title: Lifestyle factors and multimorbidity: a cross sectional study.
abstract: BACKGROUND
  Lifestyle factors have been associated mostly with individual chronic diseases. We investigated the relationship between lifestyle factors (individual and combined) and the co-occurrence of multiple chronic diseases.
  
  
  METHODS
  Cross-sectional analysis of results from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) in Quebec, Canada. Subjects aged 45 years and older. A randomly-selected cohort in the general population recruited by telephone. Multimorbidity (3 or more chronic diseases) was measured by a simple count of self-reported chronic diseases from a list of 14. Five lifestyle factors (LFs) were evaluated: 1) smoking habit, 2) alcohol consumption, 3) fruit and vegetable consumption, 4) physical activity, and 5) body mass index (BMI). Each LF was given a score of 1 (unhealthy) if recommended behavioural targets were not achieved and 0 otherwise. The combined effect of unhealthy LFs (ULFs) was evaluated using the total sum of scores.
  
  
  RESULTS
  A total of 1,196 subjects were analyzed. Mean number of ULFs was 2.6 ± 1.1 SD. When ULFs were considered separately, there was an increased likelihood of multimorbidity with low or high BMI [Odd ratio (95% Confidence Interval): men, 1.96 (1.11-3.46); women, 2.57 (1.65-4.00)], and present or past smoker [men, 3.16 (1.74-5.73)]. When combined, in men, 4-5 ULFs increased the likelihood of multimorbidity [5.23 (1.70-16.1)]; in women, starting from a threshold of 2 ULFs [1.95 (1.05-3.62)], accumulating more ULFs progressively increased the likelihood of multimorbidity.
  
  
  CONCLUSIONS
  The present study provides support to the association of lifestyle factors and multimorbidity.
authors.affiliation: Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada. Martin.Fortin@USherbrooke.ca.
authors.forename: Martin
authors.initials: M
authors.lastname: Fortin
authors.forename: Jeannie
authors.initials: J
authors.lastname: Haggerty
authors.forename: José
authors.initials: J
authors.lastname: Almirall
authors.forename: Tarek
authors.initials: T
authors.lastname: Bouhali
authors.forename: Maxime
authors.initials: M
authors.lastname: Sasseville
authors.forename: Martin
authors.initials: M
authors.lastname: Lemieux
mesh_terms: D000368:Aged; D000428:Alcohol Drinking; D015992:Body Mass Index; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004032:Diet; D015444:Exercise; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D011792:Quebec; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D013851:Thinness / Q000150:complications; D014675:Vegetables