title: Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey.
abstract: BACKGROUND
  Physical activity, diet, smoking, and alcohol consumption have been shown to be related to mortality. We examined prospectively the individual and combined influence of these risk factors on total and cause-specific mortality.
  
  
  METHODS
  The prospective cohort study included 4886 individuals at least 18 years old from a United Kingdom-wide population in 1984 to 1985. A health behavior score was calculated, allocating 1 point for each poor behavior: smoking; fruits and vegetables consumed less than 3 times daily; less than 2 hours physical activity per week; and weekly consumption of more than 14 units of alcohol (in women) and more than 21 units (in men) (range of points, 0-4). We examined the relationship between health behaviors and mortality using Cox models and compared it with the mortality risk associated with aging.
  
  
  RESULTS
  During a mean follow-up period of 20 years, 1080 participants died, 431 from cardiovascular diseases, 318 from cancer, and 331 from other causes. Adjusted hazard ratios and 95% confidence intervals (CIs) for total mortality associated with 1, 2, 3, and 4 poor health behaviors compared with those with none were 1.85 (95% CI, 1.28-2.68), 2.23 (95% CI, 1.55-3.20), 2.76 (95% CI, 1.91-3.99), and 3.49 (95% CI, 2.31-5.26), respectively (P value for trend, <.001). The effect of combined health behaviors was strongest for other deaths and weakest for cancer mortality. Those with 4 compared with those with no poor health behaviors had an all-cause mortality risk equivalent to being 12 years older.
  
  
  CONCLUSIONS
  The combined effect of poor health behaviors on mortality was substantial, indicating that modest, but sustained, improvements to diet and lifestyle could have significant public health benefits.
authors.affiliation: Department of Nutrition, University of Oslo, PO Box 1046 Blindern, N-0316 Oslo, Norway. ekvaavik@medisin.uio.no
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kvaavik
authors.forename: G David
authors.initials: GD
authors.lastname: Batty
authors.forename: Giske
authors.initials: G
authors.lastname: Ursin
authors.forename: Rachel
authors.initials: R
authors.lastname: Huxley
authors.forename: Catharine R
authors.initials: CR
authors.lastname: Gale
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000401:mortality; D015984:Causality; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D004032:Diet; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D018570:Risk Assessment; D012737:Sex Factors; D012907:Smoking / Q000401:mortality; D011795:Surveys and Questionnaires; D006113:United Kingdom