Research Article: Combined Impact of Lifestyle-Related Factors on Total and Cause-Specific Mortality among Chinese Women: Prospective Cohort Study

Date Published: September 14, 2010

Publisher: Public Library of Science

Author(s): Sarah J. Nechuta, Xiao-Ou Shu, Hong-Lan Li, Gong Yang, Yong-Bing Xiang, Hui Cai, Wong-Ho Chow, Butian Ji, Xianglan Zhang, Wanqing Wen, Yu-Tang Gao, Wei Zheng, Kay-Tee Khaw

Abstract: Findings from the Shanghai Women’s Health Study confirm those derived from other, principally Western, cohorts regarding the combined impact of lifestyle-related factors on mortality.

Partial Text: Lifestyle-related factors—such as high adiposity, low or no exercise participation, unhealthy dietary habits, and environmental tobacco smoke—each have been linked to an increased risk of multiple chronic diseases and premature death [1]–[11]. However, few studies have investigated the combined impact of these lifestyle-related factors and mortality outcomes [2],[12]–[15]. Research to quantify the overall impact of lifestyle-related factors on mortality outcomes will provide important information valuable for disease prevention. A recent prospective cohort study of 77,782 participants of the Nurse’s Health Study (NHS) found a more than 4-fold increase in risk of all-cause mortality among women aged 34–59 y who reported ever smoking, a body mass index (BMI) ≥25 kg/m2, <30 min per day of physical activity, an unhealthy diet score, and heavy or no alcohol drinking, compared to women with none of these risk factors [13]. Another prospective cohort study among 20,244 British men and women aged 45–79 y similarly reported a 4-fold increase in risk of all-cause mortality for participants with no health behaviors compared to participants who had four health behaviors (nonsmoker, plasma vitamin C levels indicative of ≥5 daily servings of fruits and vegetables, moderate alcohol intake, and physically active) [14]. After an average of 9.1 y of follow-up (648,096 person-years), 2,860 deaths were identified among the 71,243 women who reported never smoking or drinking alcohol regularly, including 1,351 from cancer and 775 from CVDs. Compared to women who survived during follow-up, a higher percentage of deceased participants were classified as underweight, overweight or obese, had a higher WHR, reported not participating in exercise regularly, were exposed to spousal smoking, and had a lower daily intake of fruits and vegetables (Table 2). In this population-based prospective cohort study of Chinese women aged 40–70 y, we found that healthier lifestyle-related factors—including normal weight, lower WHR, participation in exercise, never being exposed to spousal smoking, and higher daily fruit and vegetable intake—were significantly and independently associated with lower risk of total and cause-specific mortality. Healthy lifestyle scores, composite measures of these five factors, were significantly associated with decreasing mortality as a number of healthy factors increased. The associations persisted for all women regardless of their baseline comorbidities. To our knowledge, this is the first large prospective cohort study specifically designed to quantify the combined impact of lifestyle-related factors on mortality outcomes among lifetime nonsmokers and nonalcohol drinkers. Results show that lifestyle factors other than active smoking and alcohol drinking have a major combined impact on mortality on a scale comparable to the effect of smoking as the leading cause of death in most populations [11],[13],[14]. Source:


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