title: Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study.
abstract: BACKGROUND
  There is overwhelming evidence that behavioural factors influence health, but their combined impact on the general population is less well documented. We aimed to quantify the potential combined impact of four health behaviours on mortality in men and women living in the general community.
  
  
  RESULTS
  We examined the prospective relationship between lifestyle and mortality in a prospective population study of 20,244 men and women aged 45-79 y with no known cardiovascular disease or cancer at baseline survey in 1993-1997, living in the general community in the United Kingdom, and followed up to 2006. Participants scored one point for each health behaviour: current non-smoking, not physically inactive, moderate alcohol intake (1-14 units a week) and plasma vitamin C >50 mmol/l indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from zero to four. After an average 11 y follow-up, the age-, sex-, body mass-, and social class-adjusted relative risks (95% confidence intervals) for all-cause mortality(1,987 deaths) for men and women who had three, two, one, and zero compared to four health behaviours were respectively, 1.39 (1.21-1.60), 1.95 (1.70--2.25), 2.52 (2.13-3.00), and 4.04 (2.95-5.54) p < 0.001 trend. The relationships were consistent in subgroups stratified by sex, age, body mass index, and social class, and after excluding deaths within 2 y. The trends were strongest for cardiovascular causes. The mortality risk for those with four compared to zero health behaviours was equivalent to being 14 y younger in chronological age.
  
  
  CONCLUSIONS
  Four health behaviours combined predict a 4-fold difference in total mortality in men and women, with an estimated impact equivalent to 14 y in chronological age.
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom. kk101@medschl.cam.ac.uk
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nicholas
authors.initials: N
authors.lastname: Wareham
authors.forename: Sheila
authors.initials: S
authors.lastname: Bingham
authors.forename: Ailsa
authors.initials: A
authors.lastname: Welch
authors.forename: Robert
authors.initials: R
authors.lastname: Luben
authors.forename: Nicholas
authors.initials: N
authors.lastname: Day
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D001205:Ascorbic Acid / Q000097:blood; D004032:Diet / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006801:Humans; D008017:Life Expectancy; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D009043:Motor Activity; D010808:Physical Examination; D011446:Prospective Studies; D012306:Risk; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014675:Vegetables
chemical_list: D001205:Ascorbic Acid