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More evidence linking a healthy lifestyle to longevity!

willThe secrets of old age revealed?

By Dr. W.A. Arrindell, psychologist

Introduction

In many countries in the world, leading health specialists are more than before calling on their public to take responsibility for their own health by adopting a healthier lifestyle to help ward off the onset of disease and premature death. Major concerns focus on smoking, bodily weight, physical activity, diet and alcohol consumption; and the concept of a healthy lifestyle is usually defined with reference to combinations of these factors. The calls to adopt a healthy lifestyle are based on the outcome of so-called prospective, long-running (longitudinal) studies on determinants of longevity. A prospective study is one in which large groups of individuals (cohorts) are selected on the basis of factors that are to be examined for possible effects on some outcome. For example, the effects of exposure to specific risk factors on the eventual Development of a particular disease can be studied; in doing so, participants are followed over long periods of time, with data being collected at multiple time-intervals (for example, annually).

 

Genes and environment Data from studies of twins suggest that genes determine about 25% of the differences (variations) between individuals in life expectancy. This leaves perhaps about 75% of the relevant differences between individuals that can be attributed to potentially

modifiable (environmental or non-genetic) factors, for example, smoking and alcohol consump-

tion, that together with genes might promote or help prevent reduction of longevity. The find-

ings from three notable studies will be described. In addition, the outcome will be described of the latest study which included the longest follow-up of participants to date, namely 30 years.

Netherlands Cohort Study The Netherlands Cohort Study (NLCS) was initiated in 1986 and included 62,573 women and 58,279 men, ages 55-69 years. At initiation, participants completed

questionnaires on dietary and other lifestyle habits. A combined lifestyle score was constructed

by taking into account the following healthy lifestyle factors: non-smoking, normal weight, regular physical activity, and adhering to the Mediterranean diet. The traditional Mediterranean diet is characterized by high intakes of vegetables, fruit, legumes (for example, peas, beans), nuts, fish, whole (natural) grains, healthy fat (olive oil) instead of saturated fat; low intakes of meat (products), and alcohol consumption of approximately 0.5 to 2 glasses per day. A mortality follow-up until 1996 (10 years later) was obtained for the entire cohort by linkage to the Dutch Central Bureau of Genealogy.

The researchers demonstrated that combined adherence to the Mediterranean diet with non-

smoking and having a normal bodily weight and doing regular exercise coincided with lower mortality figures in both women and men: women who led an overall healthy lifestyle lived, on

average, 15.1 years longer than their counterparts who failed to do so. For males who lead an

overall healthy lifestyle, the advantage in life-expectancy was 8.4 years (American Journal of

Clinical Nutrition, 94, 913-920).

EPIC Study Scientists from the German Cancer Research Centre (Heidelberg, Germany) calculated what the risks are of leading an unhealthy lifestyle characterized by heavy drinking, heavy smoking, eating large quantities of red meat and/or sausage products, and being overweight.

Their findings were based on an ongoing cohort study in Heidelberg as part of the European Prospective Investigation into Cancer and Nutrition (EPIC), in which 22,469 subjects participated (12,234 women), mostly 40-year-olds or older. They were recruited from 1994 (base-line) to 1998. Information on vital status was collected through the official death registry system and reports from next of kin. All reported deaths were verified by obtaining official death certificates. Mortality data were analysed until December 31, 2009, by which time the vital status of all participants had been completely ascertained.

The average follow-up time was 11 years. The combined loss of remaining years to live for heavy smoking, obesity, heavy alcohol drinking, and high consumption of processed/red meat, in contrast to never smoking, optimal bodily weight (BMI), no/light alcohol drinking, and low consumption of processed/red meat, was 17.0 years for men and 13.9 years for women. The researchers estimated that at the age of 40 years, their participants with the most favourable risk profiles could look forward to another 47.5 years (men) and 48.7 years (women) of life.

Hence, based on these findings, the life expectancy for this subgroup with optimal risk profiles

would reach about 87.5 (men)and 88.7 years (women) (BMC Medicine, doi:10.1186/1741-

7015-12-59). Physicians' Health Study US researchers examined modifiable factors associated with a life span of 90 or more years and late-life function in men. Participants were enrolled in the PHS (Physicians' Health Study), a cohort of 2,357 healthy US male physicians assembled in 1981 to1984 (mean age: 72 years). The participants were born on or before December 31, 1915, and had the potential to survive to age 90 years during follow-up ending March 31, 2006.

The researchers defined survival to age 90 as "exceptional longevity" because it far exceeded

the 46- to 52-year estimated life-expectancy for a man born in the US in 1900 to 1915. Life-style and biological factors and bodily condition were assessed at baseline and annually. Mortality and presence (incidence) of major diseases were confirmed by medical record review. Late-life function was assessed 16 years after baseline.

A total of 970 men (41%) survived to at least age 90 years. Smoking was associated with increased risk of mortality before age 90 years, and similar associations were observed with diabetes, obesity, and high blood pressure. Regular exercise was associated with nearly 30% lower mortality risk. The probability of a 90-year life span at age 70 years was 54% in the absence of smoking, diabetes, obesity, high blood pressure, or a physically inactive (sedentary) lifestyle. The probability decreased with increasing numbers of adverse lifestyle factors: from about 22% - 36% with two adverse factors to negligible (only 4%) with five. Compared with non-survivors, men with exceptional longevity not only had a healthier lifestyle (67% versus

53% had zero or one adverse life-style factor); they also had a lower incidence of chronic diseases, and were three to five years older at disease onset. In addition, they also had better late-life physical function and mental well-being.

More than 68% (versus 45%) rated their late-life health as excellent or very good, and less than

8% (versus 22%) reported fair or poor health. Regular exercise was associated with meaningfully better – and smoking and overweight with significantly worse – late-life physical function. Smoking was also associated with a significant decrement in mental function (Archives of Internal Medicine, 168, 284-290).

Significance

In many Western countries, basic, self-modifiable lifestyle risk factors, like smoking, overweight, unhealthy diet, heavy alcohol drinking, and lack of physical activity, have been causing a large part of the premature deaths among adults. If we were able to optimize lifestyle conditions by, for example, not smoking, not drinking, adhering to healthy diets and so on, the number of disease cases and deaths could be meaningfully reduced. Refraining from smoking alone could reduce the number of disease cases and premature deaths by 28%. Reducing excessive bodily weight could reduce disease cases and premature deaths by 14%; reducing unhealthy diets would do so by 9% to16%; reducing lack of physical activity by 7% to 16%;

and reducing heavy alcohol drinking by 3% to18%. If these factors were significantly reduced altogether (combined), the number of disease cases and premature deaths could drop by as much as 42% to 60%.

Studies such as the ones reported here are important as they help provide public health officials with information on what to tackle through public health campaigns in order to prevent and/or

bring down the numbers of associated diseases and unnecessary premature deaths in the general

population.

"Ultimately, however, decisions about [adopting healthy] behaviours lie with the individuals and

there is therefore an urgent need to establish a more effective partnership between health services

and citizens." (Elwood P., Galante J., Pickering J., Palmer S., Bayer A. et al., Healthy lifestyles reduce the incidence of chronic diseases and dementia: Evidence from the Caerphilly Cohort Study. DOI: 10.1371/journal.pone.0081877).

Caerphilly Cohort Study Recently, health officials, charities, and members of the public in Wales were confronted with the findings of a 30-year long-running study – still ongoing – which has

uncovered the enormous health benefits of following a healthy life-style. Starting in 1979, the lifestyle habits of 2,235 men ages 45-59 years were tracked in Caerphilly, United Kingdom. The Caerphilly Cohort Study is the longest running study of its kind to probe the influence of evironmental factors on chronic disease. During the 30 years following 1979, incident diabetes, vascular disease (heart attacks and strokes), cancers and deaths were recorded and in 2004 cognitive state was also determined. Healthy lifestyles assessed over the years included non-smoking, an acceptable bodily weight (healthy body mass index), a high fruit and vegetable

intake, regular physical activity, and low/moderate alcohol intake.

The researchers found that, within a representative sample of middle-aged men, the follow-

ing of increasing numbers of healthy behaviours was associated with increasing reductions

in several important chronic diseases and mortality: an estimated 50% reduction in diabetes, 50%

in vascular disease, and 60% for all-cause mortality. In addition, in men who followed four or five of the healthy behaviours previously mentioned, a delay was observed in vascular disease events of up to12 years. Moreover, of enormous importance in an ageing population, taking into account pre-morbid mental ability (that is, mental functioning prior to initiation of disease), the following of increasing numbers of healthy behaviours was also associated with a reduction of about 60% in cognitive impairment (for example, attention and memory problems) and about the same in dementia. The authors reported that their findings were closely similar to those reported from other co-horts in other countries, including the US where for example the subjects amongst the 43,000 US Health Professionals who had adopted the five healthy behaviours experienced an 87% reduction in heart disease; and among the 84,000 women in the US Nurses' Health Study in whom the risk of coronary events was reduced by 85% when they too had adopted the five relevant healthy behaviours.

The adoption, however, of a healthy lifestyle by men was low and was demonstrated not to have changed during the subsequent 30 years, with under 1% of men following all five of the healthy behaviours and only 5% reporting four or more in 1979 and in 2009 (PLOS ONE 8(12):e81877. doi: 10.1371/journal.pone.0081877).

Overall conclusion

Adoption of a healthy lifestyle is associated with longevity, with increased disease-free survival,

and with reduced cognitive impairment. However, the uptake(adoption) of a healthy lifestyle

remains too low.

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