Published 16 September 2008, doi:10.1136/bmj.a1440
Cite this as: BMJ 2008;337:a1440

Research

Combined impact of lifestyle factors on mortality: prospective cohort study in US women

Rob M van Dam, assistant professor of medicine1,2, Tricia Li, research fellow1, Donna Spiegelman, professor of epidemiology and biostatistics3,4, Oscar H Franco, researcher5, Frank B Hu, professor of nutrition and epidemiology1,2,3

1 Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA, 2 Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston MA 02115, 3 Department of Epidemiology, Harvard School of Public Health, 4 Department of Biostatistics, Harvard School of Public Health, 5 Unilever Corporate Research, Sharnbrook, Bedfordshire MK44 1LQ

Correspondence to: R van Dam rvandam{at}hsph.harvard.edu

Objective To evaluate the impact of combinations of lifestyle factors on mortality in middle aged women.

Design Prospective cohort study.

Setting Nurses’ health study, United States.

Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980.

Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors (cigarette smoking, being overweight, taking little moderate to vigorous physical activity, no light to moderate alcohol intake, and low diet quality score).

Results 8882 deaths were documented, including 1790 from cardiovascular disease and 4527 from cancer. Each lifestyle factor independently and significantly predicted mortality. Relative risks for five compared with zero lifestyle risk factors were 3.26 (95% confidence interval 2.45 to 4.34) for cancer mortality, 8.17 (4.96 to 13.47) for cardiovascular mortality, and 4.31 (3.51 to 5.31) for all cause mortality. A total of 28% (25% to 31%) of deaths during follow-up could be attributed to smoking and 55% (47% to 62%) to the combination of smoking, being overweight, lack of physical activity, and a low diet quality. Additionally considering alcohol intake did not substantially change this estimate.

Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower mortality in middle aged women. Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified.


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors
Eric B Rimm, Paige Williams, Kerry Fosher, Michael Criqui, and Meir J Stampfer
BMJ 1999 319: 1523-1528. [Abstract] [Full Text] [PDF]

Ecological analysis of collectivity of alcohol consumption in England: importance of average drinker
Helen Colhoun, Yoav Ben-Shlomo, Wei Dong, Lulu Bost, and Michael Marmot
BMJ 1997 314: 1164. [Abstract] [Full Text]

This article has been cited by other articles:

  • van Dam, R. M., Willett, W. C. (2009). Unmet Potential for Cardiovascular Disease Prevention in the United States. Circulation 120: 1171-1173 [Full text]  
  • Terre, L. (2009). Communicating Cancer Risk Reduction. AMERICAN JOURNAL OF LIFESTYLE MEDICINE 3: 362-364 [Abstract]  
  • Ferrie, J E, Singh-Manoux, A, Kivimaki, M, Mindell, J, Breeze, E, Smith, G D., Shipley, M J (2009). Cardiorespiratory risk factors as predictors of 40-year mortality in women and men. Heart 95: 1250-1257 [Abstract] [Full text]  
  • Garcia-Aymerich, J., Varraso, R., Anto, J. M., Camargo, C. A. Jr. (2009). Prospective Study of Physical Activity and Risk of Asthma Exacerbations in Older Women. Am. J. Respir. Crit. Care Med. 179: 999-1003 [Abstract] [Full text]  
  • Polkey, M. I., Rabe, K. F. (2009). Chicken or egg: physical activity in COPD revisited. Eur Respir J 33: 227-229 [Full text]  
  • (2008). Nurses' Health Study Confirms Lifestyle Factors Associated with Excess Mortality Risk. JWatch General 2008: 4-4 [Full text]  
  • (2008). Healthy Lifestyle's Effect on Mortality Risk. JWatch Women's Health 2008: 1-1 [Full text]  

Rapid Responses:

Read all Rapid Responses

Does extremely vigorous exercise deserve a distinct risk stratification?
Edoardo Cervoni
bmj.com, 17 Sep 2008 [Full text]
Would the Nurses health study be able to tell us how quickly the benefits of a change in lifestyle appear?
Anita C Roy, et al.
bmj.com, 8 Oct 2008 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ