title: Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality.
abstract: BACKGROUND
  Few studies have evaluated the combined impact of following recommended lifestyle behaviors on cancer, cardiovascular disease (CVD) and all-cause mortality, and most included tobacco avoidance. Because 80% of Americans are never or former smokers, it is important to consider the impact of other recommended behaviors.
  
  
  METHODS
  In 1992 and 1993, 111,966 nonsmoking men and women in the Cancer Prevention Study-II Nutrition Cohort completed diet and lifestyle questionnaires. A score ranging from 0 to 8 points was computed to reflect adherence to the American Cancer Society cancer prevention guidelines on body mass index, physical activity, diet, and alcohol consumption, with 8 points representing optimal adherence. Multivariable-adjusted relative risks (RR) of death and 95% CI were computed by Cox proportional hazard regression.
  
  
  RESULTS
  During 14 years of follow-up, 10,369 men and 6,613 women died. The RR of all-cause mortality was lower for participants with high (7, 8) versus low (0-2) scores (men, RR = 0.58, 95% CI: 0.53-0.62; women, RR = 0.58, 95% CI: 0.52-0.64). Inverse associations were found with CVD mortality (men, RR = 0.52, 95% CI: 0.45-0.59; women, RR = 0.42, 95% CI: 0.35-0.51) and cancer mortality (men, RR = 0.70, 95% CI: 0.61-0.80; women, RR = 0.76, 95% CI: 0.65-0.89). Similar associations, albeit not all statistically significant, were observed for never and former smokers.
  
  
  CONCLUSIONS
  Adherence to cancer prevention guidelines for obesity, diet, physical activity, and alcohol consumption is associated with lower risk of death from cancer, CVD, and all causes in nonsmokers.
  
  
  CONCLUSIONS
  Beyond tobacco avoidance, following other cancer prevention guidelines may substantially lower risk of premature mortality in older adults.
authors.affiliation: 1Epidemiology Research Program, American Cancer Society, Atlanta, Georgia 30303-1002, USA. marji.mccullough@cancer.org
authors.forename: Marjorie L
authors.initials: ML
authors.lastname: McCullough
authors.forename: Alpa V
authors.initials: AV
authors.lastname: Patel
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Kushi
authors.forename: Roshni
authors.initials: R
authors.lastname: Patel
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.forename: Colleen
authors.initials: C
authors.lastname: Doyle
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thun
authors.forename: Susan M
authors.initials: SM
authors.lastname: Gapstur
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D004032:Diet; D015444:Exercise; D005260:Female; D006287:Health Planning Guidelines; D006801:Humans; D008019:Life Style; D008297:Male; D009369:Neoplasms / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D018570:Risk Assessment; D016540:Smoking Cessation; D015996:Survival Rate