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Multicenter Study
. 2020 May 1;180(5):760-768.
doi: 10.1001/jamainternmed.2020.0618.

Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases

Solja T Nyberg  1 , Archana Singh-Manoux  2   3 , Jaana Pentti  1   4   5 , Ida E H Madsen  6 , Severine Sabia  2   3 , Lars Alfredsson  7   8 , Jakob B Bjorner  6 , Marianne Borritz  9 , Hermann Burr  10 , Marcel Goldberg  11   12 , Katriina Heikkilä  13 , Markus Jokela  14 , Anders Knutsson  15 , Tea Lallukka  1   16 , Joni V Lindbohm  1 , Martin L Nielsen  17 , Maria Nordin  18   19 , Tuula Oksanen  16 , Jan H Pejtersen  20 , Ossi Rahkonen  1 , Reiner Rugulies  6   21 , Martin J Shipley  2 , Pyry N Sipilä  1 , Sari Stenholm  4   5 , Sakari Suominen  4   22 , Jussi Vahtera  4   5 , Marianna Virtanen  23   24 , Hugo Westerlund  18 , Marie Zins  11   12 , Mark Hamer  25 , G David Batty  2   26 , Mika Kivimäki  1   2
Affiliations
Multicenter Study

Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases

Solja T Nyberg et al. JAMA Intern Med. .

Abstract

Importance: It is well established that selected lifestyle factors are individually associated with lower risk of chronic diseases, but how combinations of these factors are associated with disease-free life-years is unknown.

Objective: To estimate the association between healthy lifestyle and the number of disease-free life-years.

Design, setting, and participants: A prospective multicohort study, including 12 European studies as part of the Individual-Participant-Data Meta-analysis in Working Populations Consortium, was performed. Participants included 116 043 people free of major noncommunicable disease at baseline from August 7, 1991, to May 31, 2006. Data analysis was conducted from May 22, 2018, to January 21, 2020.

Exposures: Four baseline lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) were each allocated a score based on risk status: optimal (2 points), intermediate (1 point), or poor (0 points) resulting in an aggregated lifestyle score ranging from 0 (worst) to 8 (best). Sixteen lifestyle profiles were constructed from combinations of these risk factors.

Main outcomes and measures: The number of years between ages 40 and 75 years without chronic disease, including type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease.

Results: Of the 116 043 people included in the analysis, the mean (SD) age was 43.7 (10.1) years and 70 911 were women (61.1%). During 1.45 million person-years at risk (mean follow-up, 12.5 years; range, 4.9-18.6 years), 17 383 participants developed at least 1 chronic disease. There was a linear association between overall healthy lifestyle score and the number of disease-free years, such that a 1-point improvement in the score was associated with an increase of 0.96 (95% CI, 0.83-1.08) disease-free years in men and 0.89 (95% CI, 0.75-1.02) years in women. Comparing the best lifestyle score with the worst lifestyle score was associated with 9.9 (95% CI 6.7-13.1) additional years without chronic diseases in men and 9.4 (95% CI 5.4-13.3) additional years in women (P < .001 for dose-response). All of the 4 lifestyle profiles that were associated with the highest number of disease-free years included a body-mass index less than 25 (calculated as weight in kilograms divided by height in meters squared) and at least 2 of the following factors: never smoking, physical activity, and moderate alcohol consumption. Participants with 1 of these lifestyle profiles reached age 70.3 (95% CI, 69.9-70.8) to 71.4 (95% CI, 70.9-72.0) years disease free depending on the profile and sex.

Conclusions and relevance: In this multicohort analysis, various healthy lifestyle profiles appeared to be associated with gains in life-years without major chronic diseases.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Nyberg reported receiving grants from NordForsk during the conduct of the study. Dr Sabia reported receiving grants from the National Institute of Ageing and grants from French Agence Nationale de la Recherche outside the submitted work. Dr Alfredsson reported receiving grants from the Swedish Research Council for Health, Working Life and Welfare during the conduct of the study; and grants from the Swedish Research Council for Health, Working Life and Welfare, the Swedish Brain Foundation, and AstraZenica outside the submitted work. Dr Lallukka reported receiving grants from the Academy of Finland during the conduct of the study and personal fees from LähiTapiola Insurance Company outside the submitted work. Dr Lindbohm reported receiving grants from the Academy of Finland (nonprofit government organization) during the conduct of the study. Dr Sipilä reported receiving grants from the Helsinki Institute of Life Science during the conduct of the study and grants from the Finnish Foundation for Alcohol Studies outside the submitted work. Dr Stenholm reported receiving grants from the Academy of Finland during the conduct of the study. Dr Westerlund reported receiving grants from the Swedish Research Council (Vetenskapsrådet) during the conduct of the study. Dr Kivimäki reported receiving grants from NordForsk, the UK Medical Research Council, the US National Institute on Aging, the Academy of Finland, and Helsinki Institute of Life Science during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Flowchart of Sample Selection for Multicohort Analysis
Derivation of the final analysis sample from the Individual-Participant-Data Meta-Analysis in Working Populations (IPD-Work) consortium. Twelve of the 19 IPD-Work Consortium cohorts that had data on 4 lifestyle factors at baseline and a follow-up of 6 chronic diseases (type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease). Participants were included in the analyses if they did not have these diseases at baseline, had information on sex, age, socioeconomic status, lifestyle factors (weight, height, smoking, physical activity, and alcohol consumption), and had follow-up for these incident diseases.
See this image and copyright information in PMC

Comment in

  • Weight Management and Healthy Lifestyles.
    Hoerster KD, Gray K, Raffa SD. Hoerster KD, et al. JAMA Intern Med. 2020 Oct 1;180(10):1403-1404. doi: 10.1001/jamainternmed.2020.2765. JAMA Intern Med. 2020. PMID: 32833002 No abstract available.
  • Weight Management and Healthy Lifestyles.
    Kyle TK, Nadglowski JF, Stanford FC. Kyle TK, et al. JAMA Intern Med. 2020 Oct 1;180(10):1403. doi: 10.1001/jamainternmed.2020.2743. JAMA Intern Med. 2020. PMID: 32833003 Free PMC article. No abstract available.
  • Weight Management and Healthy Lifestyles-Reply.
    Nyberg ST, Singh-Manoux A, Kivimäki M. Nyberg ST, et al. JAMA Intern Med. 2020 Oct 1;180(10):1404-1405. doi: 10.1001/jamainternmed.2020.2762. JAMA Intern Med. 2020. PMID: 32833004 No abstract available.

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