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Lifestyle-Related Factors and Total Mortality in a Mediterranean Prospective Cohort

  • Liz Ruiz-Estigarribia
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
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  • Miguel Á. Martínez-González
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain

    CIBER Pathophysiology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain

    IDISNA Navarra's Health Research Institute, Pamplona, Spain

    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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  • Jesús Díaz-Gutiérrez
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
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  • Alfredo Gea
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain

    CIBER Pathophysiology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain

    IDISNA Navarra's Health Research Institute, Pamplona, Spain
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  • Anaïs Rico-Campà
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain

    CIBER Pathophysiology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
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  • Maira Bes-Rastrollo
    Correspondence
    Address correspondence to: Prof. Maira Bes-Rastrollo, PharmD, PhD, Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Ed. Investigación, C/Irunlarrea 1, Pamplona 31008, Spain.
    Affiliations
    Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain

    CIBER Pathophysiology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain

    IDISNA Navarra's Health Research Institute, Pamplona, Spain
    Search for articles by this author

      Introduction

      Lifestyle-related habits have a strong influence on morbidity and mortality worldwide. This study investigates the association between a multidimensional healthy lifestyle score and all-cause mortality risk, including in the score some less-studied lifestyle-related factors.

      Methods

      Participants (n=20,094) of the Seguimiento Universidad de Navarra cohort were followed up from 1999 to 2018. The analysis was conducted in 2019. A 10-point healthy lifestyle score previously associated with a lower risk of major cardiovascular events was applied, assigning 1 point to each of the following items: never smoking, moderate-to-high physical activity, moderate-to-high Mediterranean diet adherence, healthy BMI, moderate alcohol consumption, avoidance of binge drinking, low TV exposure, short afternoon nap, time spent with friends, and working ≥40 hours per week.

      Results

      During a median follow-up of 10.8 years, 407 deaths were documented. In the multivariable adjusted analysis, the highest category of adherence to the score (7–10 points) showed a 60% lower risk of all-cause mortality than the lowest category (0–3 points) (hazard ratio=0.40, 95% CI=0.27, 0.60, p<0.001 for trend). In analyses of the healthy lifestyle score as a continuous variable, for each additional point in the score, a 18% relatively lower risk of all-cause mortality was observed (adjusted hazard ratio=0.82, 95% CI=0.76, 0.88).

      Conclusions

      Adherence to a healthy lifestyle score, including some less-studied lifestyle-related factors, was longitudinally associated with a substantially lower mortality rate in a Mediterranean cohort. Comprehensive health promotion should be a public health priority.
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