Combined impact of lifestyle factors on mortality: prospective cohort study in US women.
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.
van Dam
Rob M
RM
Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA. rvandam@hsph.harvard.edu
Li
Tricia
T
Spiegelman
Donna
D
Franco
Oscar H
OH
Hu
Frank B
FB
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
JAMA. 1998 Feb 18;279(7):535-40
9480365
Am J Med. 2002 Dec 30;113 Suppl 9B:13S-24S
12566134
Cancer Causes Control. 2007 Jun;18(5):571-9
17387622
Ann Intern Med. 2005 Feb 15;142(4):233-9
15710956
Am J Clin Nutr. 2002 May;75(5):848-55
11976158
Am J Epidemiol. 1999 Mar 15;149(6):531-40
10084242
Am J Clin Nutr. 2002 Dec;76(6):1261-71
12450892
JAMA. 1987 Jan 16;257(3):353-8
3795418
Am J Clin Nutr. 2003 May;77(5):1146-55
12716665
JAMA. 2004 Sep 22;292(12):1433-9
15383513
Am J Epidemiol. 1994 Aug 15;140(4):303-9
8059765
Arch Intern Med. 1998 Dec 7-21;158(22):2433-40
9855381
PLoS Med. 2008 Jan 8;5(1):e12
18184033
J Natl Cancer Inst. 2004 Jan 21;96(2):99-106
14734699
Biometrics. 1993 Sep;49(3):865-72
8241375
Int J Epidemiol. 1994 Oct;23(5):991-9
7860180
BMJ. 1999 Dec 11;319(7224):1523-8
10591709
Lancet. 1994 Jun 11;343(8911):1454-9
7911176
N Engl J Med. 2001 Sep 13;345(11):790-7
11556298
N Engl J Med. 2000 Jul 6;343(1):16-22
10882764
Am J Epidemiol. 1994 Dec 1;140(11):1016-9
7985649
JAMA. 2006 Apr 5;295(13):1549-55
16595758
Public Health Nutr. 2004 Feb;7(1A):187-200
14972060
Am J Epidemiol. 1991 Apr 15;133(8):810-7
2021148
N Engl J Med. 1997 Apr 17;336(16):1117-24
9099655
JAMA. 1995 Feb 1;273(5):402-7
7823386
Epidemiology. 1990 Nov;1(6):466-73
2090285
N Engl J Med. 2001 May 3;344(18):1343-50
11333990
N Engl J Med. 1995 May 11;332(19):1245-50
7708067
J Natl Cancer Inst. 1997 Jul 2;89(13):948-55
9214674
Int J Epidemiol. 1989 Dec;18(4):858-67
2621022
BMJ. 1997 Apr 19;314(7088):1164-8
9146389
Alcohol Res Health. 2003;27(1):39-51
15301399
JAMA. 2004 Mar 10;291(10):1238-45
15010446
Stat Med. 1990 Dec;9(12):1501-15
2281238
Arch Intern Med. 2006 Dec 11-25;166(22):2437-45
17159008
Biometrics. 2005 Sep;61(3):847-55
16135037
World Health Organ Tech Rep Ser. 2000;894:i-xii, 1-253
11234459
Prev Med. 2004 May;38(5):613-9
15066364