Sustained enjoyment of life and mortality at older ages: analysis of the English Longitudinal Study of Ageing

Which one Matters at Older Ages? Wellbeing, Activity, Or Diet?

Zaninotto P, et al investigated whether the number of reports of enjoyment of life over a four year period is quantitatively associated with all cause mortality, and with death from cardiovascular disease and from other causes. They reported that mortality was inversely associated with the number of occasions on which participants reported high enjoyment of life. Compared with the no high enjoyment group, the hazard ratio for all cause mortality was 0.83 (95% confidence interval 0.70 to 0.99) for two reports of enjoyment of life, and 0.76 (0.64 to 0.89) for three reports, after adjustment for demographic factors, baseline health, mobility impairment, and depressive symptoms. It pointed out the importance of sustained wellbeing over several years and all cause mortality.1

Elderly population is increasing fast and life expectancy is longer. They want to live healthy until dying. General recommendations with a confirmed evidence have been released. Nonetheless, pretty many dietary supplements are widespread and many people are taking them. Money spent for them is uncountable. It should be noted that recent three studies reported no effectiveness of supplementation with a multivitamin.2-4 These would suggest that supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful and therefore, these vitamins should not be used for chronic disease prevention.5-7

On the other hand, the dose-response associations between total physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events8 and dietary fibre intake and any potential dose-response association with coronary heart disease and cardiovascular disease9. They observed that total physical activity were significantly associated with lower risk for all outcomes, major gains occurred at lower levels of activity (up to 3000-4000 metabolic equivalent (MET) minutes/week) and that total dietary fibre intake was inversely associated with risk of cardiovascular disease (risk ratio 0.91 per 7 g/day) and coronary heart disease (0.91). Further, insoluble fibre and fibre from cereal and vegetable sources were inversely associated with risk of coronary heart disease and cardiovascular disease. Indeed, no statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes. They concluded that although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.10

All these studies points the importance of wellbeing and therapeutic life style changes mostly consisting of healthy diet and regular exercise compared with drugs intervention.11

Funding: None, Disclosures: None

REFERENCES
1. Zaninotto P, Wardle J, Steptoe A. Sustained enjoyment of life and mortality at older ages: analysis of the English Longitudinal Study of Ageing. BMJ 2016;355:i6267.

2. Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: an updated systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2013; 159:824-834.

3. Lamas GA, Boineau R, Goertz C, Mark DB, Rosenberg Y, Stylianou M, et al, for the TACT (Trial to Assess Chelation Therapy) Investigators. Oral high-dose multivitamins and minerals after myocardial infarction: a randomized trial. Ann Intern Med 2013;159:797-805.

4. Grodstein F, O’Brien J, Kang JH, Dushkes R, Cook NR, Okereke O, et al. Long-term multivitamin supplementation and cognitive function in men: a randomized trial Ann Intern Med 2013;159:806-814.

5. Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER, III. Enough is enough: stop wasting money on vitamin and mineral supplements. Ann Intern Med 2013;159:850-851.

6. Koh KK. Reconfirm to follow guidelines to prevent cardiovascular diseases.
BMJ 2016, Published on 5 March 2016, http://www.bmj.com/content/352/bmj.i721/rr-0

7. Koh KK. Which one matters? Lower or higher levels of activity? Or diet? BMJ 2016, Published 12 August 2016, http://www.bmj.com/content/354/bmj.i3857/rr-2.

8. Kyu H, Bachman V, Alexander L, et al. Physical activity and risks of breast cancer, colon
cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review
and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ
2016;354:i3857.

9. Threapleton DE, Greenwood DC, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, et al. Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 2013;347:f6879.

10. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug
interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347:f5577.

11. Koh KK. What should we do to reduce the risk of all cause and cause-specific mortality? BMJ 2016, Published 27 November 2016, http://www.bmj.com/content/355/bmj.i5855/rr-0