Bowel health has emerged as a critical area of investigation in public health, particularly concerning the prevalence of chronic gastrointestinal disorders such as chronic diarrhea and chronic constipation. These conditions not only significantly impair quality of life but also pose considerable healthcare challenges, leading to increased morbidity and healthcare costs (1). Chronic gastrointestinal conditions like chronic diarrhea and constipation are often associated with various risk factors, including diet, physical activity, and psychological stress, all of which can have profound implications for overall health and well-being (2–4).

Life’s Simple 7 (LS7), a framework established by the American Heart Association, encompasses essential health behaviors and metrics, such as smoking cessation, body mass index (BMI), physical activity, dietary quality, and the management of blood pressure, glucose, and cholesterol (5). Although originally designed to assess cardiovascular health, LS7’s potential impact on gastrointestinal health is becoming increasingly recognized. Evidence suggests that adherence to LS7 may mitigate the risk of developing chronic gastrointestinal conditions, with studies showing that healthier lifestyle choices correlate with improved bowel function and reduced incidence of chronic constipation and diarrhea (6, 7).

The relationship between LS7 and bowel health can be attributed to the beneficial effects of each of the LS7 components. For example, a high-quality diet rich in fiber has been associated with enhanced bowel function and lower rates of gastrointestinal conditions (8, 9). Regular physical activity, another key component of LS7, has also been shown to positively influence gut motility and reduce symptoms of both constipation and diarrhea (10, 11). Additionally, maintaining a healthy weight and controlling blood glucose levels are critical to preventing metabolic dysfunctions that can negatively impact bowel health (12, 13).

Moreover, socioeconomic factors play a significant role in the prevalence of chronic bowel conditions. Individuals from lower socioeconomic backgrounds are often at higher risk due to poorer diet quality, limited access to healthcare, and increased psychological stress (14, 15). These social determinants of health contribute to disparities in the incidence of gastrointestinal disorders, making it essential to understand the combined influence of lifestyle and socioeconomic status on bowel health (16, 17).

Recent findings from population-based studies have highlighted that a lack of adherence to healthy lifestyle metrics, such as those included in LS7, is associated with an increased prevalence of chronic gastrointestinal conditions like constipation and diarrhea (18, 19). This aligns with broader evidence linking poor lifestyle choices— including smoking, excessive alcohol consumption, and physical inactivity—with a higher risk of gastrointestinal problems (20–22). Addressing these lifestyle factors through public health initiatives could be instrumental in reducing the burden of bowel disorders and improving overall health outcomes (23).

In light of these considerations, this study aims to explore the association between Life’s Simple 7 and the prevalence of chronic diarrhea and constipation using data from the National Health and Nutrition Examination Survey (NHANES). By investigating these associations, we hope to provide valuable insights into the multifactorial influences on bowel health and inform future interventions to enhance gastrointestinal well-being.

The findings of this study underscore the importance of LS7 as a potential modifiable factor in promoting bowel health, specifically in reducing the risk of chronic constipation and diarrhea. Our results indicate that adherence to LS7 is inversely associated with both chronic constipation and diarrhea, particularly highlighting its protective role against chronic diarrhea. These findings are consistent with previous research demonstrating that lifestyle factors such as diet, physical activity, and weight management can significantly influence gastrointestinal health (2, 25).

Understanding the underlying mechanisms that contribute to chronic diarrhea and constipation is crucial for developing effective prevention and treatment strategies. Chronic constipation is often characterized by reduced bowel motility, which can be influenced by factors such as diet, fluid intake, physical activity, and certain medications (26). Low dietary fiber intake is one of the most well-established risk factors for constipation, as fiber plays a crucial role in increasing stool bulk and promoting regular bowel movements (27, 28). Additionally, inadequate hydration can lead to hard stools, making them more difficult to pass.

The gut microbiota also plays a significant role in gastrointestinal function.

Dysbiosis, or an imbalance in gut bacteria, has been linked to both constipation and diarrhea (29, 30). For example, studies have shown that individuals with chronic constipation often have reduced microbial diversity and lower levels of beneficial bacteria, such as Bifidobacteria and Lactobacilli, which are known to aid in digestion and promote gut health (31, 32). Conversely, chronic diarrhea is frequently associated with an overgrowth of pathogenic bacteria, which can disrupt normal gut function and lead to symptoms (33, 34).

In our study, the strong association between LS7 and bowel health may be partially explained by its impact on gut microbiota composition and function. A diet rich in fruits, vegetables, whole grains, and adequate hydration—components emphasized in LS7— has been shown to promote a healthy gut microbiome (35, 36). Physical activity, another component of LS7, not only enhances bowel motility but also positively influences gut microbiota diversity (37, 38). Thus, adherence to LS7 may support the maintenance of a balanced microbiome, which could, in turn, mitigate the risks associated with chronic gastrointestinal disorders.

Several studies have reported similar associations between lifestyle factors and bowel health. For instance, a study conducted by Mego et al. found that a high-fiber diet, which is part of the dietary recommendations in LS7, significantly reduced the incidence of chronic constipation among adults (39). Similarly, a research by Paluska et al. indicated that increased physical activity was associated with lower rates of gastrointestinal disorders, including constipation (40). Our findings further extend these observations by demonstrating that the comprehensive LS7 framework not only affects cardiovascular health but also plays a crucial role in maintaining bowel health.

The demographic variations observed in our study further emphasize the necessity of tailoring public health interventions. Specifically, our subgroup analyses revealed that males and individuals with a BMI under 30 kg/m² showed a stronger protective effect of LS7 against chronic constipation. This aligns with previous studies suggesting that sex and body weight may modulate the relationship between lifestyle factors and bowel health outcomes (41, 42). For instance, research has indicated that men may respond differently to dietary interventions compared to women, potentially due to hormonal and metabolic differences (43, 44). Furthermore, the role of BMI in mediating the effects of lifestyle on bowel health is supported by studies that demonstrate the association between obesity and increased risk of gastrointestinal issues (45, 46).

The relationship between LS7 and chronic diarrhea was particularly notable among younger adults and those without hypertension, echoing findings from previous studies that highlight the impact of age and comorbidities on gastrointestinal health (47, 48). Younger populations may benefit more from lifestyle modifications, as they often have fewer chronic conditions that could complicate bowel health (49). This suggests that early interventions targeting LS7 adherence could be crucial for preventing bowel disorders in at-risk populations (50).

Our study also contributes to the growing body of literature emphasizing the role of socioeconomic factors in bowel health. Participants with lower educational attainment and those living in poverty exhibited higher rates of chronic constipation and diarrhea, reflecting the disparities in access to healthy food options and healthcare services (51, 52). This is consistent with existing literature that has identified socioeconomic status as a significant determinant of health outcomes, including gastrointestinal diseases (53, 54). For example, a study by Adams et al. found that individuals from lower socioeconomic backgrounds reported higher rates of gastrointestinal disorders, emphasizing the need for targeted interventions (55). Interventions aimed at improving education and access to resources may help mitigate these disparities and promote healthier lifestyles (56, 57).

The use of RCS analysis provided a nuanced understanding of the relationship between LS7 and bowel health, suggesting a dose–response effect, particularly for chronic diarrhea. While a significant non-linear relationship was not established, the observed trends indicate that higher LS7 scores are associated with lower odds of chronic diarrhea, supporting findings from other studies that have demonstrated the benefits of dietary quality and physical activity in reducing gastrointestinal symptoms (58, 59).

These results hold substantial implications for public health strategies aimed at reducing the burden of chronic gastrointestinal disorders. By emphasizing the importance of LS7, healthcare providers can advocate for comprehensive lifestyle interventions that focus on smoking cessation, physical activity, healthy dietary habits, and weight management (60, 61). Moreover, integrating these strategies into routine healthcare practices could improve overall patient outcomes and reduce healthcare costs associated with managing chronic bowel diseases (62).

Despite the strengths of this study, including the use of a nationally representative sample and comprehensive adjustments for confounding factors, there are limitations to consider. The reliance on self-reported measures for bowel health may introduce reporting bias, as individuals may have varying perceptions of their bowel habits (63), (64). Additionally, the cross-sectional design limits the ability to draw causal inferences between LS7 and bowel health outcomes. Future longitudinal studies are warranted to establish causal pathways and further elucidate the mechanisms through which lifestyle factors influence bowel health. Another limitation of this study is the non-application of the Rome IV criteria for the diagnosis of functional constipation and diarrhea. The Rome IV criteria provide a standardized and validated framework for diagnosing functional gastrointestinal disorders. Its absence in this study could lead to misclassification, as self-reported data might not accurately capture functional gastrointestinal conditions. Future research should incorporate these diagnostic criteria to enhance the reliability and validity of the findings, particularly in distinguishing functional constipation and diarrhea from other causes. A further limitation of this study is the lack of detailed information regarding the exclusion of individuals with specific gastrointestinal conditions, such as inflammatory bowel disease (IBD), hemorrhoids, fissures, or pelvic floor disorders. Additionally, the study did not account for the potential impact of thyroid disorders (both hypothyroidism and hyperthyroidism) or the use of medications known to affect bowel function, such as those that cause constipation or diarrhea. These factors may have significant effects on bowel health and represent an important gap in the study design. Future research should carefully consider these variables by implementing clear inclusion and exclusion criteria and examining the influence of thyroid dysfunction and medications to enhance the robustness and applicability of the findings.

In conclusion, our findings highlight the significant role of LS7 in promoting bowel health and preventing chronic constipation and diarrhea. Tailoring interventions to specific populations based on demographic and health characteristics may enhance the effectiveness of these strategies. As we move toward a more holistic approach to healthcare, integrating lifestyle modifications into clinical practice could lead to improved gastrointestinal health outcomes and a better quality of life for individuals at risk of chronic bowel disorders.