. 2020 Jan 8:368:l6669.

doi: 10.1136/bmj.l6669.

Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study

Yanping Li¹, Josje Schoufour^{2

3}, Dong D Wang¹, Klodian Dhana^{1

4}, An Pan⁵, Xiaoran Liu¹, Mingyang Song^{1

6

7

8}, Gang Liu^{1

9}, Hyun Joon Shin¹⁰, Qi Sun^{1

11}, Laila Al-Shaar¹, Molin Wang⁶, Eric B Rimm^{1

11}, Ellen Hertzmark¹², Meir J Stampfer^{1

6

11}, Walter C Willett^{1

6

11}, Oscar H Franco^{2

13}, Frank B Hu^{1

6

11}

Affiliations

¹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
² Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.
³ Faculty of Sports and Nutrition, ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.
⁴ Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
⁵ Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
⁹ Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁰ Division of General Internal Medicine, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
¹¹ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹² Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹³ Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.

PMID: 31915124
PMCID: PMC7190036
DOI: 10.1136/bmj.l6669

Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study

Yanping Li et al. BMJ. 2020.

. 2020 Jan 8:368:l6669.

doi: 10.1136/bmj.l6669.

Authors

Affiliations

¹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
² Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.
³ Faculty of Sports and Nutrition, ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.
⁴ Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
⁵ Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
⁹ Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁰ Division of General Internal Medicine, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
¹¹ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹² Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹³ Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.

PMID: 31915124
PMCID: PMC7190036
DOI: 10.1136/bmj.l6669

Abstract

Objective: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases.

Design: Prospective cohort study.

Setting and participants: The Nurses' Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366).

Main exposures: Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%).

Main outcome: Life expectancy free of diabetes, cardiovascular diseases, and cancer.

Results: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50.

Conclusion: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: support from the National Institutes of Health; YL has receiving research support from the California Walnut Commission; AP has received research support from BY-HEALTH outside of the submitted work; FBH has received research support from the California Walnut Commission, and honorariums for lectures from Metagenics and Standard Process, and honorariums from Diet Quality Photo Navigation, outside the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

Figures

**Fig 1**
Estimated life expectancy at age 50 years with and without cancer, cardiovascular disease (CVD), and/or type 2 diabetes among participants of Nurses’ Health Study (women) and Health Professionals Follow-up Study (men) according to number of low risk lifestyle factors. Low risk lifestyle factors included cigarette smoking (never smoking), physical activity (≥3.5 hours/week moderate to vigorous intensity activity), high diet quality (upper 40% of Alternate Healthy Eating Index), moderate alcohol intake of 5-15 g/day (women) or 5-30 g/day (men), and normal weight (body mass index <25). Estimates of multivariate adjusted hazard ratios (sex specific) for morbidity and mortality associated with low risk lifestyles compared with people with zero low risk lifestyle factors adjusted for age, ethnicity, current multivitamin use, current aspirin use, family history of diabetes, myocardial infarction, or cancer, and menopausal status and hormone use (women only)

**Fig 2**
Estimated life expectancy at age 50 years with and without cancer, cardiovascular disease (CVD), and/or type 2 diabetes among participants of Nurses’ Health Study (women) and Health Professionals Follow-up Study (men) according to levels of individual lifestyle risk factors. Estimates of multivariate adjusted hazard ratios (sex specific) for morbidity and mortality associated with low risk lifestyles compared with people with zero low risk lifestyle factors adjusted for age, ethnicity, current multivitamin use, current aspirin use, family history of diabetes, myocardial infarction, or cancer, and menopausal status and hormone use (women only). AHEI=Alternate Healthy Eating Index; BMI=body mass index; F=fifth. *Cigarettes/day. †Hours/week. ‡Grams/day

See this image and copyright information in PMC

Comment in

We shouldn't recommend harmful foods "in moderation".
Craig MF. Craig MF. BMJ. 2020 Feb 3;368:m365. doi: 10.1136/bmj.m365. BMJ. 2020. PMID: 32014886 No abstract available.
Healthy lifestyle and life expectancy: fund prevention programmes to end the cycle of preventable morbidity.
Van Duinen GL. Van Duinen GL. BMJ. 2020 Feb 4;368:m427. doi: 10.1136/bmj.m427. BMJ. 2020. PMID: 32019741 No abstract available.
Improving nutrition in India: encouraging informed food choices.
Roy MP. Roy MP. BMJ. 2020 Feb 10;368:m367. doi: 10.1136/bmj.m367. BMJ. 2020. PMID: 32041694 No abstract available.

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Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study

Affiliations

Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

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Grants and funding

LinkOut - more resources

Full Text Sources

Medical