title: Modifiable Healthy Lifestyle Behaviors: 10-Year Health Outcomes From a Health Promotion Program.
abstract: Previous studies have examined the impact of healthy lifestyle choices on health-related outcomes; however, given their fragmented, often cross-sectional nature, assessing the relative impact of daily modifiable behaviors on overall long-term outcomes, particularly for a diverse working adult population, remains challenging.
  
  
  
  Relationships between ten self-reported healthy lifestyle behaviors and health outcomes during the subsequent 9 years in a cohort of 10,248 participants enrolled during 2003 in a voluntary workplace wellness program were assessed. Cox proportional-hazards models computed hazard ratios (HRs) for lifestyle characteristics associated with time to one of seven self-reported chronic diseases or death. Data were collected between 2003 and 2012 and analyzed between 2014 and 2016.
  
  
  
  Behaviors that most significantly affected future outcomes were low-fat diet, aerobic exercise, nonsmoking, and adequate sleep. A dose-response effect was seen between dietary fat intake and hypertension, obesity, diabetes, heart disease, and hypercholesterolemia. After dietary fat intake, aerobic exercise was the next most significant behavior associated with development of outcomes. Compared with sedentary participants, those who exercised 4 days per week were less likely to develop new-onset diabetes (HR=0.31, 95% CI=0.20, 0.48); heart disease (HR=0.46, 95% CI=0.27, 0.80); and hypercholesterolemia (HR=0.61, 95% CI=0.50, 0.74). Low-fat diet and adequate sleep were more significant than commonly promoted healthy behaviors, such as eating a daily breakfast.
  
  
  
  Modifiable lifestyle behaviors targeted in health promotion programs should be prioritized in an evidence-based manner. Top priorities for workplace health promotion should include low-fat diet, aerobic exercise, nonsmoking, and adequate sleep.
authors.affiliation: Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University, Nashville, Tennessee. Electronic address: daniel.byrne@vanderbilt.edu.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Byrne
authors.affiliation: Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Rolando
authors.affiliation: Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Medicine, Vanderbilt University, Nashville, Tennessee; Department of Health Policy, Vanderbilt University, Nashville, Tennessee.
authors.forename: Muktar H
authors.initials: MH
authors.lastname: Aliyu
authors.affiliation: Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.
authors.forename: Paula W
authors.initials: PW
authors.lastname: McGown
authors.affiliation: Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Connor
authors.affiliation: Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Awalt
authors.affiliation: Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee.
authors.forename: Marilyn C
authors.initials: MC
authors.lastname: Holmes
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Medicine, Vanderbilt University, Nashville, Tennessee; Department of Health Policy, Vanderbilt University, Nashville, Tennessee.
authors.forename: Mary I
authors.initials: MI
authors.lastname: Yarbrough
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006293:Health Promotion / Q000706:statistics & numerical data*; D000070497:Healthy Lifestyle; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009786:Occupational Health Services; D017132:Workplace; D055815:Young Adult