title: The combined impact of adherence to five lifestyle factors on all-cause, cancer and cardiovascular mortality: a prospective cohort study among Danish men and women.
abstract: Individual lifestyle factors have been associated with lifestyle diseases and premature mortality by an accumulating body of evidence. The impact of a combination of lifestyle factors on mortality has been investigated in several studies, but few have applied a simple index taking national guidelines into account. The objective of the present prospective cohort study was to investigate the combined impact of adherence to five lifestyle factors (smoking, alcohol intake, physical activity, waist circumference and diet) on all-cause, cancer and cardiovascular mortality based on international and national health recommendations. A Cox proportional hazards model was used to estimate hazard ratios (HR) with 95 % CI. During a median follow-up of 14 years, 3941 men and 2827 women died. Among men, adherence to one additional health recommendation was associated with an adjusted HR of 0·73 (95 % CI 0·71, 0·75) for all-cause mortality, 0·74 (95 % CI 0·71, 0·78) for cancer mortality and 0·70 (95 % CI 0·65, 0·75) for cardiovascular mortality. Among women, the corresponding HR was 0·72 (95 % CI 0·70, 0·75) for all-cause mortality, 0·76 (95 % CI 0·73, 0·80) for cancer mortality and 0·63 (95 % CI 0·57, 0·70) for cardiovascular mortality. In the present study, adherence to merely one additional health recommendation had a protective effect on mortality risk, indicating a huge potential in enhancing healthy lifestyle behaviours of the population.
authors.affiliation: Danish Cancer Society Research Center,Strandboulevarden 49,2100Copenhagen Ø,Denmark.
authors.forename: Kristina E N
authors.initials: KE
authors.lastname: Petersen
authors.affiliation: Danish Cancer Society Research Center,Strandboulevarden 49,2100Copenhagen Ø,Denmark.
authors.forename: Nina F
authors.initials: NF
authors.lastname: Johnsen
authors.affiliation: Danish Cancer Society Research Center,Strandboulevarden 49,2100Copenhagen Ø,Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.affiliation: Danish Cancer Society Research Center,Strandboulevarden 49,2100Copenhagen Ø,Denmark.
authors.forename: Vanna
authors.initials: V
authors.lastname: Albieri
authors.affiliation: Danish Cancer Society Research Center,Strandboulevarden 49,2100Copenhagen Ø,Denmark.
authors.forename: Lise K H
authors.initials: LK
authors.lastname: Olsen
authors.affiliation: Department of Nutrition,Exercise and Sports, Faculty of Science, University of Copenhagen,Copenhagen,Denmark.
authors.forename: Lars O
authors.initials: LO
authors.lastname: Dragsted
authors.affiliation: Section of Epidemiology, Department of Public Health,Aarhus University,Aarhus,Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Danish Cancer Society Research Center,Strandboulevarden 49,2100Copenhagen Ø,Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Danish Cancer Society Research Center,Strandboulevarden 49,2100Copenhagen Ø,Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Egeberg
mesh_terms: D064829:Alcohol Abstinence; D000428:Alcohol Drinking / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009043:Motor Activity; D009369:Neoplasms / Q000209:etiology / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy; D018673:Nutrition Policy; D050177:Overweight / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D010349:Patient Compliance; D011446:Prospective Studies; D016540:Smoking Cessation; D055105:Waist Circumference; D015431:Weight Loss
keywords: Recommendations