title: Combined impact of lifestyle factors on mortality: prospective cohort study in US women.
abstract: OBJECTIVE
  To evaluate the impact of combinations of lifestyle factors on mortality in middle aged women.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Nurses' health study, United States.
  
  
  METHODS
  77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980.
  
  
  METHODS
  Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors (cigarette smoking, being overweight, taking little moderate to vigorous physical activity, no light to moderate alcohol intake, and low diet quality score).
  
  
  RESULTS
  8882 deaths were documented, including 1790 from cardiovascular disease and 4527 from cancer. Each lifestyle factor independently and significantly predicted mortality. Relative risks for five compared with zero lifestyle risk factors were 3.26 (95% confidence interval 2.45 to 4.34) for cancer mortality, 8.17 (4.96 to 13.47) for cardiovascular mortality, and 4.31 (3.51 to 5.31) for all cause mortality. A total of 28% (25% to 31%) of deaths during follow-up could be attributed to smoking and 55% (47% to 62%) to the combination of smoking, being overweight, lack of physical activity, and a low diet quality. Additionally considering alcohol intake did not substantially change this estimate.
  
  
  CONCLUSIONS
  These results indicate that adherence to lifestyle guidelines is associated with markedly lower mortality in middle aged women. Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA. rvandam@hsph.harvard.edu
authors.forename: Rob M
authors.initials: RM
authors.lastname: van Dam
authors.forename: Tricia
authors.initials: T
authors.lastname: Li
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality; D002908:Chronic Disease / Q000401:mortality*; D004032:Diet / Q000706:statistics & numerical data; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D009765:Obesity / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000401:mortality; D014481:United States / Q000453:epidemiology
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