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    1 Comment for this article
    Genomic or Patient History factors and Healthy Lifestyle
    Deven Atnoor |
    The study focuses mostly on behavioral and environmental factors and may provide only a partial picture. It would be interesting to see if there are any genomic or patient history associations ( if genomic data are not available readily).
    Original Investigation
    April 6, 2020

    Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases

    Author Affiliations
    • 1Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
    • 2Department of Epidemiology and Public Health, University College London, London, United Kingdom
    • 3Inserm U1153, Epidemiology of Ageing and Neurodegenrative Diseases, Paris, France
    • 4Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland
    • 5Centre for Population Health Research, University of Turku, Turku University Hospital, Turku, Finland
    • 6National Research Centre for the Working Environment, Copenhagen, Denmark
    • 7Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
    • 8Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
    • 9Bispebjerg University Hospital, Copenhagen, Denmark
    • 10Federal Institute for Occupational Safety and Health, Berlin, Germany
    • 11Faculty of Medicine, Paris Descartes University, Paris, France
    • 12Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
    • 13Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
    • 14Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
    • 15Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
    • 16Finnish Institute of Occupational Health, Helsinki, Finland
    • 17AS3 Employment, AS3 Companies, Viby J, Denmark
    • 18Stress Research Institute, Stockholm University, Stockholm, Sweden
    • 19Department of Psychology, Umeå University, Umeå, Sweden
    • 20VIVE–The Danish Center for Social Science Research, Copenhagen, Denmark
    • 21Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
    • 22University of Skövde, School of Health and Education, Skövde, Sweden
    • 23School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
    • 24Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    • 25Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
    • 26School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon
    JAMA Intern Med. 2020;180(5):760-768. doi:10.1001/jamainternmed.2020.0618
    Key Points

    Question  Are different combinations of lifestyle factors associated with years lived without chronic diseases?

    Findings  In a multicohort study of 116 043 participants, a statistically significant association between overall healthy lifestyle score and an increased number of disease-free life-years was noted. Of 16 different lifestyle profiles studied, the 4 that were associated with the greatest disease-free life years included body mass index lower than 25 and at least 2 of 3 factors: never smoking, physical activity, and moderate alcohol consumption.

    Meaning  Various healthy lifestyle profiles appear to be associated with extended gains in life lived without type 2 diabetes, cardiovascular and respiratory diseases, and cancer.


    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.