A nested case-control study within the prospective China Kadoorie Biobank (CKB) study examined the associations of self-reported physical activity and sedentary leisure time with Nightingale's comprehensive metabolic profile containing information on plasma lipoproteins, lipids, amino acids and fatty acids.

The study, with 3,195 incident CVD cases and 1,465 controls, explored whether circulating metabolites explain associations of physical activity and sedentary leisure with vascular disease. More than 100 metabolic markers were associated with physical activity and sedentary leisure time. In further examination, metabolic markers potentially explained roughly 70% of the protective associations of physical activity and roughly 50% of the positive associations of sedentary leisure time with occlusive CVD.