Vitamin C improves endothelium-dependent vasodilation by restoring nitric oxide activity in essential hypertension. Circulation 97 , 2222-2229, doi:10.1161/01.cir.97.22.2222 (1998). Han, M. et al. Ascorbate protects endothelial barrier function during septic insult: Role of protein phosphatase type 2A. Free Radic. Biol. Med. 48 , 128-135, doi:10.1016/j.freeradbiomed.2009.10.034 (2010). Cárcamo, J. M., Pedraza, A., Bórquez-Ojeda, O. & Golde, D. W. Vitamin C suppresses TNF alpha-induced NF kappa B activation by inhibiting I kappa B alpha phosphorylation. Biochemistry 41 , 12995-13002, doi:10.1021/bi0263210 (2002). Haendeler, J., Zeiher, A. M. & Dimmeler, S. Vitamin C and E prevent lipopolysaccharide-induced apoptosis in human endothelial cells by modulation of Bcl-2 and Bax. Eur. J. Pharmacol. 317 , 407-411, doi:10.1016/s0014-2999(96)00759-5 (1996). Utoguchi, N. et al. Ascorbic acid stimulates barrier function of cultured endothelial cell monolayer. J. Cell. Physiol. 163 , 393-399, doi:10.1002/jcp.1041630219 (1995). Mohammed, B. M. et al. Vitamin C: a novel regulator of neutrophil extracellular trap formation. Nutrients 5 , 3131-3151, doi:10.3390/nu5083131 (2013). Agus, D. B. et al. Vitamin C crosses the blood-brain barrier in the oxidized form through the glucose transporters. J. Clin. Invest. 100 , 2842-2848, doi:10.1172/jci119832 (1997). Li, P. & Luo, L. Identification of Critical Genes and Signaling Pathways in Human Monocytes Following High-Intensity Exercise. Healthcare (Basel) 9 , doi:10.3390/healthcare9060618 (2021). Ogbutor, U. G. et al. Proinflammatory and Anti-inflammatory Cytokine Response to Isometric Handgrip Exercise and the Effects of Duration and Intensity of the Isometric Efforts in Prehypertensive Participants. J. Chiropr. Med. 21 , 177-186, doi:10.1016/j.jcm.2022.05.002 (2022). Ye, X. & Liu, R. Exercise-induced cytosolic calcium oscillations: mechanisms and modulation of T-cell function. Biochem. Biophys. Res. Commun. 748 , 151321, doi:10.1016/j.bbrc.2025.151321 (2025). Borkow, G. & Bentwich, Z. Chronic immune activation associated with chronic helminthic and human immunodeficiency virus infections: role of hyporesponsiveness and anergy. Clin. Microbiol. Rev. 17 , 1012-1030, table of contents, doi:10.1128/cmr.17.4.1012-1030.2004 (2004). Barbian, H. J. et al. Effective treatment of SIVcpz-induced immunodeficiency in a captive western chimpanzee. Retrovirology 14 , 35, doi:10.1186/s12977-017-0359-0 (2017). D'Atri, L. P. et al. Expression and functionality of Toll-like receptor 3 in the megakaryocytic lineage. J. Thromb. Haemost. 13 , 839-850, doi:10.1111/jth.12842 (2015). Leng, Q. et al. Immune activation correlates better than HIV plasma viral load with CD4 T-cell decline during HIV infection. J. Acquir. Immune Defic. Syndr. 27 , 389-397, doi:10.1097/00126334-200108010-00010 (2001). Wróblewska, J., Złocińska, H., Wróblewski, M., Nuszkiewicz, J. & Woźniak, A. The Role of Vitamins in Pediatric Urinary Tract Infection: Mechanisms and Integrative Strategies. Biomolecules 15 , doi:10.3390/biom15040566 (2025). van 't Klooster, C. C. et al. The relation between healthy lifestyle changes and decrease in systemic inflammation in patients with stable cardiovascular disease. Atherosclerosis 301 , 37-43, doi:10.1016/j.atherosclerosis.2020.03.022 (2020). Hodel, F. et al. The combined impact of persistent infections and human genetic variation on C-reactive protein levels. BMC Med. 20 , 416, doi:10.1186/s12916-022-02607-7 (2022). Additional Declarations No competing interests reported. Supplementary Files 1.regressionresultsnoexposureanyVC.csv 2.regressionresultsnoexposureanyPA.csv 3.regressionresultsnoexposureanyVCPA.csv 4.regressionresultsexposurehvVC.csv 5.regressionresultsexposurehvPA.csv 6.regressionresultsexposurehvVCPA.csv 7.regressionresultsexposurehivVC.csv 8.regressionresultsexposurehivPA.csv 9.regressionresultsexposurehivVCPA.csv 10.regressionresultsexposurehpvVC.csv 11.regressionresultsexposurehpvPA.csv 12.regressionresultsexposurehpvVCPA.csv 13.regressionresultsexposurehsvVC.csv 14.regressionresultsexposurehsvPA.csv 15.regressionresultsexposurehsvVCPA.csv 16.regressionresultsexposureanyVC.csv 17.regressionresultsexposureanyPA.csv 18.regressionresultsexposureanyVCPA.csv Rawdata.xlsx Figure2results.xls Figure3results.xls Figure4results.xls Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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05:04:48","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54827,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of study participants selection.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6641016/v1/1a94b68c68bab7c19a87213f.jpg"},{"id":82576369,"identity":"d0e60424-a201-42ef-b1fd-a9537deb9b29","added_by":"auto","created_at":"2025-05-13 05:36:48","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":156234,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences in Inflammatory Biomarkers Between Low and High Vitamin C Intake Groups Across Subpopulations with Varying Pathogen Exposure\u003cbr\u003e\n \u003cem\u003e(A) Helicobacter pylori (Hp); (B) Human Immunodeficiency Virus (HIV); (C) Human Papillomavirus (HPV); (D) Herpes Simplex Virus (HSV); (E) Seropositive to Any Infectious Pathogen; (F) Seronegative Individuals.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6641016/v1/7c69fedf79168a1b8101ac1a.jpg"},{"id":82576045,"identity":"731a87ec-8bc7-4ac2-be98-77f2f39cfe25","added_by":"auto","created_at":"2025-05-13 05:28:48","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":200763,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences in Inflammatory Biomarkers Between Mild/Light and Moderate/Vigorous Physical Activity Levels Across Subpopulations with Varying Pathogen Exposure\u003cbr\u003e\n \u003cem\u003e(A) Helicobacter pylori (Hp); (B) Human Immunodeficiency Virus (HIV); (C) Human Papillomavirus (HPV); (D) Herpes Simplex Virus (HSV); (E) Seropositive to Any Infectious Pathogen; (F) Seronegative Individuals.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6641016/v1/e72c4fc7d8d8e7a92afd8a49.jpg"},{"id":82574099,"identity":"4e7d7001-2d50-4f2e-b538-56b5d335c2a9","added_by":"auto","created_at":"2025-05-13 05:04:48","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":210549,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences in Inflammatory Biomarkers Between Combined Exposure Groups: Low Vitamin C Intake with Mild/Light Physical Activity vs. High Vitamin C Intake with Moderate/Vigorous Physical Activity, Stratified by Pathogen Serostatus\u003cbr\u003e\n \u003cem\u003e(A) Helicobacter pylori (Hp); (B) Human Immunodeficiency Virus (HIV); (C) Human Papillomavirus (HPV); (D) Herpes Simplex Virus (HSV); (E) Seropositive to Any Infectious Pathogen; (F) Seronegative Individuals.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6641016/v1/6c553b98cdfb59cc58636d5c.jpg"},{"id":83462798,"identity":"3a9a2ec0-08ba-4cfd-b672-e18215c6ed44","added_by":"auto","created_at":"2025-05-26 17:16:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3565345,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6641016/v1/3551058c-dd91-424c-bfee-d813ab86dc0f.pdf"},{"id":82576044,"identity":"431c6fad-09e7-428b-949e-f98303505e8f","added_by":"auto","created_at":"2025-05-13 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05:04:49","extension":"xls","order_by":21,"title":"","display":"","copyAsset":false,"role":"supplement","size":26112,"visible":true,"origin":"","legend":"","description":"","filename":"Figure3results.xls","url":"https://assets-eu.researchsquare.com/files/rs-6641016/v1/78091673b017d3dd6a2729d1.xls"},{"id":82574137,"identity":"926653f7-9b3e-4f17-8276-5770e2a80bc6","added_by":"auto","created_at":"2025-05-13 05:04:49","extension":"xls","order_by":22,"title":"","display":"","copyAsset":false,"role":"supplement","size":26112,"visible":true,"origin":"","legend":"","description":"","filename":"Figure4results.xls","url":"https://assets-eu.researchsquare.com/files/rs-6641016/v1/d8a5805081193eed9868ca8d.xls"}],"financialInterests":"No competing interests reported.","formattedTitle":"Can Vitamin C Intake and Physical Activity Individually and Jointly Lower Inflammation in Chronically Infected Populations? Insights from NHANES 2005–2018","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic low-grade inflammation plays a central role in the development and progression of numerous noncommunicable diseases, including cardiovascular disease, diabetes, cancer, and neurodegeneration \u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. In recent years, hematologic biomarkers derived from routine complete blood counts\u0026mdash;such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and particularly the systemic immune-inflammation index (SII)\u0026mdash;have emerged as accessible, integrative markers of systemic immune activation \u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. These indices reflect the dynamic balance between innate and adaptive immunity, and higher values have been consistently linked with increased morbidity and mortality in both clinical and community settings \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eModifiable lifestyle factors such as diet and physical activity have been widely studied as potential modulators of systemic inflammation. Vitamin C, a potent dietary antioxidant and cofactor in multiple immune processes, has been shown to attenuate oxidative stress and inflammatory signaling \u003csup\u003e\u003cspan additionalcitationids=\"CR14 CR15 CR16 CR17\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Regular physical activity is similarly associated with reduced levels of proinflammatory cytokines and improved leukocyte function through mechanisms involving adipokine modulation, reduced visceral adiposity, and neuroendocrine regulation \u003csup\u003e\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. While each of these factors has been independently linked to inflammatory outcomes, limited evidence exists on their combined effect\u0026mdash;and, critically, whether such associations are consistent across individuals with varying infectious exposures.\u003c/p\u003e \u003cp\u003eChronic or latent viral infections, such as those caused by hepatitis viruses (HAV, HBV, HCV, HDV, HEV), human papillomavirus (HPV), herpes simplex virus (HSV), and human immunodeficiency virus (HIV), are highly prevalent in adult populations and are known to induce sustained immune perturbations, even in the absence of overt disease \u003csup\u003e\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. These infections may alter leukocyte distribution and amplify systemic inflammation through persistent antigenic stimulation, immune exhaustion, and epigenetic remodeling \u003csup\u003e\u003cspan additionalcitationids=\"CR27 CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. However, individuals harboring these infections have been largely overlooked in studies linking lifestyle exposures to inflammatory status.\u003c/p\u003e \u003cp\u003eTo address this gap, we conducted a cross-sectional analysis of 33,590 U.S. adults participating in the National Health and Nutrition Examination Survey (NHANES) from 2005 through 2018. Our aim was to evaluate the independent and joint associations of dietary vitamin C intake and physical activity with multiple systemic inflammatory markers, including SII, PLR, NLR, and their component cell counts. Uniquely, we stratified all analyses by serostatus to four major classes of infectious pathogens to assess whether the associations differed in the context of chronic viral exposure. By integrating nationally representative data on diet, behavior, immunity, and infection, this study offers novel insights into modifiable determinants of systemic immune-inflammation across both healthy and immunologically vulnerable populations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Sample Selection\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional analysis using data from adults participating in the NHANES from 2005 through 2018 to investigate associations between vitamin C intake, physical activity, and systemic immune-inflammation. NHANES is a nationally representative survey of the U.S. population that employs a complex, stratified, multistage probability sampling design and includes both interviews and physical examinations. Detailed information is publicly available from the Centers for Disease Control and Prevention (CDC) (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/nchs/nhanes/index.htm\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/nchs/nhanes/index.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA total of 70,427 participants were initially enrolled. We excluded 25,332 individuals who were not adults, 214 with missing data on physical activity, 9,786 without vitamin C intake data, and 1,505 without SII values, resulting in 33,590 eligible adult participants (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among them, subgroups were identified based on seropositivity to various infectious pathogens, including hepatitis viruses (HAV, HBV, HCV, HDV, HEV; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16,544), human immunodeficiency virus (HIV; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;82), human papillomavirus (HPV; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2,200), and herpes simplex virus (HSV; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10,306). All data collection was conducted by the CDC with informed consent obtained from participants under protocols approved by the National Center for Health Statistics Ethics Review Board.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment of Vitamin C Intake\u003c/h3\u003e\n\u003cp\u003eThe primary exposure of interest in this study was dietary vitamin C intake, assessed through two 24-hour dietary recalls conducted as part of NHANES. The first dietary recall was administered in person at a mobile examination center, and the second was conducted by telephone 3 to 10 days later. The average daily intake of vitamin C was calculated based on data from both recalls, using the Food and Nutrient Database for Dietary Studies (FNDDS) developed by the United States Department of Agriculture (USDA).\u003c/p\u003e\n\u003ch3\u003eAssessment of Physical Activity\u003c/h3\u003e\n\u003cp\u003ePhysical activity was assessed using self-reported data collected through standardized physical activity questionnaires administered during the NHANES interview. Participants were asked to report the frequency and duration of moderate and vigorous physical activities performed during a typical week, including both recreational and transportation-related activities. Based on established NHANES coding protocols, physical activity levels were classified into two categories: mild/light and moderate/vigorous. This classification reflected both the intensity and duration of reported activity, in accordance with national physical activity guidelines.\u003c/p\u003e\n\u003ch3\u003eAssessment of Seropositivity to Infectious Pathogens\u003c/h3\u003e\n\u003cp\u003eWe included viruses that were consistently assessed across multiple NHANES cycles from 2005 to 2018 to ensure sufficient sample size and statistical power. Viruses evaluated in only a single cycle, such as cytomegalovirus (CMV), were excluded due to limited data availability. Seropositivity to HAV, HBV, HCV, HDV, and HEV was determined using a solid-phase competitive immunoassay. HIV antibodies were detected using a synthetic peptide enzyme immunoassay (Bio-Rad Laboratories, Redmond, WA). For HPV, purified DNA was analyzed using multiplex polymerase chain reaction (PCR). Seropositivity to herpes simplex virus types 1 and 2 (HSV-1, HSV-2) was assessed with a solid-phase enzymatic immunoassay. Detailed descriptions of the laboratory procedures are available on the NHANES website.\u003c/p\u003e\n\u003ch3\u003eMeasurement of Immunoinflammatory Indices\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was the SII, calculated as platelet count (PC) \u0026times; neutrophil count (NC) / lymphocyte count (LC), based on values obtained from the complete blood count \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. All hematologic parameters were measured in units of 1,000 cells/mL, following standardized laboratory protocols available on the NHANES website. Secondary outcomes included other inflammatory biomarkers derived from the same components: PLR, NLR, PPN, as well as PC, NC, and LC individually. To comprehensively evaluate the associations between nutrient intake and systemic inflammation, we examined both SII and these related markers in dose\u0026ndash;response analyses.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of Covariates\u003c/h2\u003e \u003cp\u003eThe data collected by the NHANES personnel during the household interview included information on the age, sex, poverty income ratio (PIR), education attainment, alcohol consumption, cigarette-smoking status, and body mass index (BMI) of the participants. The age of the participant was calculated in years at the time of screening (variable name prefix RIDAGEYR). Sex was categorized by NHANES personnel as either male or female (variable name prefix RIAGENDR). PIR was defined as the ratio of family income to poverty guidelines (variable name prefix INDFMPIR). The education level was determined by the question (variable name prefix DMDEDUC2). The question posed was as follows: \"Please indicate the highest grade or level of school you have completed or the highest degree you have received.\" The Alcohol Use Questionnaire (variable name prefix ALQ) focused on both lifetime and current use (past 12 months). The questions do not distinguish between the types of alcohol consumed. For adults aged 18 years or older, the Cigarette Use Questionnaire (variable name prefix SMQ) was administered in the home by trained interviewers utilizing the Computer Assisted Personal Interview (CAPI) system. The BMI was collected, in the Mobile Examination Center (MEC), by trained health technicians. The health technician was assisted by a recorder during the body measures examination.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003e All analyses were performed in accordance with the NHANES analytic guidelines, incorporating appropriate sampling weights to account for the complex, multistage, stratified survey design, thereby ensuring nationally representative estimates of the U.S. adult population. Descriptive statistics were presented as means with standard deviations (SD) for continuous variables and as frequencies with percentages for categorical variables. Group comparisons were conducted using two-sample t-tests.\u003c/p\u003e \u003cp\u003eTo evaluate the associations between vitamin C intake, physical activity, and inflammatory markers, multivariable linear regression models were applied, adjusting for total energy intake, age, sex, PIR, educational attainment, alcohol consumption, smoking status, and BMI. Missing covariate data (excluding exposure and outcome variables) were addressed using random forest-based multiple imputation techniques.\u003c/p\u003e \u003cp\u003eStatistical significance was defined as a two-sided \u003cem\u003eP\u003c/em\u003e-value less than 0.05. Analyses were conducted using SAS software, version 9.4 (SAS Institute, Cary, NC, USA), and R software, version 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy population characteristics\u003c/h2\u003e \u003cp\u003eA total of 33,590 adult participants aged 20 years or older were included in the final analytic sample. Baseline characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, stratified by serostatus for various infectious pathogens. Among these participants, 10,827 were seronegative, and 22,763 were seropositive for at least one pathogen. Subgroups included those seropositive for hepatitis viruses (HAV, HBV, HCV, HDV, or HEV; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16,544), HIV (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;82), HPV (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2,200), and HSV (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10,306).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of the Study Population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeronegative individuals \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003eSeropositivity to infectious pathogens \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;10,827\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHepatitis\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;16,544\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHIV\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;82\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHPV\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;2,200\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHSV\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;10,306\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAny pathogens\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;22,763\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, years, mean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52.07 (17.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.01 (18.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40.38 (9.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e39.98 (11.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e35.60 (8.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e48.34 (17.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePIR, mean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.90 (1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.30 (1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.97 (1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.29 (1.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.25 (1.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.34 (1.58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI, kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e, \u003cb\u003emean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.68 (0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.65 (0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.45 (0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.68 (0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.68 (0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.66 (0.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSII, mean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.38 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.37 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.34 (0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.41 (0.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.40 (0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.38 (0.12)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePC, mean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.61 (0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.60 (0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.41 (0.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.62 (0.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.62 (0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.61 (0.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNC, mean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.32 (0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.33 (0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.30 (0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.35 (0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.36 (0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.34 (0.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLC, mean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.08 (0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.06 (0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.06 (0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.07 (0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.07 (0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.07 (0.16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePLR, mean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.33 (0.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.31 (0.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.15 (0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.30 (0.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.30 (0.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.31 (0.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNLR, mean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.98 (0.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.96 (0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.73 (0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.02 (0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.01 (0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.98 (0.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePPN, mean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52.07 (17.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.01 (18.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40.38 (9.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e39.98 (11.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e35.60 (8.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e48.34 (17.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,283 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,443 (51.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,524 (69.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5,712 (55.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e12,033 (52.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,544 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,101 (49.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e64 (78.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e676 (30.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4,594 (44.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10,730 (47.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation, n (%)\u003c/b\u003e \u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le; High school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6,806 (62.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,277 (44.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44 (53.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,086 (49.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5,108 (49.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10,822 (47.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,021 (37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9,267 (56.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,114 (50.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5,198 (50.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e11,941 (52.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrinking, n (%)\u003c/b\u003e \u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,941 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,997 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e529 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2,822 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e7,378 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7,886 (72.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10,547 (63.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69 (84.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,671 (76.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7,484 (72.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15,385 (67.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking, n (%)\u003c/b\u003e \u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,662 (52.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9,742 (58.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,067 (48.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6,047 (58.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e12,949 (56.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,165 (47.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6,802 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44 (53.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,133 (51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4,259 (41.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e9,814 (43.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitamin C intake, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,503 (50.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,830 (47.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36 (43.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,147 (52.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5,306 (51.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e11,292 (49.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,324 (49.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,714 (52.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46 (56.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,053 (47.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5,000 (48.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e11,471 (50.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6,561 (60.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11,290 (68.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e46 (56.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,369 (62.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6,413 (62.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e14,999 (65.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,266 (39.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,254 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36 (43.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e831 (37.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3,893 (37.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e7,764 (34.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u0026thinsp;+\u0026thinsp;Vitamin C intake, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u0026thinsp;+\u0026thinsp;Low\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,306 (30.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,357 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e717 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3,273 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e7,417 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u0026thinsp;+\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7,521 (69.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11,187 (67.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60 (73.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,483 (67.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7,033 (68.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15,346 (67.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e Data shown are either frequency (%) or mean (SD).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e Missing values were imputed with random forest imputation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eAbbreviations: BMI, body mass index; HIV, human immunodeficiency virus; HPV, human papillomavirus; HSV, herpes simplex virus; LC, lymphocyte count; NC, neutrophil count; NLR, neutrophil-to-lymphocyte ratio; PC, plate count; PIR, poverty income ratio; PLR, platelet-to-lymphocyte ratio; PPN, the product of platelet and neutrophil count; SD, standard deviation; SII, systemic immune-inflammation index.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean age ranged from 35.6 years in the HPV group to 53.0 years in the hepatitis group. Participants seropositive for any pathogen tended to have lower socioeconomic status, as indicated by lower poverty income ratios (mean PIR: 2.34 vs. 2.90 in seronegative individuals), and a slightly lower proportion of participants with a college education or higher (52.5% vs. 62.9%). The mean SII was generally comparable across groups, with values ranging from 2.34 to 2.41. Similar patterns were observed for related biomarkers, including PC, NC, LC, PLR, NLR, and PPN.\u003c/p\u003e \u003cp\u003eSex distribution varied substantially by infection type. For example, 78.0% of the HIV-seropositive group were women, whereas the majority of HPV-positive participants were men (69.3%). Lifestyle factors also differed: current smoking was more prevalent among pathogen-positive individuals (e.g., 58.7% in the HSV group vs. 52.3% among seronegative participants), while alcohol use was less common among those with HIV (15.9%) compared to other groups.\u003c/p\u003e \u003cp\u003eRegarding exposure variables, low vitamin C intake was reported in approximately half of the study population, with minimal variation across groups. Mild or light physical activity was more common than moderate or vigorous activity, particularly among participants seropositive for hepatitis (68.2%). In joint exposure categories, approximately two-thirds of participants in all groups fell into the favorable category of high vitamin C intake and moderate/vigorous physical activity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDifferences in Inflammatory Biomarkers by Vitamin C Intake Across Pathogen Exposure Subgroups\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates differences in inflammatory biomarkers between participants with low and high vitamin C intake across subgroups defined by seropositivity to infectious pathogens.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAmong participants seropositive for hepatitis viruses (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16,544), higher vitamin C intake was significantly associated with lower levels of LC, NC, PC, PPN, and SII (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), whereas no significant differences were observed for PLR and NLR.\u003c/p\u003e \u003cp\u003eIn the HSV subgroup (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10,306), participants with higher vitamin C intake had significantly lower LC, NC, PC, NLR, PPN, and SII values compared with those with lower intake (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all), with the most pronounced difference observed for PPN (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;1\u0026times;10⁻⁹). Similar but slightly weaker patterns were observed in the HPV subgroup (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2,200), where higher vitamin C intake was associated with reduced LC, NC, and PPN (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), although differences in SII and other markers were not statistically significant.\u003c/p\u003e \u003cp\u003eAmong individuals seropositive for any of the evaluated pathogens (HPV, HIV, HSV, hepatitis; \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;22,763), high vitamin C intake was consistently associated with lower levels of NC, LC, PC, NLR, PPN, and SII (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating a broadly inverse relationship between vitamin C intake and systemic immune-inflammation in infected populations.\u003c/p\u003e \u003cp\u003eIn contrast, among HIV-positive participants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;82), no statistically significant differences in biomarker levels were observed between intake groups, likely due to the small sample size and limited statistical power.\u003c/p\u003e \u003cp\u003eAmong seronegative individuals (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10,827), similar inverse associations were observed for LC, NC, PC, and PPN (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 for all), although SII and NLR values did not differ significantly between the vitamin C intake groups.\u003c/p\u003e \u003cp\u003eOverall, the findings suggest that higher dietary vitamin C intake is associated with lower systemic inflammation, particularly among individuals with viral infections, with the most consistent differences observed in innate immune markers such as neutrophil count and PPN.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDifferences in Inflammatory Biomarkers by Physical Activity Levels Across Pathogen Exposure Subgroups\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrates the associations between physical activity levels and systemic inflammatory markers across pathogen exposure subgroups. Significant differences by activity level were observed primarily in seronegative individuals and those seropositive for HSV.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn seronegative participants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10,827), moderate to vigorous physical activity was associated with lower PC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006), PLR (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and SII (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006), along with a modest increase in LC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027).\u003c/p\u003e \u003cp\u003eAmong participants seropositive for HSV (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10,306), those engaging in moderate/vigorous physical activity had significantly lower PC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), PLR (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), PPN (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and SII (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), suggesting a beneficial immune-inflammatory profile associated with greater activity.\u003c/p\u003e \u003cp\u003eIn contrast, no statistically significant differences in inflammatory markers were observed between activity groups in the hepatitis, HIV, or HPV subpopulations, nor in the overall virus-positive group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;22,763), potentially due to heterogeneity in infection status and smaller subgroup sizes.\u003c/p\u003e \u003cp\u003eThese findings suggest that the anti-inflammatory effects of physical activity may be more prominent in individuals without chronic viral exposure or in those infected with HSV, particularly in relation to platelet- and neutrophil-related indices.\u003c/p\u003e \u003cp\u003e \u003cem\u003eCombined Effects of Vitamin C Intake and Physical Activity on Inflammatory Biomarkers Across Pathogen Exposure Subgroups\u003c/em\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e depicts the differences in systemic inflammatory markers between individuals with low vitamin C intake and mild/light physical activity versus those with high vitamin C intake and moderate/vigorous physical activity, stratified by serostatus.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAmong participants seropositive for HSV (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10,306), the combined high-exposure group demonstrated significantly lower levels of PC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), NC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), PPN (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and SII (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), as well as a modest reduction in LC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIn the overall virus-positive group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;22,763), individuals with high vitamin C intake and moderate/vigorous physical activity had significantly lower NC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), PC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), PPN (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and SII (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), along with a small but significant decrease in LC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015), compared with the reference group.\u003c/p\u003e \u003cp\u003eAmong seronegative participants (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10,827), similar patterns were observed, with significantly lower PC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), NC (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020), PPN (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and SII (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020) in the high-exposure group.\u003c/p\u003e \u003cp\u003eIn contrast, no statistically significant differences were observed in the HPV subgroup (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2,200), although a trend toward lower inflammatory marker levels was noted. Data for the HIV subgroup were limited and not presented due to small sample size.\u003c/p\u003e \u003cp\u003eThese results suggest that the combination of high vitamin C intake and greater physical activity is associated with a more favorable inflammatory profile, particularly among HSV-seropositive and seronegative individuals, with the most consistent reductions observed in neutrophil-related and platelet-based indices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAssociations Between Vitamin C Intake, Physical Activity, and Inflammatory Biomarkers\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the associations of vitamin C intake, physical activity, and their joint effects with seven inflammatory biomarkers, stratified by pathogen serostatus. Among individuals seropositive for any infectious pathogen (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;22,763), higher vitamin C intake was significantly associated with lower levels of PC, NC, LC, SII, and PPN, with β estimates ranging from \u0026minus;\u0026thinsp;0.004 to \u0026minus;\u0026thinsp;0.015 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations of Vitamin C Intake, Physical Activity, and Their Joint Effects with Seven Inflammatory Biomarkers Among Seronegative Individuals and Those Seropositive to Infectious Pathogens\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependent variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeronegative individuals \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003eSeropositivity to infectious pathogens \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;10,827\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHepatitis\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;16,544\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHIV\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;82\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHPV\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;2,200\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHSV\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;10,306\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAny pathogens\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;22,763\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003eDependent variable: PC, \u003cem\u003eβ\u003c/em\u003e (\u003cem\u003eP\u003c/em\u003e) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.003 (0.169)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.004 (0.035)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.026 (0.261)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.004 (0.422)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.008 (\u0026lt;\u0026thinsp;0.001)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-0.006 (\u0026lt;\u0026thinsp;0.001)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.006 (0.009)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000 (0.797)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002 (0.938)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.002 (0.723)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.005 (0.018)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.002 (0.259)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u0026thinsp;+\u0026thinsp;Vitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u0026thinsp;+\u0026thinsp;Low\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u0026thinsp;+\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.006 (0.014)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.003 (0.086)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.023 (0.367)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.006 (0.280)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.010 (\u0026lt;\u0026thinsp;0.001)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-0.006 (\u0026lt;\u0026thinsp;0.001)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDependent variable: NC\u003c/b\u003e, \u003cb\u003eβ\u003c/b\u003e \u003cb\u003e(\u003c/b\u003e\u003cb\u003eP\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.008 (0.013)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.006 (0.026)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.055 (0.235)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.005 (0.530)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.011 (0.002)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-0.009 (\u0026lt;\u0026thinsp;0.001)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.001 (0.696)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.004 (0.171)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.008 (0.855)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.011 (0.166)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.006 (0.109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.004 (0.128)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u0026thinsp;+\u0026thinsp;Vitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u0026thinsp;+\u0026thinsp;Low\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u0026thinsp;+\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.005 (0.131)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.003 (0.275)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.037 (0.471)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.002 (0.805)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.006 (0.117)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-0.005 (0.040)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDependent variable: LC\u003c/b\u003e, \u003cb\u003eβ\u003c/b\u003e \u003cb\u003e(\u003c/b\u003e\u003cb\u003eP\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.006 (0.020)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.002 (0.275)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.004 (0.909)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.005 (0.355)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.006 (0.010)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-0.004 (0.032)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.001 (0.670)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.002 (0.455)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.007 (0.834)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.008 (0.163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.002 (0.411)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.002 (0.268)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u0026thinsp;+\u0026thinsp;Vitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u0026thinsp;+\u0026thinsp;Low\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u0026thinsp;+\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.003 (0.364)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.002 (0.354)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.023 (0.554)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.005 (0.425)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.008 (0.002)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-0.004 (0.021)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDependent variable: SII\u003c/b\u003e, \u003cb\u003eβ\u003c/b\u003e \u003cb\u003e(\u003c/b\u003e\u003cb\u003eP\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.004 (0.342)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.007 (0.006)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.088 (0.114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.003 (0.736)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.012 (0.006)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-0.011 (0.001)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.008 (0.074)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.003 (0.521)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001 (0.984)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.005 (0.656)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.009 (0.058)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.003 (0.327)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u0026thinsp;+\u0026thinsp;Vitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u0026thinsp;+\u0026thinsp;Low\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u0026thinsp;+\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.008 (0.093)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.004 (0.296)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.086 (0.160)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.003 (0.771)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.008 (0.109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-0.007 (0.044)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDependent variable: PLR\u003c/b\u003e, \u003cb\u003eβ\u003c/b\u003e \u003cb\u003e(\u003c/b\u003e\u003cb\u003eP\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.004 (0.259)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.001 (0.603)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.029 (0.457)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001 (0.847)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.001 (0.654)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.002 (0.406)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.007 (0.034)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001 (0.634)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.008 (0.830)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007 (0.347)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.003 (0.314)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.000 (0.857)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u0026thinsp;+\u0026thinsp;Vitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u0026thinsp;+\u0026thinsp;Low\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u0026thinsp;+\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.003 (0.392)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.001 (0.689)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.045 (0.290)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.001 (0.892)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.002 (0.536)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.002 (0.434)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDependent variable: NLR\u003c/b\u003e, \u003cb\u003eβ\u003c/b\u003e \u003cb\u003e(\u003c/b\u003e\u003cb\u003eP\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.001 (0.779)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.003 (0.269)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.055 (0.284)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001 (0.949)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.004 (0.270)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.005 (0.054)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.002 (0.518)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.002 (0.539)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000 (0.994)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.002 (0.773)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.003 (0.375)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.001 (0.597)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u0026thinsp;+\u0026thinsp;Vitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u0026thinsp;+\u0026thinsp;Low\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u0026thinsp;+\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.002 (0.579)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.001 (0.776)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.057 (0.318)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003 (0.737)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003 (0.509)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.000 (0.882)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDependent variable: PPN\u003c/b\u003e, \u003cb\u003eβ\u003c/b\u003e \u003cb\u003e(\u003c/b\u003e\u003cb\u003eP\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.011 (0.010)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.010 (0.007)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.085 (0.103)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.009 (0.388)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.019 (\u0026lt;\u0026thinsp;0.001)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-0.015 (\u0026lt;\u0026thinsp;0.001)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.007 (0.107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.004 (0.246)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.005 (0.916)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.013 (0.213)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.010 (0.018)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.006 (0.087)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u0026thinsp;+\u0026thinsp;Vitamin C intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild/Light\u0026thinsp;+\u0026thinsp;Low\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate/Vigorous\u0026thinsp;+\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e-0.011 (0.017)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.006 (0.092)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.064 (0.266)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.008 (0.462)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e-0.016 (0.001)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-0.011 (\u0026lt;\u0026thinsp;0.001)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e \u003cb\u003eMultivariable linear regression models accounted for key demographic and behavioral covariates, including age, sex, level of education, alcohol use, smoking behavior, body mass index (BMI), and the poverty income ratio (PIR). Statistically significant associations (\u003c/b\u003e\u003cb\u003eP\u003c/b\u003e\u0026thinsp;\u003cb\u003e\u0026lt;\u0026thinsp;0.05) are indicated in boldface.\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the seronegative population (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10,827), moderate to vigorous physical activity was modestly associated with reduced PC (β = \u0026minus;\u0026thinsp;0.006, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009) and PLR (β = \u0026minus;\u0026thinsp;0.007, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034), although associations with other markers were not statistically significant. Among pathogen-positive individuals, the associations of physical activity with inflammatory markers were generally weaker and less consistent.\u003c/p\u003e \u003cp\u003eJoint exposure to high vitamin C intake and moderate/vigorous physical activity was more consistently associated with reduced inflammatory marker levels. In particular, participants seropositive for any pathogen who reported both high vitamin C intake and higher physical activity exhibited significantly lower SII (β = \u0026minus;\u0026thinsp;0.007, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044), PC (β = \u0026minus;\u0026thinsp;0.006, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and PPN (β = \u0026minus;\u0026thinsp;0.011, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared with the low intake/low activity reference group.\u003c/p\u003e \u003cp\u003eAssociations in the HIV and HPV subgroups were less robust and generally nonsignificant, likely reflecting limited sample sizes. Collectively, these findings suggest that vitamin C intake and physical activity, particularly when combined, are associated with lower levels of systemic inflammation and related hematologic indices.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this nationally representative sample of U.S. adults, higher dietary vitamin C intake and moderate to vigorous physical activity were independently and jointly associated with lower levels of systemic immune-inflammation, as assessed by SII and related hematologic markers. Notably, these associations were most consistent and pronounced among individuals seropositive for HSV and those without evidence of chronic viral exposure. Our findings underscore the potential of modifiable lifestyle factors to mitigate chronic inflammation, even in the context of latent or persistent viral infection.\u003c/p\u003e \u003cp\u003eThe SII has emerged as a robust marker of immune system activation, integrating components of both the innate (neutrophils and platelets) and adaptive (lymphocytes) immune responses \u003csup\u003e\u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Elevated SII has been linked to adverse outcomes in cardiovascular disease, cancer, and all-cause mortality, even in community-based settings \u003csup\u003e\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. The observed inverse associations between vitamin C intake and SII\u0026mdash;particularly in HSV-positive and seronegative individuals\u0026mdash;support the anti-inflammatory role of this micronutrient. Mechanistically, vitamin C may reduce oxidative stress, stabilize neutrophil function, and preserve lymphocyte viability, thereby shifting the immune balance toward a less inflammatory phenotype \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSimilarly, physical activity was modestly but significantly associated with lower levels of PC, PLR, and SII in seronegative individuals and those with HSV seropositivity. While these associations were weaker in pathogen-positive groups overall, the consistency of effects in HSV-positive individuals is notable, given the immunologic burden of herpesviruses. Exercise has been shown to reduce inflammatory cytokines, enhance regulatory immune cell function, and modulate hematologic parameters, including platelet activation and leukocyte distribution \u003csup\u003e\u003cspan additionalcitationids=\"CR44 CR45\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. Our findings extend this evidence to a nationally representative infected population, suggesting that regular physical activity may partially offset chronic viral-driven immune activation.\u003c/p\u003e \u003cp\u003eThe biologic plausibility of our findings is supported by established immunologic mechanisms through which vitamin C and physical activity influence inflammatory tone and leukocyte dynamics. Vitamin C serves not only as a potent antioxidant but also plays critical roles in leukocyte trafficking, phagocytosis, and the regulation of cytokine production \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. By scavenging reactive oxygen species (ROS), vitamin C limits NF-κB\u0026ndash;dependent transcription of pro-inflammatory cytokines (e.g., IL-6, TNF-α), thus dampening chronic immune activation \u003csup\u003e\u003cspan additionalcitationids=\"CR49 CR50\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePhysical activity, in turn, has been shown to activate the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal (HPA) axis and the sympathetic nervous system, both of which exert immunoregulatory effects \u003csup\u003e\u003cspan additionalcitationids=\"CR53 CR54 CR55 CR56 CR57\" citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e. Acute bouts of moderate exercise transiently increase circulating immune cells, while regular physical activity downregulates toll-like receptor expression on monocytes and reduces systemic IL-1β and CRP levels \u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e,\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e. Exercise also upregulates anti-inflammatory cytokines such as IL-10 and promotes the expansion of regulatory T cells (Tregs), supporting a shift toward immune homeostasis \u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e,\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the context of chronic viral infections, such as HSV or hepatitis viruses, the immune system is often skewed toward persistent activation, with heightened neutrophil and platelet activity and reduced lymphocyte surveillance \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan additionalcitationids=\"CR63 CR64\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e\u003c/sup\u003e. Our observation that vitamin C and physical activity ameliorated inflammation particularly in HSV-seropositive individuals suggests that these exposures may blunt virus-induced immune dysregulation. HSV latency is known to induce intermittent reactivation and low-level systemic immune engagement; thus, interventions that reduce oxidative stress and support lymphocyte resilience may be especially effective in this context.\u003c/p\u003e \u003cp\u003eThese mechanistic pathways offer a coherent framework for interpreting our epidemiologic findings and support the hypothesis that lifestyle factors can exert immunomodulatory effects even under conditions of latent viral challenge.\u003c/p\u003e \u003cp\u003eThe novelty of our study lies in its focus on infection-stratified populations\u0026mdash;a frequently overlooked group in epidemiologic research on inflammation. Most prior studies have treated chronic viral exposure as a confounder or exclusion criterion, rather than an effect modifier. Yet persistent infections such as HSV, HPV, HIV, and hepatitis viruses are common in adults and may interact with nutritional and behavioral factors in shaping immune function \u003csup\u003e\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e. By explicitly stratifying analyses by serostatus, we provide new insight into the heterogeneity of lifestyle-inflammation associations across immunologic contexts.\u003c/p\u003e \u003cp\u003eOur findings also suggest that the joint effects of high vitamin C intake and moderate/vigorous physical activity may be more than additive. Individuals reporting both favorable exposures consistently exhibited lower SII, PC, NC, and PPN levels, especially in HSV-positive and seronegative groups. This convergence reinforces the hypothesis that combined lifestyle optimization may confer synergistic benefits in attenuating systemic inflammation \u003csup\u003e\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e,\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite the strengths of our study\u0026mdash;including its large, diverse sample and standardized data collection\u0026mdash;several limitations merit consideration. First, the cross-sectional design precludes causal inference. Second, vitamin C intake and physical activity were based on self-report, which is subject to measurement error and recall bias. Third, serostatus does not reflect active viral replication or disease stage, and we cannot assess whether the observed associations differ by viral load or immune suppression. Finally, while we adjusted for key sociodemographic and behavioral confounders, residual confounding by unmeasured factors such as medication use or other dietary components cannot be ruled out.\u003c/p\u003e \u003cp\u003eIn conclusion, higher vitamin C intake and moderate to vigorous physical activity were independently and jointly associated with lower systemic immune-inflammation, particularly among HSV-seropositive and seronegative individuals. These findings support the relevance of lifestyle-based strategies in mitigating chronic inflammation, even in populations with latent viral exposure. Future longitudinal and mechanistic studies are warranted to clarify causality and inform targeted interventions in at-risk subgroups.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the Director and staff of the Department of Clinical Laboratory, People's Hospital of Naxi District, for their valuable assistance and full support during the conduct of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors’ responsibilities were as follows—Hongyin Zhou and Yonggang Hu contributed to data curation, formal analysis, writing – original draft, and project administration; Hui Zhang and Yaxin Huang were responsible for conceptualization, visualization and methodology. Hongyin Zhou, Hui Zhang and Yonggang Hu were responsible for funding acquisition and investigation. Yonggang Hu and Hongyin Zhou were responsible for supervision, validation and writing – review \u0026amp; editing. All authors declare that they have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was financially supported by the Luzhou City People's Hospital of Naxi District. The findings and conclusions presented in this article are solely those of the authors and do not necessarily reflect the official views of the Centers for Disease Control and Prevention (CDC) or the U.S. Department of Health and Human Services. No commercial sponsors were involved in the design of the study, data collection, data analysis, data interpretation, manuscript preparation, or the decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe National Health and Nutrition Examination Survey (NHANES) is conducted by the National Center for Health Statistics (NCHS) and has received approval from the NCHS Research Ethics Review Board. All participants provided written informed consent at the time of data collection. The present study utilized publicly available, de-identified NHANES data and was conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its subsequent revisions. As a secondary analysis of anonymized data, this study was deemed exempt from institutional review board (IRB) oversight.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlur, İ. Low-Grade Inflammation: A Familiar Factor in Cardiovascular Diseases. \u003cem\u003eJACC Basic Transl Sci\u003c/em\u003e \u003cstrong\u003e8\u003c/strong\u003e, 1475, doi:10.1016/j.jacbts.2023.09.010 (2023).\u003c/li\u003e\n\u003cli\u003eDoi, T., Langsted, A. \u0026amp; Nordestgaard, B. G. Dual elevated remnant cholesterol and C-reactive protein in myocardial infarction, atherosclerotic cardiovascular disease, and mortality. \u003cem\u003eAtherosclerosis\u003c/em\u003e \u003cstrong\u003e379\u003c/strong\u003e, 117141, doi:10.1016/j.atherosclerosis.2023.05.010 (2023).\u003c/li\u003e\n\u003cli\u003eAlshuweishi, Y.\u003cem\u003e et al.\u003c/em\u003e Platelet/High-Density Lipoprotein Ratio (PHR) Predicts Type 2 Diabetes in Obese Patients: A Retrospective Study. \u003cem\u003eHealthcare (Basel)\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, doi:10.3390/healthcare12151540 (2024).\u003c/li\u003e\n\u003cli\u003eLaouali, N.\u003cem\u003e et al.\u003c/em\u003e Dietary inflammatory index and type 2 diabetes risk in a prospective cohort of 70,991 women followed for 20 years: the mediating role of BMI. \u003cem\u003eDiabetologia\u003c/em\u003e \u003cstrong\u003e62\u003c/strong\u003e, 2222-2232, doi:10.1007/s00125-019-04972-0 (2019).\u003c/li\u003e\n\u003cli\u003eStuart, C. M.\u003cem\u003e et al.\u003c/em\u003e Mild Systemic Inflammation Increases Erythrocyte Fragility. \u003cem\u003eInt. J. Mol. Sci.\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, doi:10.3390/ijms25137027 (2024).\u003c/li\u003e\n\u003cli\u003eCarpio-Orantes, L. D., Garc\u0026iacute;a-M\u0026eacute;ndez, S. \u0026amp; Hern\u0026aacute;ndez-Hern\u0026aacute;ndez, S. N. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index in patients with COVID-19-associated pneumonia. \u003cem\u003eGac. Med. Mex.\u003c/em\u003e \u003cstrong\u003e156\u003c/strong\u003e, 527-531, doi:10.24875/gmm.M21000480 (2020).\u003c/li\u003e\n\u003cli\u003eZhong, Y., Zhong, L., Zhou, Y., Liao, Y. \u0026amp; Deng, J. Dynamic neutrophil-to-lymphocyte-platelet ratio trajectories predict 30-day and 1-year mortality in sepsis: a retrospective cohort study based on MIMIC-IV 2.2. \u003cem\u003eBMC Infect. Dis.\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, 594, doi:10.1186/s12879-025-10987-3 (2025).\u003c/li\u003e\n\u003cli\u003eLiao, S.\u003cem\u003e et al.\u003c/em\u003e Neutrophil-to-lymphocyte ratio-based prognostic score can predict outcomes in patients with advanced non-small cell lung cancer treated with immunotherapy plus chemotherapy. \u003cem\u003eBMC Cancer\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, 697, doi:10.1186/s12885-025-13811-y (2025).\u003c/li\u003e\n\u003cli\u003eSambataro, G.\u003cem\u003e et al.\u003c/em\u003e The Model for Early COvid-19 Recognition (MECOR) Score: A Proof-of-Concept for a Simple and Low-Cost Tool to Recognize a Possible Viral Etiology in Community-Acquired Pneumonia Patients during COVID-19 Outbreak. \u003cem\u003eDiagnostics (Basel)\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, doi:10.3390/diagnostics10090619 (2020).\u003c/li\u003e\n\u003cli\u003eLiu, Y.\u003cem\u003e et al.\u003c/em\u003e Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. \u003cem\u003eJ. Infect.\u003c/em\u003e \u003cstrong\u003e81\u003c/strong\u003e, e6-e12, doi:10.1016/j.jinf.2020.04.002 (2020).\u003c/li\u003e\n\u003cli\u003eFois, A. G.\u003cem\u003e et al.\u003c/em\u003e The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients. \u003cem\u003eMolecules\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, doi:10.3390/molecules25235725 (2020).\u003c/li\u003e\n\u003cli\u003eBuonacera, A., Stancanelli, B., Colaci, M. \u0026amp; Malatino, L. Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. \u003cem\u003eInt. J. Mol. Sci.\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, doi:10.3390/ijms23073636 (2022).\u003c/li\u003e\n\u003cli\u003eEllulu, M. S., Rahmat, A., Patimah, I., Khaza\u0026apos;ai, H. \u0026amp; Abed, Y. Effect of vitamin C on inflammation and metabolic markers in hypertensive and/or diabetic obese adults: a randomized controlled trial. \u003cem\u003eDrug Des. Devel. Ther.\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 3405-3412, doi:10.2147/dddt.S83144 (2015).\u003c/li\u003e\n\u003cli\u003eUpritchard, J. E., Sutherland, W. H. \u0026amp; Mann, J. I. Effect of supplementation with tomato juice, vitamin E, and vitamin C on LDL oxidation and products of inflammatory activity in type 2 diabetes. \u003cem\u003eDiabetes Care\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 733-738, doi:10.2337/diacare.23.6.733 (2000).\u003c/li\u003e\n\u003cli\u003eMurer, S. B.\u003cem\u003e et al.\u003c/em\u003e Antioxidant supplements reduced oxidative stress and stabilized liver function tests but did not reduce inflammation in a randomized controlled trial in obese children and adolescents. \u003cem\u003eJ. Nutr.\u003c/em\u003e \u003cstrong\u003e144\u003c/strong\u003e, 193-201, doi:10.3945/jn.113.185561 (2014).\u003c/li\u003e\n\u003cli\u003ePopovic, L. M.\u003cem\u003e et al.\u003c/em\u003e Influence of vitamin C supplementation on oxidative stress and neutrophil inflammatory response in acute and regular exercise. \u003cem\u003eOxid. Med. Cell. Longev.\u003c/em\u003e \u003cstrong\u003e2015\u003c/strong\u003e, 295497, doi:10.1155/2015/295497 (2015).\u003c/li\u003e\n\u003cli\u003eWawrzyniak-Gramacka, E.\u003cem\u003e et al.\u003c/em\u003e The Association of Anti-Inflammatory Diet Ingredients and Lifestyle Exercise with Inflammaging. \u003cem\u003eNutrients\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, doi:10.3390/nu13113696 (2021).\u003c/li\u003e\n\u003cli\u003eAlberts, A., Moldoveanu, E. T., Niculescu, A. G. \u0026amp; Grumezescu, A. M. Vitamin C: A Comprehensive Review of Its Role in Health, Disease Prevention, and Therapeutic Potential. \u003cem\u003eMolecules\u003c/em\u003e \u003cstrong\u003e30\u003c/strong\u003e, doi:10.3390/molecules30030748 (2025).\u003c/li\u003e\n\u003cli\u003eClemente-Su\u0026aacute;rez, V. J.\u003cem\u003e et al.\u003c/em\u003e The Role of Adipokines in Health and Disease. \u003cem\u003eBiomedicines\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, doi:10.3390/biomedicines11051290 (2023).\u003c/li\u003e\n\u003cli\u003eTaherkhani, S., Suzuki, K. \u0026amp; Castell, L. A Short Overview of Changes in Inflammatory Cytokines and Oxidative Stress in Response to Physical Activity and Antioxidant Supplementation. \u003cem\u003eAntioxidants (Basel)\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, doi:10.3390/antiox9090886 (2020).\u003c/li\u003e\n\u003cli\u003eMoldoveanu, A. I., Shephard, R. J. \u0026amp; Shek, P. N. The cytokine response to physical activity and training. \u003cem\u003eSports Med.\u003c/em\u003e \u003cstrong\u003e31\u003c/strong\u003e, 115-144, doi:10.2165/00007256-200131020-00004 (2001).\u003c/li\u003e\n\u003cli\u003eZuniga, E. I., Macal, M., Lewis, G. M. \u0026amp; Harker, J. A. Innate and Adaptive Immune Regulation During Chronic Viral Infections. \u003cem\u003eAnnu Rev Virol\u003c/em\u003e \u003cstrong\u003e2\u003c/strong\u003e, 573-597, doi:10.1146/annurev-virology-100114-055226 (2015).\u003c/li\u003e\n\u003cli\u003eQuirino, A.\u003cem\u003e et al.\u003c/em\u003e Viral Hepatitis: Host Immune Interaction, Pathogenesis and New Therapeutic Strategies. \u003cem\u003ePathogens\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, doi:10.3390/pathogens13090766 (2024).\u003c/li\u003e\n\u003cli\u003eWilson, E. M. \u0026amp; Sereti, I. Immune restoration after antiretroviral therapy: the pitfalls of hasty or incomplete repairs. \u003cem\u003eImmunol. Rev.\u003c/em\u003e \u003cstrong\u003e254\u003c/strong\u003e, 343-354, doi:10.1111/imr.12064 (2013).\u003c/li\u003e\n\u003cli\u003eBr\u0026uuml;ggemann, Y., Kl\u0026ouml;hn, M., Wedemeyer, H. \u0026amp; Steinmann, E. Hepatitis E virus: from innate sensing to adaptive immune responses. \u003cem\u003eNat. Rev. Gastroenterol. Hepatol.\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 710-725, doi:10.1038/s41575-024-00950-z (2024).\u003c/li\u003e\n\u003cli\u003eBelk, J. A., Daniel, B. \u0026amp; Satpathy, A. T. Epigenetic regulation of T cell exhaustion. \u003cem\u003eNat. Immunol.\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 848-860, doi:10.1038/s41590-022-01224-z (2022).\u003c/li\u003e\n\u003cli\u003eAbdel-Hakeem, M. S.\u003cem\u003e et al.\u003c/em\u003e Epigenetic scarring of exhausted T cells hinders memory differentiation upon eliminating chronic antigenic stimulation. \u003cem\u003eNat. Immunol.\u003c/em\u003e \u003cstrong\u003e22\u003c/strong\u003e, 1008-1019, doi:10.1038/s41590-021-00975-5 (2021).\u003c/li\u003e\n\u003cli\u003ePascutti, M. F., Erkelens, M. N. \u0026amp; Nolte, M. A. Impact of Viral Infections on Hematopoiesis: From Beneficial to Detrimental Effects on Bone Marrow Output. \u003cem\u003eFront. Immunol.\u003c/em\u003e \u003cstrong\u003e7\u003c/strong\u003e, 364, doi:10.3389/fimmu.2016.00364 (2016).\u003c/li\u003e\n\u003cli\u003eFaist, A.\u003cem\u003e et al.\u003c/em\u003e Virus Infection and Systemic Inflammation: Lessons Learnt from COVID-19 and Beyond. \u003cem\u003eCells\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, doi:10.3390/cells11142198 (2022).\u003c/li\u003e\n\u003cli\u003eHu, B.\u003cem\u003e et al.\u003c/em\u003e Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. \u003cem\u003eClin. Cancer Res.\u003c/em\u003e \u003cstrong\u003e20\u003c/strong\u003e, 6212-6222, doi:10.1158/1078-0432.Ccr-14-0442 (2014).\u003c/li\u003e\n\u003cli\u003eQin, Z.\u003cem\u003e et al.\u003c/em\u003e Systemic Immune-Inflammation Index Is Associated With Increased Urinary Albumin Excretion: A Population-Based Study. \u003cem\u003eFront. Immunol.\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 863640, doi:10.3389/fimmu.2022.863640 (2022).\u003c/li\u003e\n\u003cli\u003eNascimento, M. A. L., Ferreira, L. G. R., Alves, T. V. G. \u0026amp; Rios, D. R. A. Inflammatory Hematological Indices, Cardiovascular Disease and Mortality: A Narrative Review. \u003cem\u003eArq. Bras. Cardiol.\u003c/em\u003e \u003cstrong\u003e121\u003c/strong\u003e, e20230752, doi:10.36660/abc.20230752 (2024).\u003c/li\u003e\n\u003cli\u003eYan, Q.\u003cem\u003e et al.\u003c/em\u003e Systemic immune-inflammation index (SII): A More Promising Inflammation-Based Prognostic Marker for Patients with synchronic colorectal peritoneal carcinomatosis. \u003cem\u003eJ. Cancer\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 5264-5272, doi:10.7150/jca.46446 (2020).\u003c/li\u003e\n\u003cli\u003eOkutan, İ., Aci, R., Keskin, \u0026Acirc;., Bilgin, M. \u0026amp; Kızılet, H. New inflammatory markers associated with disease activity in rheumatoid arthritis: pan-immune-inflammation value, systemic immune-inflammation index, and systemic inflammation response index. \u003cem\u003eReumatologia\u003c/em\u003e \u003cstrong\u003e62\u003c/strong\u003e, 439-446, doi:10.5114/reum/196066 (2024).\u003c/li\u003e\n\u003cli\u003eDervisevic, A.\u003cem\u003e et al.\u003c/em\u003e Systemic Immune-inflammation Index in Evaluation of Inflammation in Rheumatoid Arthritis Patients. \u003cem\u003eMedeni Med J\u003c/em\u003e \u003cstrong\u003e39\u003c/strong\u003e, 183-191, doi:10.4274/MMJ.galenos.2024.60533 (2024).\u003c/li\u003e\n\u003cli\u003eJiang, Y.\u003cem\u003e et al.\u003c/em\u003e Associations between folate intake, serum folate, and stroke risk: The mediating role of dietary inflammatory index from NHANES 2007-2018. \u003cem\u003eJ. Stroke Cerebrovasc. Dis.\u003c/em\u003e \u003cstrong\u003e34\u003c/strong\u003e, 108318, doi:10.1016/j.jstrokecerebrovasdis.2025.108318 (2025).\u003c/li\u003e\n\u003cli\u003eWang, H., Nie, H., Bu, G., Tong, X. \u0026amp; Bai, X. Systemic immune-inflammation index (SII) and the risk of all-cause, cardiovascular, and cardio-cerebrovascular mortality in the general population. \u003cem\u003eEur. J. Med. Res.\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, 575, doi:10.1186/s40001-023-01529-1 (2023).\u003c/li\u003e\n\u003cli\u003eUzun, M., Gokcek, S., Kaya, E. \u0026amp; Semiz, H. S. The prognostic role of systemic immune-inflammation index, SII, in Metastatic Castration-Resistant Prostate Cancer patients. \u003cem\u003eDiscov Oncol\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 317, doi:10.1007/s12672-025-02084-3 (2025).\u003c/li\u003e\n\u003cli\u003eLi, C. X.\u003cem\u003e et al.\u003c/em\u003e Pan-immune-inflammatory value and systemic immune-inflammatory index in relation to osteoradionecrosis of the jaws: a single institutional experience over 15 years. \u003cem\u003eOdontology\u003c/em\u003e, doi:10.1007/s10266-025-01101-9 (2025).\u003c/li\u003e\n\u003cli\u003eLiugan, M. \u0026amp; Carr, A. C. Vitamin C and Neutrophil Function: Findings from Randomized Controlled Trials. \u003cem\u003eNutrients\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, doi:10.3390/nu11092102 (2019).\u003c/li\u003e\n\u003cli\u003eMousavi, S., Bereswill, S. \u0026amp; Heimesaat, M. M. Immunomodulatory and Antimicrobial Effects of Vitamin C. \u003cem\u003eEur. J. Microbiol. Immunol. (Bp)\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 73-79, doi:10.1556/1886.2019.00016 (2019).\u003c/li\u003e\n\u003cli\u003eDe la Fuente, M.\u003cem\u003e et al.\u003c/em\u003e Vitamin C and vitamin C plus E improve the immune function in the elderly. \u003cem\u003eExp. Gerontol.\u003c/em\u003e \u003cstrong\u003e142\u003c/strong\u003e, 111118, doi:10.1016/j.exger.2020.111118 (2020).\u003c/li\u003e\n\u003cli\u003eGuo, L.\u003cem\u003e et al.\u003c/em\u003e Associations of lifestyle characteristics with circulating immune markers in the general population based on NHANES 1999 to 2014. \u003cem\u003eSci. Rep.\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 13444, doi:10.1038/s41598-024-63875-2 (2024).\u003c/li\u003e\n\u003cli\u003eKohut, M. L., Thompson, J. R., Lee, W. \u0026amp; Cunnick, J. E. Exercise training-induced adaptations of immune response are mediated by beta-adrenergic receptors in aged but not young mice. \u003cem\u003eJ Appl Physiol (1985)\u003c/em\u003e \u003cstrong\u003e96\u003c/strong\u003e, 1312-1322, doi:10.1152/japplphysiol.00792.2003 (2004).\u003c/li\u003e\n\u003cli\u003eLin, D.\u003cem\u003e et al.\u003c/em\u003e Associations Between Leisure-Time Physical Activity Level and Peripheral Immune Cell Populations in the US General Population, Analysis of the National Health and Nutrition Examination Survey Data, 1999-2018. \u003cem\u003eSports Med Open\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 101, doi:10.1186/s40798-023-00643-y (2023).\u003c/li\u003e\n\u003cli\u003eCerqueira, \u0026Eacute;., Marinho, D. A., Neiva, H. P. \u0026amp; Louren\u0026ccedil;o, O. Inflammatory Effects of High and Moderate Intensity Exercise-A Systematic Review. \u003cem\u003eFront. Physiol.\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 1550, doi:10.3389/fphys.2019.01550 (2019).\u003c/li\u003e\n\u003cli\u003eTan, Y.\u003cem\u003e et al.\u003c/em\u003e Vitamin B12, Folate, Homocysteine, Inflammatory Mediators (Interleukin-6, Tumor Necrosis Factor-\u0026alpha; and C-Reactive Protein) Levels in Adolescents with Anxiety or Depressive Symptoms. \u003cem\u003eNeuropsychiatr. Dis. Treat.\u003c/em\u003e \u003cstrong\u003e19\u003c/strong\u003e, 785-800, doi:10.2147/ndt.S399378 (2023).\u003c/li\u003e\n\u003cli\u003eDragičević Tomičić, D.\u003cem\u003e et al.\u003c/em\u003e Effects of Vitamin D, Melatonin, and Omega-3 Fatty Acids on Periodontal Health: A Narrative Review. \u003cem\u003eDent J (Basel)\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, doi:10.3390/dj13040178 (2025).\u003c/li\u003e\n\u003cli\u003eChoi, S., Lee, J., Park, J. H. \u0026amp; Kim, G. Inhibitory effects of AptaminC320 targeting vitamin C on LPS-induced inflammation in RAW264.7 cells. \u003cem\u003eBiochem Biophys Rep\u003c/em\u003e \u003cstrong\u003e41\u003c/strong\u003e, 101951, doi:10.1016/j.bbrep.2025.101951 (2025).\u003c/li\u003e\n\u003cli\u003eKumar, S.\u003cem\u003e et al.\u003c/em\u003e The Interplay of Oxidative Stress and ROS Scavenging: Antioxidants as a Therapeutic Potential in Sepsis. \u003cem\u003eVaccines (Basel)\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, doi:10.3390/vaccines10101575 (2022).\u003c/li\u003e\n\u003cli\u003eLiu, Z.\u003cem\u003e et al.\u003c/em\u003e Role of ROS and Nutritional Antioxidants in Human Diseases. \u003cem\u003eFront. Physiol.\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 477, doi:10.3389/fphys.2018.00477 (2018).\u003c/li\u003e\n\u003cli\u003eTaddei, S., Virdis, A., Ghiadoni, L., Magagna, A. \u0026amp; Salvetti, A. Vitamin C improves endothelium-dependent vasodilation by restoring nitric oxide activity in essential hypertension. \u003cem\u003eCirculation\u003c/em\u003e \u003cstrong\u003e97\u003c/strong\u003e, 2222-2229, doi:10.1161/01.cir.97.22.2222 (1998).\u003c/li\u003e\n\u003cli\u003eHan, M.\u003cem\u003e et al.\u003c/em\u003e Ascorbate protects endothelial barrier function during septic insult: Role of protein phosphatase type 2A. \u003cem\u003eFree Radic. Biol. Med.\u003c/em\u003e \u003cstrong\u003e48\u003c/strong\u003e, 128-135, doi:10.1016/j.freeradbiomed.2009.10.034 (2010).\u003c/li\u003e\n\u003cli\u003eC\u0026aacute;rcamo, J. M., Pedraza, A., B\u0026oacute;rquez-Ojeda, O. \u0026amp; Golde, D. W. Vitamin C suppresses TNF alpha-induced NF kappa B activation by inhibiting I kappa B alpha phosphorylation. \u003cem\u003eBiochemistry\u003c/em\u003e \u003cstrong\u003e41\u003c/strong\u003e, 12995-13002, doi:10.1021/bi0263210 (2002).\u003c/li\u003e\n\u003cli\u003eHaendeler, J., Zeiher, A. M. \u0026amp; Dimmeler, S. Vitamin C and E prevent lipopolysaccharide-induced apoptosis in human endothelial cells by modulation of Bcl-2 and Bax. \u003cem\u003eEur. J. Pharmacol.\u003c/em\u003e \u003cstrong\u003e317\u003c/strong\u003e, 407-411, doi:10.1016/s0014-2999(96)00759-5 (1996).\u003c/li\u003e\n\u003cli\u003eUtoguchi, N.\u003cem\u003e et al.\u003c/em\u003e Ascorbic acid stimulates barrier function of cultured endothelial cell monolayer. \u003cem\u003eJ. Cell. Physiol.\u003c/em\u003e \u003cstrong\u003e163\u003c/strong\u003e, 393-399, doi:10.1002/jcp.1041630219 (1995).\u003c/li\u003e\n\u003cli\u003eMohammed, B. M.\u003cem\u003e et al.\u003c/em\u003e Vitamin C: a novel regulator of neutrophil extracellular trap formation. \u003cem\u003eNutrients\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, 3131-3151, doi:10.3390/nu5083131 (2013).\u003c/li\u003e\n\u003cli\u003eAgus, D. B.\u003cem\u003e et al.\u003c/em\u003e Vitamin C crosses the blood-brain barrier in the oxidized form through the glucose transporters. \u003cem\u003eJ. Clin. Invest.\u003c/em\u003e \u003cstrong\u003e100\u003c/strong\u003e, 2842-2848, doi:10.1172/jci119832 (1997).\u003c/li\u003e\n\u003cli\u003eLi, P. \u0026amp; Luo, L. Identification of Critical Genes and Signaling Pathways in Human Monocytes Following High-Intensity Exercise. \u003cem\u003eHealthcare (Basel)\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, doi:10.3390/healthcare9060618 (2021).\u003c/li\u003e\n\u003cli\u003eOgbutor, U. G.\u003cem\u003e et al.\u003c/em\u003e Proinflammatory and Anti-inflammatory Cytokine Response to Isometric Handgrip Exercise and the Effects of Duration and Intensity of the Isometric Efforts in Prehypertensive Participants. \u003cem\u003eJ. Chiropr. Med.\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 177-186, doi:10.1016/j.jcm.2022.05.002 (2022).\u003c/li\u003e\n\u003cli\u003eYe, X. \u0026amp; Liu, R. Exercise-induced cytosolic calcium oscillations: mechanisms and modulation of T-cell function. \u003cem\u003eBiochem. Biophys. Res. Commun.\u003c/em\u003e \u003cstrong\u003e748\u003c/strong\u003e, 151321, doi:10.1016/j.bbrc.2025.151321 (2025).\u003c/li\u003e\n\u003cli\u003eBorkow, G. \u0026amp; Bentwich, Z. Chronic immune activation associated with chronic helminthic and human immunodeficiency virus infections: role of hyporesponsiveness and anergy. \u003cem\u003eClin. Microbiol. Rev.\u003c/em\u003e \u003cstrong\u003e17\u003c/strong\u003e, 1012-1030, table of contents, doi:10.1128/cmr.17.4.1012-1030.2004 (2004).\u003c/li\u003e\n\u003cli\u003eBarbian, H. J.\u003cem\u003e et al.\u003c/em\u003e Effective treatment of SIVcpz-induced immunodeficiency in a captive western chimpanzee. \u003cem\u003eRetrovirology\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 35, doi:10.1186/s12977-017-0359-0 (2017).\u003c/li\u003e\n\u003cli\u003eD\u0026apos;Atri, L. P.\u003cem\u003e et al.\u003c/em\u003e Expression and functionality of Toll-like receptor 3 in the megakaryocytic lineage. \u003cem\u003eJ. Thromb. Haemost.\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 839-850, doi:10.1111/jth.12842 (2015).\u003c/li\u003e\n\u003cli\u003eLeng, Q.\u003cem\u003e et al.\u003c/em\u003e Immune activation correlates better than HIV plasma viral load with CD4 T-cell decline during HIV infection. \u003cem\u003eJ. Acquir. Immune Defic. Syndr.\u003c/em\u003e \u003cstrong\u003e27\u003c/strong\u003e, 389-397, doi:10.1097/00126334-200108010-00010 (2001).\u003c/li\u003e\n\u003cli\u003eWr\u0026oacute;blewska, J., Złocińska, H., Wr\u0026oacute;blewski, M., Nuszkiewicz, J. \u0026amp; Woźniak, A. The Role of Vitamins in Pediatric Urinary Tract Infection: Mechanisms and Integrative Strategies. \u003cem\u003eBiomolecules\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, doi:10.3390/biom15040566 (2025).\u003c/li\u003e\n\u003cli\u003evan \u0026apos;t Klooster, C. C.\u003cem\u003e et al.\u003c/em\u003e The relation between healthy lifestyle changes and decrease in systemic inflammation in patients with stable cardiovascular disease. \u003cem\u003eAtherosclerosis\u003c/em\u003e \u003cstrong\u003e301\u003c/strong\u003e, 37-43, doi:10.1016/j.atherosclerosis.2020.03.022 (2020).\u003c/li\u003e\n\u003cli\u003eHodel, F.\u003cem\u003e et al.\u003c/em\u003e The combined impact of persistent infections and human genetic variation on C-reactive protein levels. \u003cem\u003eBMC Med.\u003c/em\u003e \u003cstrong\u003e20\u003c/strong\u003e, 416, doi:10.1186/s12916-022-02607-7 (2022).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vitamin C intake, Physical activity, Systemic immune-inflammation index, Chronic viral infection, NHANES, Inflammatory biomarkers, Herpes simplex virus, Neutrophil-to-lymphocyte ratio, Lifestyle factors, Population health","lastPublishedDoi":"10.21203/rs.3.rs-6641016/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6641016/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003cbr\u003e\n\u003c/strong\u003eSystemic immune-inflammation is a key contributor to chronic disease pathogenesis. Whether vitamin C intake and physical activity influence inflammatory status in individuals with latent viral infections remains unclear.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003cbr\u003e\n\u003c/strong\u003eWe conducted a cross-sectional analysis of 33,590 U.S. adults from NHANES 2005–2018. Vitamin C intake was assessed by two 24-hour dietary recalls; physical activity was self-reported. The primary outcome was the systemic immune-inflammation index (SII), with secondary outcomes including NLR, PLR, PPN, PC, NC, and LC. Multivariable linear regression models adjusted for sociodemographic and behavioral covariates. Analyses were stratified by serostatus to hepatitis viruses, HIV, HPV, and HSV.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003cbr\u003e\n\u003c/strong\u003eHigher vitamin C intake was associated with lower SII, PC, NC, and PPN, particularly among HSV-seropositive and seronegative individuals. Moderate/vigorous physical activity was independently associated with lower inflammatory markers in these same subgroups. Joint exposure to high vitamin C intake and higher activity showed the most consistent anti-inflammatory profiles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003cbr\u003e\n\u003c/strong\u003eHigher vitamin C intake and physical activity were independently and jointly associated with lower systemic inflammation, with pronounced effects among those with HSV infection or no viral exposure. These findings support the role of lifestyle modification in mitigating inflammation, particularly in populations with chronic immune activation.\u003c/p\u003e","manuscriptTitle":"Can Vitamin C Intake and Physical Activity Individually and Jointly Lower Inflammation in Chronically Infected Populations? Insights from NHANES 2005–2018","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 05:04:43","doi":"10.21203/rs.3.rs-6641016/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c5258f0c-0633-4efe-81ce-2786e52ecd79","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":48364309,"name":"Health sciences/Diseases/Infectious diseases"},{"id":48364310,"name":"Health sciences/Medical research/Epidemiology"},{"id":48364311,"name":"Health sciences/Pathogenesis/Infection"},{"id":48364312,"name":"Health sciences/Pathogenesis/Inflammation"}],"tags":[],"updatedAt":"2025-05-26T17:08:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-13 05:04:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6641016","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6641016","identity":"rs-6641016","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}