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

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.

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