Most people probably realize that healthy lifestyle choices can postpone or avoid major chronic diseases. But most people probably don’t realize that embracing multiple healthy lifestyle choices predicts huge reductions in risks of chronic diseases. The following widely cited studies, all published in top journals, highlight the upside that you can expect … if you get on the healthy lifestyle choices bandwagon. We’re talking about postponing or avoiding premature death, coronary heart disease, heart attack, diabetes, heart attack death, and cancer.
Coronary heart disease in women
Back in 2000, several lifestyle factors, including not smoking, moderate body mass index, moderate or vigorous physical inactivity, moderate alcohol intake, and a healthy diet, individually predicted lower risk of coronary heart disease. Would people who embrace all of these lifestyle factors enjoy greatly reduced risk of coronary heart events (heart attack or death due to coronary heart disease)? Researchers at Harvard used data from 84,129 women in the Nurses’ Health Study who were followed for 14 years to find out. As expected, all 5 healthy lifestyle factors independently predicted lower risk of a coronary event. After adjusting for confounding factors and compared to women who had zero healthy lifestyle factors, women who had all 5 healthy lifestyle factors had a whopping 83 percent lower risk of having a coronary event during follow-up. Compared to women with zero healthy lifestyle factors, women with 1 or 2 or 3 or 4 or 5 healthy lifestyle factors had progressively lower risks of a coronary event in a step-wise manner, suggesting cause-and-effect. Thus, even just one lifestyle factor predicted lower risk of a coronary event, but the huge payoff arose for embracing all five.
Coronary heart disease in men
Research has identified several healthy lifestyle habits that individually predict coronary heart disease in US women. But until recently, little was known about the joint effects of multiple healthy habits on the risk of coronary heart disease on middle-aged men, especially those taking drugs to reduce blood pressure or cholesterol. Researchers at Harvard used data from 42,847 men aged 40-75 years at baseline in the Health Professionals Follow-up Study to address this shortcoming. The researchers defined health lifestyle habits as 1) not currently smoking, 2) moderate body mass (BMI < 25), 3) modest alcohol consumption (less than 1 to about 2 drinks per day), 4) active physically (> 30 minutes per week of moderate-intensity or strenuous exercise), and 5) good diet (scoring in the top 40 percent of adherence to the Alternative Healthy Eating Index).
Over 16 years of follow-up, men who had all five healthy habits had an 87 percent lower risk of coronary heart disease compared to those who lacked any healthy habits. The relative risk declined in a progressive manner as the number of healthy habits increased from 1 to 5 for medication users and non-medication users alike. Extrapolating the trend of relative risk to six health habits suggested zero relative risk of coronary heart disease. On average, those who adopted all five healthy habits would avoid 62 percent of coronary heart disease incidents. For medication users, the value was 57 percent. Thus, over half of the observed coronary heart disease could have been prevented by adopting healthy habits.
Interestingly, those who adopted two more healthy habits during the study reduced their relative risk of coronary heart disease, while those who eliminated two healthy habits increased their relative risk. The health professionals in this study probably followed better health habits than people in the general US population. Thus, the beneficial effects of adopting all five of these healthy habits would likely be even greater across the entire US population. A mere 4 percent of the participants in the Health Professionals Follow-up Study exhibited all five healthy habits. There’s lots of room for improvement.
Type 2 diabetes
Diabetes accounts for a significant portion of the US medical care burden, not to mention the toll of human suffering. Researchers wondered how much modifiable lifestyle factors contribute to the surge of diabetes in America. Data from 84,941 women who participated in the Nurses’ Health Study addressed this question. In 1976, the nurses responded to a questionnaire that requested medical, lifestyle, and other health-related information. Beginning in 1980, dietary information was included.
In 1990 after 16 years of follow-up, body mass index explained more of the risk of type 2 diabetes that any other risk factor, with 61 percent of the nurses’ diabetes cases attributable to BMI greater than 25 (in the overweight or obesity category). Lack of exercise, current smoking, and abstinence from alcohol were all associated with significant risk of diabetes, even after for adjusting for body-mass index. Collectively, 91 percent of the nurses’ cases of diabetes could be prevented by weight loss, physical exercise, improved diet, consumption of moderate of alcohol, and not smoking, If the nurses had adopted other healthy lifestyle factors, such as cultivate social connections, would diabetes have been effectively eliminated?
Premature death, diabetes, heart attack, stroke, cancer
Studies published in the early 2000s showed that healthy lifestyle factors could dramatically lower risks of cardiovascular disease, diabetes, and cancer in Americans. An international team of scientists extended this line of research to determine whether four healthy lifestyle factors would predict subsequent risks of four leading causes of illness and death (coronary heart disease, diabetes, stroke, cancer) in German subjects. Data came from 23,153 men and women residents of Potsdam, Germany, with an average of 49 years (range 40-65) at baseline in the European Prospective Investigation into Cancer and Nutrition – Potsdam. The four healthy lifestyle factors included 1) never smoking, 2) body mass index of less than 30 (normal weight or overweight, 3) engaging in 30 minutes or more of daily physical activity, and 4) a high-quality diet that favored more vegetables, fruits, whole grain bread, and less red meat.
After adjusting for confounding factors, participants who had all four healthy lifestyle factors had a significant 78 percent lower risk of developing cancer, diabetes, heart attack or stroke during 8 years of follow-up. As the number of healthy lifestyle factors increased from zero to four, the risk of developing these chronic diseases declined in a step-wise manner, suggesting cause-and-effect. The effect of healthy lifestyle factors was most pronounced for diabetes, with a 93 percent lower risk for participants with all four healthy lifestyle choices. Ponder the previous sentence for a moment. It means that type 2 diabetes is almost entirely preventable with healthy lifestyle choices. This is huge!
Stroke
Stroke is the third leading cause of death in the US. Non-fatal stroke is a leading cause of permanent disability and decreased quality of life. While a healthy lifestyle is associated with lower risk of cardiovascular disease and diabetes, little is known about the effect of healthy lifestyle behaviors on stroke. Researchers at Harvard used data from the Nurses’ Health Study and the Health Professionals Follow-up Study to address this point. The researchers defined health lifestyle habits as 1) not smoking, 2) moderate body mass (BMI < 25), 3) modest alcohol consumption (less than 1 to 2 drinks per day for men and less than 1 drink per day for women), 4) active physically (> 30 minutes per week of moderate-intensity exercise), and 5) good diet (scoring in the top 40 percent of adherence to the Alternative Healthy Eating Index). At baseline, the mean age of participants was 50 years for women and 54 years for men.
Women and men who had all five healthy habits had a 79 and 81 percent lower risk of stroke, respectively, during 18 years of follow-up, compared to those who lacked any healthy habits. The risk of stroke for women declined in a progressive manner as the number of healthy habits increased from 1 to 5. Men exhibited a similar pattern. Both studies involved health professionals, people who presumably followed better health habits that people in the general population. Thus, the beneficial effects of adopting all five of these healthy habits would likely be even greater across the entire US population.
Sudden cardiac death
Would women who embrace multiple healthy lifestyle choices greatly reduce their risk of a fatal heart attack? To find out, researchers at Harvard used data from 81,722 women in the Nurse’s Health Study, which began in 1984 and continued until 2010. Low-risk lifestyle included 1) not smoking, 2) body mass index < 25 (normal weight), 3) exercise > 30 minutes per day, and 4) in the top 40 percent of the Alternate Mediterranean Diet Score, which emphasizes high intake of vegetables, fruits, nuts, legumes, whole grains, fish, and moderate alcohol. Women at low risk for all four factors had a 92 percent lower risk of a fatal heart attack compared to women with no low-risk factors. If the associations are causal, 81 percent of the heart attack deaths could theoretically have been prevented if all women had adhered to a low-risk lifestyle. While 80 percent of American women don’t smoke, adherence to other healthful habits is low.
What to do
Find one healthy lifestyle choice that you can see yourself embracing and which you believe would improve your overall health and well-being. At least in the beginning, the best healthy lifestyle choice for you is the one that you will actually embrace and incorporate into your daily life. You could select one the healthy choices in the studies you’ve just read or you could choose another one featured in my book, Choose Better, Live Better – Nine Healthy Choices that Nurture Body, Mind, and Spirit. After you’ve incorporated your healthy lifestyle choice into your everyday life, pick another healthy choice and embrace it, then another. You’ll likely live better and longer.
