ArticleEuropean journal of epidemiology2013
Healthy lifestyle behaviors and decreased risk of mortality in a large prospective study of U.S. women and men.
Article in European journal of epidemiology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 4 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
37 citing papers in PubMed, 4 syntheses or guidelines pooled it, 99 citations in OpenAlex.
- The influence of socioeconomic status on the association between unhealthy lifestyle factors and adverse health outcomes: a systematic review.Wellcome open research · 2023Pooled it
- Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review.JAMA network open · 2021Pooled it
- The impact of physical activity and an additional behavioural risk factor on cardiovascular disease, cancer and all-cause mortality: a systematic review.BMC public health · 2019Pooled it
- Pooled it
- Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial.Translational behavioral medicine · 2021Trial
- Multiple approaches to associations of physical activity and adherence to the Mediterranean diet with all-cause mortality in older adults: the PREvención con DIeta MEDiterránea study.European journal of nutrition · 2019Trial
- A Lifestyle Behavior Score Predicting Cardiovascular and Other Causes of Death in a Cohort of Middle-Aged Men Followed up Until Extinction.Journal of cardiovascular development and disease · 2026Article
- Plant-based diets and mortality in Black and low-income Americans: findings from a large prospective cohort study.The American journal of clinical nutrition · 2025Article
- Association between healthy lifestyle and cognitive decline, all-cause mortality, and mortality from cardiovascular and cerebrovascular diseases: a 10-year population-based prospective cohort study.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- Co-occurrence of behavioural risk factors for non-communicable diseases and mortality risk in Spain: a population-based cohort study.BMJ open · 2025Article
- Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program.BMC public health · 2024Article
- Associations between Liver Enzymes, Lifestyle Risk Factors and Pre-Existing Medical Conditions in a Population-Based Cross-Sectional Sample.Journal of clinical medicine · 2023Article
- Associations of dietary and lifestyle inflammation scores with mortality due to CVD, cancer, and all causes among Black and White American men and women.The British journal of nutrition · 2023Article
- First Clinical Nutrition Outpatient Consultation: A Review of Basic Principles in Nutritional Care of Adults with Hematologic Disease.TheScientificWorldJournal · 2023Review
- Impact of Physical Activity on the Characteristics and Metabolic Consequences of Alcohol Consumption: A Cross-Sectional Population-Based Study.International journal of environmental research and public health · 2022Article
- Effects of lifestyle risk behaviour clustering on cardiovascular disease among UK adults: latent class analysis with distal outcomes.Scientific reports · 2022Article
- Differential associations among social support, health promoting behaviors, health-related quality of life and subjective well-being in older and younger persons: a structural equation modelling approach.Health and quality of life outcomes · 2022Article
- Prevalence and co-occurrence of lifestyle risk factors for non-communicable diseases according to sociodemographic characteristics among adults Chilean residents.Scientific reports · 2021Article
- A novel evolutionary-concordance lifestyle score is inversely associated with all-cause, all-cancer, and all-cardiovascular disease mortality risk.European journal of nutrition · 2021Article
- Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain.Cardiovascular diabetology · 2021Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Adiposity, insufficient physical activity, cigarette smoking, and poor diet have all been related independently to increased chronic disease risk, but their joint impact on overall health remains unclear. In a cohort of 170,672 women and men aged 51-71 years at baseline in 1996/1997 and followed-up through 2009, we investigated the individual and joint impact of four low-risk lifestyle factors: abdominal leanness (waist circumference <88 cm in women and <102 cm in men); recommended physical activity level (30 min or more of moderate exercise at least 5 times per week or 20 min or more of vigorous exercise at least 3 times per week); long-term non-smoking (never-smoker or quit smoking more than 10 years ago); and healthy diet (Mediterranean diet score within the upper two sex-specific quintiles). During 2,126,089 person-years of follow-up, 20,903 participants died. In multivariate Cox models, statistically significant decreased risks of mortality were observed for the low-risk factors abdominal leanness (relative risk (RR) = 0.86; 95 % confidence interval (CI) = 0.83-0.89), physical activity (RR = 0.86; 95 % CI = 0.84-0.89), non-smoking (RR = 0.43; 95 % CI = 0.42-0.45), and healthy diet (RR = 0.86; 95 % CI = 0.83-0.88). The larger the number of low-risk lifestyle factors, the lower was the mortality risk. The RR comparing adherence to all versus none of the factors was 0.27 (95 % CI = 0.25-0.29). We estimate that 33 % (95 % CI = 30-35 %) of deaths in our cohort were premature and could have been avoided if all study participants had adhered to all low-risk factors.
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