title: Adherence to a healthy lifestyle and all-cause mortality in CKD.
abstract: OBJECTIVE
  Among general populations, a healthy lifestyle has been associated with lower risk of death. This study evaluated this association in individuals with CKD.
  
  
  METHODS
  A total of 2288 participants with CKD (estimated GFR < 60 ml/min per 1.73 m(2) or microalbuminuria) in the Third National Health and Nutrition Examination Survey were included. A weighted healthy lifestyle score was calculated (range, -4 to 15, with 15 indicating healthiest lifestyle) on the basis of the multivariable Cox proportional hazards model regression coefficients of the following lifestyle factors: smoking habit, body mass index (BMI), physical activity, and diet. Main outcome was all-cause mortality, ascertained through December 31, 2006.
  
  
  RESULTS
  After median follow-up of 13 years, 1319 participants had died. Compared with individuals in the lowest quartile of weighted healthy lifestyle score, adjusted hazard ratios (95% confidence intervals) of all-cause mortality were 0.53 (0.41-0.68), 0.52 (0.42-0.63), and 0.47 (0.38-0.60) for individuals in the second, third, and fourth quartiles, respectively. Mortality increased 30% among individuals with a BMI of 18.5 to <22 kg/m(2) versus 22 to <25 kg/m(2) (P<0.05); decreased mortality was associated with never-smoking versus current smoking (0.54 [0.41-0.70]) and regular versus no physical activity (0.80 [0.65-0.99]). Diet was not significantly associated with mortality.
  
  
  CONCLUSIONS
  Compared with nonadherence, adherence to a healthy lifestyle was associated with lower all-cause mortality risk in CKD. Examination of individual components of the healthy lifestyle score, with adjustment for other components, suggested that the greatest reduction in all-cause mortality was related to nonsmoking.
authors.affiliation: Department of Medicine, ivision of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, IL 60612, USA. aricar2@uic.edu
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ricardo
authors.forename: Magdalena
authors.initials: M
authors.lastname: Madero
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Cheryl
authors.initials: C
authors.lastname: Anderson
authors.forename: Matthew
authors.initials: M
authors.lastname: Menezes
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fischer
authors.forename: Mary
authors.initials: M
authors.lastname: Turyk
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
mesh_terms: D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000401:mortality*; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D014481:United States / Q000453:epidemiology