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


Background:
Although cigarette smoking, excessive alcohol drinking, obesity, and several other well-studied unhealthy lifestyle-related factors each have been linked to the risk of multiple chronic diseases and premature death, little is known about the combined impact on mortality outcomes, in particular among Chinese and other non-Western populations. The objective of this study was to quantify the overall impact of lifestyle-related factors beyond that of active cigarette smoking and alcohol consumption on all-cause and cause-specific mortality in Chinese women.

Methods and Findings:
We used data from the Shanghai Women's Health Study, an ongoing population-based prospective cohort study in China. Participants included 71,243 women aged 40 to 70 years enrolled during 1996–2000 who never smoked or drank alcohol regularly. A healthy lifestyle score was created on the basis of five lifestyle-related factors shown to be independently associated with mortality outcomes (normal weight, lower waist-hip ratio, daily exercise, never exposed to spouse's smoking, higher daily fruit and vegetable intake). The score ranged from zero (least healthy) to five (most healthy) points. During an average follow-up of 9 years, 2,860 deaths occurred, including 775 from cardiovascular disease (CVD) and 1,351 from cancer. Adjusted hazard ratios for mortality decreased progressively with an increasing number of healthy lifestyle factors. Compared to women with a score of zero, hazard ratios (95% confidence intervals) for women with four to five factors were 0.57 (0.44–0.74) for total mortality, 0.29 (0.16–0.54) for CVD mortality, and 0.76 (0.54–1.06) for cancer mortality. The inverse association between the healthy lifestyle score and mortality was seen consistently regardless of chronic disease status at baseline. The population attributable risks for not having 4–5 healthy lifestyle factors were 33% for total deaths, 59% for CVD deaths, and 19% for cancer deaths.

Conclusions:
In this first study, to our knowledge, to quantify the combined impact of lifestyle-related factors on mortality outcomes in Chinese women, a healthier lifestyle pattern—including being of normal weight, lower central adiposity, participation in physical activity, nonexposure to spousal smoking, and higher fruit and vegetable intake—was associated with reductions in total and cause-specific mortality among lifetime nonsmoking and nondrinking women, supporting the importance of overall lifestyle modification in disease prevention.

: Please see later in the article for the Editors' Summary


Vyšlo v časopise: Combined Impact of Lifestyle-Related Factors on Total and Cause-Specific Mortality among Chinese Women: Prospective Cohort Study. PLoS Med 7(9): e32767. doi:10.1371/journal.pmed.1000339
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pmed.1000339

Souhrn

Background:
Although cigarette smoking, excessive alcohol drinking, obesity, and several other well-studied unhealthy lifestyle-related factors each have been linked to the risk of multiple chronic diseases and premature death, little is known about the combined impact on mortality outcomes, in particular among Chinese and other non-Western populations. The objective of this study was to quantify the overall impact of lifestyle-related factors beyond that of active cigarette smoking and alcohol consumption on all-cause and cause-specific mortality in Chinese women.

Methods and Findings:
We used data from the Shanghai Women's Health Study, an ongoing population-based prospective cohort study in China. Participants included 71,243 women aged 40 to 70 years enrolled during 1996–2000 who never smoked or drank alcohol regularly. A healthy lifestyle score was created on the basis of five lifestyle-related factors shown to be independently associated with mortality outcomes (normal weight, lower waist-hip ratio, daily exercise, never exposed to spouse's smoking, higher daily fruit and vegetable intake). The score ranged from zero (least healthy) to five (most healthy) points. During an average follow-up of 9 years, 2,860 deaths occurred, including 775 from cardiovascular disease (CVD) and 1,351 from cancer. Adjusted hazard ratios for mortality decreased progressively with an increasing number of healthy lifestyle factors. Compared to women with a score of zero, hazard ratios (95% confidence intervals) for women with four to five factors were 0.57 (0.44–0.74) for total mortality, 0.29 (0.16–0.54) for CVD mortality, and 0.76 (0.54–1.06) for cancer mortality. The inverse association between the healthy lifestyle score and mortality was seen consistently regardless of chronic disease status at baseline. The population attributable risks for not having 4–5 healthy lifestyle factors were 33% for total deaths, 59% for CVD deaths, and 19% for cancer deaths.

Conclusions:
In this first study, to our knowledge, to quantify the combined impact of lifestyle-related factors on mortality outcomes in Chinese women, a healthier lifestyle pattern—including being of normal weight, lower central adiposity, participation in physical activity, nonexposure to spousal smoking, and higher fruit and vegetable intake—was associated with reductions in total and cause-specific mortality among lifetime nonsmoking and nondrinking women, supporting the importance of overall lifestyle modification in disease prevention.

: Please see later in the article for the Editors' Summary


Zdroje

1. WhitlockG

LewingtonS

SherlikerP

ClarkeR

EmbersonJ

2009 Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373 1083 1096

2. KnoopsKT

de GrootLC

KromhoutD

PerrinAE

Moreiras-VarelaO

2004 Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA 292 1433 1439

3. PischonT

BoeingH

HoffmannK

BergmannM

SchulzeMB

2008 General and abdominal adiposity and risk of death in Europe. N Engl J Med 359 2105 2120

4. FolsomAR

KushiLH

AndersonKE

MinkPJ

OlsonJE

2000 Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study. Arch Intern Med 160 2117 2128

5. OgumaY

SessoHD

PaffenbargerRSJr

LeeIM

2002 Physical activity and all cause mortality in women: a review of the evidence. Br J Sports Med 36 162 172

6. LollgenH

BockenhoffA

KnappG

2009 Physical activity and all-cause mortality: an updated meta-analysis with different intensity categories. Int J Sports Med 30 213 224

7. SteffenLM

JacobsDRJr

StevensJ

ShaharE

CarithersT

2003 Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 78 383 390

8. GenkingerJM

PlatzEA

HoffmanSC

ComstockGW

HelzlsouerKJ

2004 Fruit, vegetable, and antioxidant intake and all-cause, cancer, and cardiovascular disease mortality in a community-dwelling population in Washington County, Maryland. Am J Epidemiol 160 1223 1233

9. World Health Organization/Food and Agricultural Organization 2003 Expert report on diet, nutrition, and the prevention of chronic diseases, technical report. Series 916. Geneva World Health Organization

10. International Agency for Research on Cancer 2004 Tobacco smoking and involuntary smoking. Lyon IARC (IARC monographs on the evaluation of carcinogenic risks to humans Vol. 83)

11. DanaeiG

DingEL

MozaffarianD

TaylorB

RehmJ

2009 The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 6 e1000058 doi:10.1371/journal.pmed.1000058

12. TamakoshiA

TamakoshiK

LinY

YagyuK

KikuchiS

2009 Healthy lifestyle and preventable death: findings from the Japan Collaborative Cohort (JACC) Study. Prev Med 48 486 492

13. van DamRM

LiT

SpiegelmanD

FrancoOH

HuFB

2008 Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ DOI:10.1136/bmj.a1440

14. KhawKT

WarehamN

BinghamS

WelchA

LubenR

2008 Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med 5 e12 doi:10.1371/journal.pmed.0050012

15. KvaavikE

BattyGD

UrsinG

HuxleyR

GaleCR

2010 Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey. Arch Intern Med 170 711 718

16. KimS

PopkinBM

Siega-RizAM

HainesPS

ArabL

2004 A cross-national comparison of lifestyle between China and the United States, using a comprehensive cross-national measurement tool of the healthfulness of lifestyles: the Lifestyle Index. Prev Med 38 160 171

17. ZhengW

ChowWH

YangG

JinF

RothmanN

2005 The Shanghai Women's Health Study: rationale, study design, and baseline characteristics. Am J Epidemiol 162 1123 1131

18. ZhangX

ShuXO

YangG

LiH

CaiH

2007 Abdominal adiposity and mortality in Chinese women. Arch Intern Med 167 886 892

19. ZhangX

ShuXO

ChowWH

YangG

LiH

2008 Body mass index at various ages and mortality in Chinese women: impact of potential methodological biases. Int J Obes (Lond) 32 1130 1136

20. MatthewsCE

JurjAL

ShuXO

LiHL

YangG

2007 Influence of exercise, walking, cycling, and overall nonexercise physical activity on mortality in Chinese women. Am J Epidemiol 165 1343 1350

21. WenW

ShuXO

GaoYT

YangG

LiQ

2006 Environmental tobacco smoke and mortality in Chinese women who have never smoked: prospective cohort study. BMJ 333 376 380

22. CaiH

ShuXO

GaoYT

LiH

YangG

2007 A prospective study of dietary patterns and mortality in Chinese women. Epidemiology 18 393 401

23. McGheeSM

HoSY

SchoolingM

HoLM

ThomasGN

2005 Mortality associated with passive smoking in Hong Kong. BMJ 330 287 288

24. KeyTJ

ThorogoodM

ApplebyPN

BurrML

1996 Dietary habits and mortality in 11,000 vegetarians and health conscious people: results of a 17 year follow up. BMJ 313 775 779

25. ShuXO

YangG

JinF

LiuD

KushiL

2004 Validity and reproducibility of the food frequency questionnaire used in the Shanghai Women's Health Study. Eur J Clin Nutr 58 17 23

26. MatthewsCE

ShuXO

YangG

JinF

AinsworthBE

2003 Reproducibility and validity of the Shanghai Women's Health Study physical activity questionnaire. Am J Epidemiol 158 1114 1122

27. WHO Expert Consultation 2004 Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363 157 163

28. AinsworthBE

HaskellWL

WhittMC

IrwinML

SwartzAM

2000 Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32 S498 504

29. AinsworthBE

HaskellWL

LeonAS

JacobsDRJr

MontoyeHJ

1993 Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 25 71 80

30. KornEL

GraubardBI

MidthuneD

1997 Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol 145 72 80

31. RockhillB

NewmanB

WeinbergC

1998 Use and misuse of population attributable fractions. Am J Public Health 88 15 19

32. WacholderS

BenichouJ

HeinemanEF

HartgeP

HooverRN

1994 Attributable risk: advantages of a broad definition of exposure. Am J Epidemiol 140 303 309

33. SpencerCA

JamrozikK

NormanPE

Lawrence-BrownM

2005 A simple lifestyle score predicts survival in healthy elderly men. Prev Med 40 712 717

34. TsubonoY

KoizumiY

NakayaN

FujitaK

TakahashiH

2004 Health practices and mortality in Japan: combined effects of smoking, drinking, walking and body mass index in the Miyagi Cohort Study. J Epidemiol 14 Suppl 1 S39 45

35. Haveman-NiesA

de GrootLP

BuremaJ

CruzJA

OslerM

2002 Dietary quality and lifestyle factors in relation to 10-year mortality in older Europeans: the SENECA study. Am J Epidemiol 156 962 968

36. MengL

MaskarinecG

LeeJ

KolonelLN

1999 Lifestyle factors and chronic diseases: application of a composite risk index. Prev Med 29 296 304

37. TsubonoY

FukaoA

HisamichiS

1993 Health practices and mortality in a rural Japanese population. Tohoku J Exp Med 171 339 348

38. BreslowL

EnstromJE

1980 Persistence of health habits and their relationship to mortality. Prev Med 9 469 483

39. 2009 Cigarette smoking among adults and trends in smoking cessation - United States, 2008. MMWR Morb Mortal Wkly Rep 58 1227 1232

40. HumbleC

CroftJ

GerberA

CasperM

HamesCG

1990 Passive smoking and 20-year cardiovascular disease mortality among nonsmoking wives, Evans County, Georgia. Am J Public Health 80 599 601

41. LahmannPH

LissnerL

GullbergB

BerglundG

2002 A prospective study of adiposity and all-cause mortality: the Malmo Diet and Cancer Study. Obes Res 10 361 369

42. KuboM

HataJ

DoiY

TanizakiY

IidaM

2008 Secular trends in the incidence of and risk factors for ischemic stroke and its subtypes in Japanese population. Circulation 118 2672 2678

43. EmbersonJR

WhincupPH

MorrisRW

WannametheeSG

ShaperAG

2005 Lifestyle and cardiovascular disease in middle-aged British men: the effect of adjusting for within-person variation. Eur Heart J 26 1774 1782

44. JiM

DingD

HovellMF

XiaX

ZhengP

2009 Home smoking bans in an urbanizing community in China. Am J Prev Med 37 132 136

Štítky
Interné lekárstvo

Článok vyšiel v časopise

PLOS Medicine


2010 Číslo 9
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Kurzy

Zvýšte si kvalifikáciu online z pohodlia domova

Eozinofilní granulomatóza s polyangiitidou
nový kurz

Betablokátory a Ca antagonisté z jiného úhlu
Autori: prof. MUDr. Michal Vrablík, Ph.D., MUDr. Petr Janský

Autori: doc. MUDr. Petr Čáp, Ph.D.

Farmakoterapie akutní a chronické bolesti

Získaná hemofilie - Povědomí o nemoci a její diagnostika

Všetky kurzy
Prihlásenie
Zabudnuté heslo

Nemáte účet?  Registrujte sa

Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa