Healthy Lifestyle Score Research Articles

Lifestyle factors, genetic susceptibility to obesity and their interactions on coronary artery disease risk: A cohort study in the UK Biobank

ObjectiveWe aimed to evaluate potential modifying effects of genetic susceptibility to obesity on the association of lifestyle factors with coronary artery disease (CAD) risk. MethodsA total of 328,606 participants (54% women) were included using data from the UK Biobank. We evaluated the risk of developing CAD associated with obesity-related polygenic scores (PGSs) and healthy lifestyle scores (HLSs). HLSs were constructed using six lifestyle factors. Obesity PGSs were created using genetic variants identified by genome-wide association studies, including 941 variants for body mass index (BMI) and 457 for waist-to-hip ratio (WHR). Both HLSs and PGSs were categorized into three groups. ResultsDuring a 9-year median follow-up, 14,541 participants developed CAD. An unhealthy lifestyle was significantly associated with an increased CAD risk (hazard ratio [HR] = 2.24, 95% confidence interval [CI] = 2.09–2.40). High BMI and WHR PGSs were each significantly associated with an increased CAD risk (HRBMI = 1.23, 1.17–1.29; HRWHR = 1.15, 1.09–1.21). Lifestyle factors explained 41% (95% CI = 38%–45%) of CAD, while genetic variants for BMI explained only 10% (7%–14%). Risks of CAD were increased with poorer HLS independent of obesity-related PGSs. Individuals with the most unhealthy lifestyle and highest BMI PGS had the highest risk of CAD risk (HR = 2.59, 95% CI = 2.26–2.97), compared with participants with the healthiest lifestyle and lowest BMI PGS. ConclusionsWhile the observational nature of the study precludes the establishment of causality, our study provides supports for a causal association between obesity and CAD risk and the importance of lifestyle modification in the prevention of CAD.

Healthy lifestyle decreases the risk of the first incidence of non-communicable chronic disease and its progression to multimorbidity and its mediating roles of metabolic components: a prospective cohort study in China

ObjectivesTo identify the influence of healthy lifestyles on the incidence of the first NCD (FNCD), multiple chronic conditions (MCCs), and the progression from FNCD to MCCs. Design: cohort study. Setting: Zhejiang, China Participants10566 subjects (55.5 ± 13.5 years, 43.1% male) free of NCDs at baseline from the Zhejiang Metabolic Syndrome prospective cohort. MeasurementsHealthy lifestyle score (HLS) was developed by 6 common healthy lifestyle factors as smoking, alcohol drinking, physical activity, body mass index (BMI) and waist-to-hip ratio (WHR). Healthy lifestyle data and metabolic biomarkers collected via a face-to-face questionnaire-based interview, clinical health examination and routine biochemical determination. Biochemical variables were determined using biochemical auto-analyzer. Participants were stratified into four group based on the levels of HLS as ≤2, 3, 4 and ≥5. Multiple Cox proportional hazards model was applied to examine the relationship between HLS and the risk of FNCD, MCCs and the progression from FNCD to MCCs. The population-attributable fractions (PAF) were used to assess the attributable role of HLS. Mediating effect was examined by mediation package in R. ResultsAfter a median of 9.92 years of follow-up, 1572 participants (14.9%) developed FNCD, and 149 (1.4%) developed MCCs. In the fully adjusted model, the higher HLS group (≥5) was associated with lower risk of FNCD (HR = 0.68 and 95% CI: 0.56−0.82), MCCs (HR = 0.31 and 95%CI: 0.14−0.69); and the progression from FNCD to MCCs (HR = 0.39 and 95%CI: 0.18−0.85). Metabolic components (TC, TG, HDL-C, LDC-C, FPG, and UA) played the mediating roles with the proportion ranging from 5.02% to 22.2% for FNCD and 5.94% to 20.1% for MCCs. PAFs (95%CI) for poor adherence to the overall healthy lifestyle (HLS ≤ 3) were 17.5% (11.2%, 23.7%) for FNCD, 42.9% (23.4%, 61.0%) for MCCs, and 37.0% (15.5%, 56.3%) for the progression from FNCD to MCCs. ConclusionsHigh HLS decreases the risk of FNCD, MCCs, and the progression from FNCD to MCCs. These effects are partially mediated by metabolic components. Maintaining healthy lifestyles might reduce the disease burden of common chronic diseases.

Psychological Stress across the Lifespan and Cognitive Function among Older Adults: The Moderating Role of a Healthy Lifestyle.

This study aimed to (a) investigate the associations between indices of stress severity across the lifespan (early, middle, late life) and cognitive function among community-dwelling older adults, and (b) examine whether a healthy lifestyle composite score comprised of physical activity, healthy diet adherence, social engagement, sleep quality, and mindful relaxation moderates the associations between lifespan stress severity and cognitive function. Participants (n=226, Mage=68.2±6.5, 68.1% female) completed questionnaires to measure stress and lifestyle behaviours, and three online neurocognitive tasks. No direct associations between stress severity and cognition were found. The healthy lifestyle composite score moderated the associations between early, midlife, and late-life stress severity and inhibitory control. Exploratory analyses suggest that this moderating effect may be sex-dependent. Despite study limitations and the need for additional research, findings provide preliminary support for the role of lifestyle behaviours in enhancing older adults' resilience to the effects of stress on cognitive health in a sex-specific manner.

Associations between healthy lifestyle and mortality across different social environments: a study among adults with frailty from the UK Biobank.

Among people living with frailty, adherence to a healthy lifestyle may be a low-cost and effective strategy to decrease frailty-induced health risks across different social environments. We included 15 594 frail participants at baseline from the UK Biobank study. We used four lifestyle factors to create a composite healthy lifestyle score and 17 social factors to construct a polysocial score. We classified the lifestyle score into two levels (unhealthy and healthy) and the polysocial score into three levels (low, intermediate and high). We used Cox regression to determine the association of each lifestyle factor and lifestyle score with all-cause mortality, respectively. We also examined the associations across polysocial score categories. We evaluated the joint association of the lifestyle score and the categorical polysocial score with all-cause mortality. During up to 14.41 follow-up years, we documented 3098 all-cause deaths. After multivariable adjustment, we found a significant association between not smoking and adequate physical activity with all-cause mortality across polysocial score categories, respectively. We also found a significant association between a healthy diet and all-cause mortality among frail participants living in an intermediate social environment. A healthy lifestyle was associated with a lower all-cause mortality risk across polysocial score categories, especially among those with a low polysocial score. Adherence to a healthy lifestyle, particularly not smoking, adequate physical activity and a healthy diet, may provide a feasible solution to decreasing mortality risk among frail adults across different social environments, especially for those in the socially disadvantaged group.

Investigating the individual and joint effects of socioeconomic status and lifestyle factors on mild cognitive impairment in older Italians living independently in the community: results from the NutBrain study

ObjectivesDespite extensive research, a clear understanding of the role of the interaction between lifestyle and socioeconomic status (SES) on cognitive health is still lacking. We investigated the joint association of socioeconomic factors in early to midlife and lifestyle in later life and Mild Cognitive Impairment (MCI). DesignObservational cross-sectional study. SettingNutBrain study in northern Italy. Participants773 community-dwelling adults aged 65 years and older (73.2 ± 6.0 SD, 58.6% females) participating in the NutBrain study (2019–2023). MeasurementsThree SES indicators (home ownership, educational level, occupation) and five lifestyle factors (adherence to Mediterranean diet, physical activity, smoking habits, social network, leisure activities) were selected. Each factor was scored and summed to calculate SES and healthy lifestyle scores; their joint effect was also examined. The association with MCI was assessed by logistic regression controlling for potential confounders. Sex-stratified analysis was performed. ResultsIn total, 24% of the subjects had MCI. The multivariable logistic model showed that a high SES and a high lifestyle score were associated with 81.8% (OR0.182; 95%CI 0.095−0.351), and 44.1% (OR0.559; 95%CI 0.323−0.968) lower odds of having MCI, respectively. When examining the joint effect of SES and lifestyle factors, the cognitive benefits of a healthy lifestyle were most pronounced in participants with low SES. A healthier lifestyle score was found to be significantly associated with lower odds of MCI, only in females. ConclusionsAccording to our findings, SES was positively associated with preserved cognitive function, highlighting the importance of active lifestyles in reducing socioeconomic health inequalities, particularly among those with a relatively low SES. Trial registrationTrial registration number NCT04461951, date of registration July 7, 2020 (retrospectively registered, ClinicalTrials.gov).

Adherence to a healthy lifestyle behavior composite score and cardiometabolic risk factors in Spanish children from the CORALS cohort

To assess the associations between the adherence to a composite score comprised of 6 healthy lifestyle behaviors and its individual components with several cardiometabolic risk factors in Spanish preschool children. Cross-sectional analyses were conducted in 938 participants included in the CORALS cohort aged 3–6 years. Six recognized healthy lifestyle behaviors (breastfeeding, sleep duration, physical activity, screentime, adherence to the Mediterranean diet, and eating speed) were assessed in a composite score. Multiple linear and logistic regression models were fitted to assess the associations with cardiometabolic risk factors (weight status, waist circumference, fat mass index, blood pressure, fasting plasma glucose, and lipid profile). In the adjusted multiple linear and logistic regression models, compared with the reference category of adherence to the healthy lifestyle behavior composite score, those participants in the category of the highest adherence showed significant decreased prevalence risk of overweight or obesity [OR (95% CI), 0.4 (0.2, 0.6)] as well as significant lower waist circumference, fat mass index (FMI), systolic blood pressure and fasting plasma glucose concentration [β (95% CI), − 1.4 cm (− 2.5, − 0.4); − 0.3 kg/m2 (− 0.5, − 0.1); and − 3.0 mmHg (− 5.2, − 0.9); − 1.9 mg/dL (− 3.5, − 0.4), respectively]. Slow eating speed was individually associated with most of the cardiometabolic risk factors. Conclusions: Higher adherence to the healthy lifestyle behavior composite score was associated with lower waist circumference, FMI, other cardiometabolic risk factors, and risk of overweight or obesity in Spanish preschool children. Further studies are required to confirm these associations.What is Known:• Lifestyle is a well-recognized etiologic factor of obesity and its comorbidities.• Certain healthy behaviors such as adhering to a healthy diet, increasing physical activity, and decreasing screentime are strategies for prevention and treatment of childhood obesity.What is New:• Higher adherence to the healthy lifestyle behavior composite score to 6 healthy behaviors (breastfeeding, sleep duration, physical activity, screentime, eating speed, and adherence to the Mediterranean diet) was associated with decreased adiposity, including prevalence risk of overweight or obesity, and cardiometabolic risk in preschool children.• Slow eating and greater adherence to the Mediterranean diet were mainly associated to lower fasting plasma and serum triglycerides concentration, respectively.

Healthy lifestyle and essential metals attenuated association of polycyclic aromatic hydrocarbons with heart rate variability in coke oven workers

Whether adopting healthy lifestyles and maintaining moderate levels of essential metals could attenuate the reduction of heart rate variability (HRV) related to polycyclic aromatic hydrocarbons (PAHs) exposure are largely unknown. In this study, we measured urinary metals and PAHs as well as HRV, and constructed a healthy lifestyle score in 1267 coke oven workers. Linear regression models were used to explore the association of healthy lifestyle score and essential metals with HRV, and interaction analysis was performed to investigate the potential interaction between healthy lifestyle score, essential metals, and PAHs on HRV. Mean age of the participants was 41.9 years (84.5% male). Per one point higher healthy lifestyle score was associated with a 2.5% (95% CI, 1.0%–3.9%) higher standard deviation of all normal to normal intervals (SDNN), 2.1% (95% CI, 0.5%–3.6%) higher root mean square of successive differences in adjacent NN intervals (r-MSSD), 4.3% (95% CI, 0.4%–8.2%) higher low frequency, 4.4% (95% CI, 0.2%–8.5%) higher high frequency, and 4.4% (95% CI, 1.2%–7.6%) higher total power, respectively. Urinary level of chromium was positively associated with HRV indices, with the corresponding β (95% CI) (%) was 5.17 (2.84, 7.50) for SDNN, 4.29 (1.74, 6.84) for r-MSSD, 12.26 (6.08, 18.45) for low frequency, 12.61 (5.87, 19.36) for high frequency, and 11.31 (6.19, 16.43) for total power. Additionally, a significant interaction was found between healthy lifestyle score and urinary total hydroxynaphthalene on SDNN (Pinteraction = 0.04), and higher level of urinary chromium could attenuate the adverse effect of total hydroxynaphthalene level on HRV (all Pinteraction <0.05). Findings of our study suggest adopting healthy lifestyle and maintaining a relatively high level of chromium might attenuate the reduction of HRV related to total hydroxynaphthalene exposure.

Healthy lifestyle and cancer survival: A multinational cohort study.

Lifestyle factors after a cancer diagnosis could influence the survival of cancer 60 survivors. To examine the independent and joint associations of healthy lifestyle factors with mortality outcomes among cancer survivors, four prospective cohorts (National Health and Nutrition Examination Survey [NHANES], National Health Interview Survey [NHIS], UK Biobank [UKB] and Kailuan study) across three countries. A healthy lifestyle score (HLS) was defined based on five common lifestyle factors (smoking, alcohol drinking, diet, physical activity and body mass index) that related to cancer survival. We used Cox proportional hazards regression to estimate the hazard ratios (HRs) for the associations of individual lifestyle factors and HLS with all-cause and cancer mortality among cancer survivors. During the follow-up period of 37,095 cancer survivors, 8927 all-cause mortality events were accrued in four cohorts and 4449 cancer death events were documented in the UK and US cohorts. Never smoking (adjusted HR = 0.77, 95% CI: 0.69-0.86), light alcohol consumption (adjusted HR = 0.86, 95% CI: 0.82-0.90), adequate physical activity (adjusted HR = 0.90, 95% CI: 0.85-0.94), a healthy diet (adjusted HR = 0.69, 95% CI: 0.61-0.78) and optimal BMI (adjusted HR = 0.89, 95% CI: 0.85-0.93) were significantly associated with a lower risk of all-cause mortality. In the joint analyses of HLS, the HR of all-cause and cancer mortality for cancer survivors with a favorable HLS (4 and 5 healthy lifestyle factors) were 0.55 (95% CI 0.42-0.64) and 0.57 (95% CI 0.44-0.72), respectively. This multicohort study of cancer survivors from the United States, the United Kingdom and China found that greater adherence to a healthy lifestyle might be beneficial in improving cancer prognosis.

Association of combined healthy lifestyle with general and abdominal obesity.

Data linking joint healthy lifestyle factors to general and abdominal obesity are scarce, in particular in the Middle East. The aim of this study was to examine the association of combined healthy lifestyle factors with general and abdominal obesity in a large population of Iranian adults. This cross-sectional study was done on 3,172 Iranian adults aged ≥18 years. We constructed healthy lifestyle score using information on dietary intakes, physical activity, smoking status, and psychological distress. To evaluate components of healthy lifestyle, we applied a validated 106-item semi-quantitative Food Frequency Questionnaire (FFQ), General Practice Physical Activity Questionnaire (GPPAQ), General Health Questionnaire (GHQ), and other pre-tested questionnaires. General obesity was defined as having a body mass index (BMI) ≥30 kg/m2 and abdominal obesity as a waist circumference (WC) of ≥102 cm in men and ≥88 cm in women. Mean age of participants was 36.54 ± 7.97 years. General and abdominal obesity were prevalent among 8.7% and 21.5% of study participants, respectively. Linear analysis showed a significant positive relationship between healthy lifestyle score and BMI among men (β: 0.30, 95% CI: 0.05, 0.54). However, no significant association was found between healthy lifestyle and abdominal obesity in men. Among women, one score increase in healthy lifestyle score was associated with a reduction of 0.65 cm in WC. In terms of individual components of healthy lifestyle, we found that low-distressed women had lower odds of abdominal obesity compared with high-distressed women. We found a significant inverse association between healthy lifestyle and WC among women. However, healthy lifestyle was positively associated with BMI among men.

Abstract A015: Impact of healthy lifestyles and polygenic risk scores on pancreatic cancer risk: The Multiethnic Cohort Study

Abstract Background: Healthy lifestyles have been observed to reduce the risk of pancreatic cancer. However, it is unknown whether this protective impact varies among individuals with different levels of genetic susceptibility for pancreatic cancer. Methods: We investigated the association between healthy lifestyles, genetic risk, and pancreatic cancer incidence in 70,780 participants (32,783 males, 37,907 females) from the Multiethnic Cohort Study (MEC), a prospective cohort of White, African American, Native Hawaiian, Japanese American, and Latino men and women. We calculated a healthy lifestyle factor score (HLFS) based on smoking status, alcohol intake, body mass index and physical activity. We also estimated genetic risk using an established polygenic risk score (PRS) of 49 pancreatic cancer risk variants. Cox regression was used to assess the independent and joint associations of the HLFS (analyzed as quintiles) and PRS (analyzed as quintiles and high/low categories) with pancreatic cancer risk. Models were adjusted for age at blood draw, sex, race, family history of pancreatic cancer, and in the genetic analyses, the first ten principal components to account for population stratification. Results: The analytical cohort was comprised of 23,643 (33.4%) Japanese Americans, 16,816 (23.8%) Latinos, 14,305 (20.2%) Whites, 10,645 (15.0%) African Americans, and 5,371 (7.6%) Native Hawaiians. There were 721 incident cases of pancreatic cancer from an average follow-up period of 13.7 (SD 4.8) years. Higher levels of the PRS were associated with a 25-62% increase in pancreatic cancer risk, compared to the first PRS quintile. These elevated risks were borderline significant for quintile 2 (HR 1.25, 95% CI 0.97-1.61) and statistically significant for quintile 3 (HR 1.35, 95% CI 1.05-1.73), quintile 4 (HR 1.46, 95% CI 1.15-1.87), and quintile 5 (HR 1.62, 95% CI 1.27-2.06). For the HLFS, higher quintiles were associated with a 10-27% decreased risk of pancreatic cancer, compared to the lowest quintile, but this was only statistically significant for the highest quintile (HR 0.73, 95% CI 0.56-0.94). When evaluating the HLFS by levels of the PRS (low 0-50% vs. high 50-100%), the association between the highest HLFS quintile and pancreatic cancer was more pronounced among those in the high PRS group (HR 0.64, 95% CI 0.45-0.91), compared to those in the low PRS group (HR 0.80, 95% CI 0.55-1.18). However, this difference in effect by PRS levels was not statistically significant (p-interaction=0.43). Conclusions: Our study demonstrates that including information on healthy lifestyles and genetic risk may improve the risk stratification of pancreatic cancer for multiethnic populations. In addition, it is possible that healthy lifestyles could provide more benefit to individuals at higher genetic risk. Citation Format: Brian Huang, Adelynn Paik, David Bogumil, Fei Chen, Peggy Wan, Lynne Wilkens, Loic Le Marchand, David Conti, Christopher Haiman, Veronica Wendy Setiawan. Impact of healthy lifestyles and polygenic risk scores on pancreatic cancer risk: The Multiethnic Cohort Study [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr A015.

Association of long-term exposure to various ambient air pollutants, lifestyle, and genetic predisposition with incident cognitive impairment and dementia

BackgroundLong-term exposure to air pollution has been found to contribute to the development of cognitive decline. Our study aimed to assess the association between various air pollutants and cognitive impairment and dementia. Additionally, explore the modification effects of lifestyle and genetic predisposition.MethodsThe exposure levels to various air pollutants, including particulate matter (PM) with diameters ≤ 2.5 (PM2.5), ≤ 10 (PM10), and between 2.5 and 10 μm (PM2.5−10) and nitrogen oxides (NO and NO2) were identified. An air pollution score (APS) was calculated to evaluate the combined exposure to these five air pollutants. A genetic risk estimate and healthy lifestyle score (HLS) were also generated. The Cox regression model adjusted by potential confounders was adopted to access the association between pollution exposure and cognitive decline, and several sensitivity analyses were additionally conducted to test the robustness.ResultsThe combined exposure to air pollutants was associated with an increased risk of incident cognitive decline. Compared with the low exposure group, the hazard ratio (HR) and 95% confidence interval (CI) for all-cause dementia, Alzheimer’s dementia, vascular dementia, and mild cognitive impairment (MCI) in those exposed to the highest levels of air pollutants were respectively 1.07 (95% CI: 1.04 to 1.09), 1.08 (95% CI: 1.04 to 1.12), 1.07 (95% CI: 1.02 to 1.13), and 1.19 (95% CI: 1.12 to 1.27). However, the modification effects from genetic predisposition were not widely observed, while on the contrary for the healthy lifestyle. Our findings were proven to be reliable and robust based on the results of sensitivity analyses.ConclusionsExposure to air pollution was found to be a significant contributing factor to cognitive impairment and dementia, and this association was not easily modified by an individual’s genetic predisposition. However, adopting a healthy lifestyle may help to manage the risk of cognitive decline related to air pollution.

Modifiable Lifestyle Factors, Genetic Risk, and Incident Peripheral Artery Disease Among Individuals With Type 2 Diabetes: A Prospective Study.

To prospectively evaluate the association between modifiable lifestyle factors and peripheral artery disease (PAD) among individuals with type 2 diabetes (T2D). We included 14,543 individuals with T2D from the UK Biobank. We defined a weighted healthy lifestyle score using nonsmoking, regular physical activity, high-quality diet, moderate alcohol consumption, optimal waist-to-hip ratio, and adequate sleep duration, and categorized into unfavorable, intermediate, and favorable lifestyles. We created a genetic risk score (GRS) using 19 single nucleotide polymorphisms previously found to be associated with PAD. We modeled the association between lifestyle score and PAD, overall and stratified by PAD genetic susceptibility. After a median 13.5 years of follow-up, 628 incident cases of PAD were documented. A linear inverse association between the weighted lifestyle score and PAD was observed, with a hazard ratio (HR) (95% CI) of 0.27 (0.19, 0.38) for favorable compared with unfavorable lifestyle (Ptrend < 0.0001). An estimated 58.3% (45.0%, 69.1%) of PAD in this population could be potentially avoidable if all participants attained a favorable lifestyle. Moreover, the PAD GRS was associated with increased PAD risk (HR [95% CI] per SD increment: 1.13 [1.03, 1.23]). A favorable lifestyle was able to partially mitigate the excess risk of PAD associated with higher GRS, albeit as a nonsignificant interaction. Several biomarkers in the lipid metabolism, hepatic/renal function, and systemic inflammation pathways collectively explained 13.3% (8.5%, 20.1%) of the association between weighted lifestyle score and PAD. A favorable lifestyle was associated with lower risk of PAD among individuals with T2D, independent of genetic predisposition to PAD.

Lifestyle and ADL Are Prioritized Factors Influencing All-Cause Mortality Risk Among Oldest Old: A Population-Based Cohort Study.

To identify key factors affecting all-cause mortality in the elderly aged 80 years and above. Data from Chinese Longitudinal Healthy Longevity Survey (2011-2018) were utilized (N = 3993). A healthy lifestyle score was obtained by assigning 8 factors: smoking, drinking, exercise, sleep duration, social activity, waist circumference, BMI, and healthful plant-based diet index. Cox regression and decision tree model were used to identify factors influencing the mortality risk. Lifestyle and activities of daily living (ADL) were 2 of the most important modifiable factors influencing the mortality risk of the oldest seniors. A higher healthy lifestyle score was associated with lower mortality risk. The HR (95% CI) of death risk in Q2, Q3, and Q4 groups were 0.91 (0.81-1.01), 0.78 (0.71-0.86), and 0.64 (0.58-0.71), respectively, when compared with the Q1 group of healthy lifestyle score. Elderly with ADL disability had a higher mortality rate than those without ADL disability. When the elderly already have ADL disability, the healthier the lifestyle, the lower the mortality rate. Among individuals aged 80 to 89 years with ADL disability, the mortality rate was higher in the healthy lifestyle score Q1-Q2 groups (92.1%) than that in the Q3-Q4 groups (71.6%). Similar results were observed among subjects aged 90 to 99 years with ADL disability (Q1-Q2: 97.9%, Q3-Q4: 92.1%). For centenarians without ADL disability, maintaining a healthy lifestyle significantly reduced mortality (Q1-Q3: 90.5%, Q4: 75.5%). Caregivers should prioritize the consideration of lifestyle and ADL in their healthcare practices of the oldest old.

Associations of Socioeconomic Status Inequity with Incident Age-related Macular Degeneration in Middle-Aged and Elderly Population.

Background: The relationship between socioeconomic status (SES) inequity and incident age-related macular degeneration (AMD) remains unclear. We aim to investigate whether low SES increases the risk of AMD and to explore the effect of a healthy lifestyle on this association. Methods: This prospective cohort study included 316,663 UK Biobank individuals. SES inequity was identified via latent class analysis using education, household income, and occupational status. Healthy lifestyle score was calculated based on smoking, alcohol drinking, and physical activity (PA). Incident AMD was defined according to diagnosis records. Cox proportional hazards models were used to evaluate the relationship of low SES and AMD. Interrelationships of healthy lifestyle score on SES-AMD association were explored, including modification, mediation, and joint effects. Results: During the average 12.2 years of follow-up, 6,355 AMD cases were diagnosed. Participants with medium SES (hazard ratio: 1.10 [95% confidence interval (CI) 1.01 to 1.21]) and low SES (hazard ratio: 1.22 [95% CI 1.11 to 1.34]) had an increased risk of incident AMD compared to participants with high SES. PA significantly affected this association. Moreover, the association between low SES and AMD was significantly mediated (11.3%, 95% CI: 6.56 to 23.0) by smoking. Similarly, alcohol drinking suppressed (9.59%, 95% CI: 4.00 to 23.2) the association between high SES and AMD. Besides, a significant joint effect of SES and healthy lifestyle score was found. Conclusions: We provide further evidence for the relationship of socioeconomic inequity, healthy lifestyle, and incident AMD. Future public health strategies should aim to reduce socioeconomic inequity to prevent AMD.

Healthy lifestyle and the risk of depression recurrence requiring hospitalisation and mortality among adults with pre-existing depression: a prospective cohort study

BackgroundAlthough lifestyle-based treatment approaches are recommended as important aspects of depression care, the quantitative influence of aggregated healthy lifestyles on depression recurrence and mortality remains unknown.ObjectiveTo investigate the association between...

Associations of Serum Vitamin D Concentration with Cardiovascular Risk Factors and the Healthy Lifestyle Score.

Vitamin D status is reportedly associated with risk factors for cardiovascular disease (CVD), although conflicting data have been generated. The healthy lifestyle score (HLS) was formulated as a primary approach toward preventing CVD; however, data on the association between the HLS and vitamin D status remain insufficient. This study aimed to investigate the associations of CVD risk factors and the HLS with serum 25-hydroxyvitamin D concentration in adults who participated in a national survey. HLS components, including body mass index, smoking status, alcohol consumption, physical activity, and dietary pattern, as well as other risk factors, including diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DL), were fitted in multiple linear regression models to determine their association with vitamin D status. DM, HTN, and DL were inversely associated whereas a balanced dietary pattern, alcohol consumption, and physical activity were positively associated with serum vitamin D concentration (p < 0.01). Furthermore, a strong association was observed between the total HLS and serum vitamin D concentration (p for trend <0.01); the regression coefficient estimate (95% confidence interval) for the highest score was 1.41 (0.65, 2.17) (p < 0.01) compared with that for the lowest. These findings suggest that CVD risk factors and the HLS may reflect vitamin D status.

IS FRAILTY THE END? ASSOCIATION OF LIFESTYLES AND SOCIAL ENVIRONMENT WITH DEATH AMONG THE FRAIL

Abstract Despite many efforts, reversing the frail status among older adults remains difficult. However, frailty does not mean the end of life. Adherence to a healthy lifestyle and a desirable social environment may reduce the risk of adverse outcomes among the frail. We examined whether adherence to a healthy lifestyle was associated with lower all-cause mortality and the joint association of lifestyles and social environment with mortality among the frail. Data were from UK Biobank; 15,594 physically frail middle-aged and older adults were included. Frailty was assessed by Fried’s physical frailty phenotype approach. We created a composite healthy lifestyle score using four lifestyle factors: smoking, alcohol consumption, physical activity, and diet. We used 17 social factors to construct a polysocial score for measuring the social environment. We used the Cox model to estimate the association of each lifestyle factor and the composite lifestyle score with mortality among the entire sample and by polysocial score (low, intermediate, and high level). We also evaluated the joint association of lifestyle and polysocial scores with mortality. Frail participants with a healthy level of smoking, physical activity, diet, and composite lifestyle score had a 40%, 33%, 15%, and 34% lower hazard of death than those with an unhealthy level, respectively. We found a joint effect of a healthy lifestyle and social environment on mortality. Adherence to a healthy lifestyle may provide an opportunity to decrease the risk of adverse health outcomes among the frail, especially among those living in an unfavorable social environment.

Parental adherence to healthy lifestyles in relation to the risk of obesity in offspring: A prospective cohort study in China.

While maternal adherence to a healthy lifestyle was shown to be associated with a lower risk of obesity in offspring, the potential role of overall parental lifestyles has not yet been explored. We aimed to address this gap by exploring whether parental adherence to an overall healthy lifestyle was associated with a lower risk of obesity in offspring. We included 5881 children and adolescents aged 6-15 years at enrolment in the 2010, 2012, and 2014 waves of the China Family Panel Studies (CFPS) who were free of obesity and followed them until 2020. Parental healthy lifestyle score at study baseline was composed of five modifiable lifestyle factors (0-5; 1 for each): never smoking, non-habitual drinking, weekly exercise, modified dietary diversity score ≥5 points, and body mass index (BMI) of 18.5-23.9 kg/m2. We defined obesity according to the age- and gender-specific cutoffs by the BMI percentile curves for Chinese children aged 6-18 years. We used multivariable Cox proportional hazard models to examine the association between parental healthy lifestyle score (both as continuous and categorical variables) and risk of offspring obesity. Overall, 597 (10.2%) offspring developed obesity during a median follow-up of 6 years. Compared to the lowest tertile of parental healthy lifestyle score, participants in the highest tertile had a 42% (hazard ratio (HR) = 0.58; 95% confidence interval (CI) = 0.45-0.74) lower risk of obesity. Both maternal (HR = 0.75; 95% CI = 0.61-0.92) and paternal (HR = 0.73; 95% CI = 0.60-0.89) healthy lifestyle scores were associated with lower risks of obesity in offspring. For specific lifestyle factors, we observed beneficial associations for paternal diverse diet (HR = 0.73; 95% CI = 0.60-0.88) and healthy BMI (HR = 0.65; 95% CI = 0.55-0.78). Adherence to an overall parental healthier lifestyle was associated with a lower risk of obesity in childhood and adolescence. This finding highlights the potential benefits of promoting a healthy lifestyle among parents for the primary prevention of offspring obesity.

Adherence to a healthy lifestyle and its association with cognitive impairment in community-dwelling older adults in Shanghai.

There is a growing body of recent literature linking the association of specific or multiple lifestyles with cognitive impairment, but most of these studies have been conducted in Western populations, and it is necessary to study multiple lifestyles and cognitive abilities in different populations, with the primary population of this study being a select group of community-dwelling older adults in Shanghai, China. The sample included 2,390 community-dwelling Chinese participants. Their cognitive function was assessed using the Mini-Mental State Examination (MMSE). We defined a healthy lifestyle score on the basis of being non-smoking, performing ≥210 min/wk moderate/vigorous-intensity physical activity, having light to moderate alcohol consumption, eating vegetables and fruits daily, having a body mass index (BMI) of 18.5-23.9 kg/m2, and having a waist-to-hip ratio (WHR) <0.90 for men and <0.85 for women, for an overall score ranging from 0 to 6. Compared with participants with ≤2 healthy lifestyle factors, the adjusted odds ratio (OR) and 95% confidence interval (CI) for participants with 4, 5, and 6 healthy lifestyle factors were 0.53 (95% CI, 0.29-0.98), 0.40 (95% CI, 0.21-0.75), and 0.36 (95% CI, 0.16-0.79), respectively. Only WHR (OR = 0.54, 95% CI = 0.37-0.78) and physical activity (OR = 0.69, 95% CI = 0.51-0.92) were associated with cognitive impairment. A healthy lifestyle correlated with overall cognition (β = 0.066, orientation (β = 0.049), language ability (β = 0.060), delayed recall (β = 0.045) and executive function (β = 0.044) (P all < 0.05). The study provides evidence on an inverse association between healthy lifestyles and cognitive impairment. We investigated whether healthy lifestyle was related to specific cognitive functions to provide a theoretical basis for accurate clinical prescription.

Association of genetic risk and lifestyle with pancreatic cancer and their age dependency: a large prospective cohort study in the UK Biobank

BackgroundPancreatic cancer (PC) is influenced by both genetic and lifestyle factors. However, further research is still needed to comprehensively clarify the relationships among lifestyle, genetic factors, their combined effect on PC, and how these associations might be age-dependent.MethodsWe included 340,631 participants from the UK Biobank. Three polygenic risk score (PRS) models for PC were applied, which were derived from the previous study and were categorized as low, intermediate, and high. Two healthy lifestyle scores (HLSs) were constructed using 9 lifestyle factors based on the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) lifestyle score and the American Cancer Society (ACS) guidelines and were categorized as unfavorable, intermediate, and favorable. Data were analyzed using Cox proportional hazards models.ResultsThere were 1,129 cases of incident PC during a median follow-up of 13.05 years. Higher PRS was significantly associated with an increased risk of PC (hazard ratio [HR], 1.58; 95% confidence intervals [CI], 1.47–1.71). Adhering to a favorable lifestyle was associated with a lower risk (HR, 0.48; 95% CI, 0.41–0.56). Participants with an unfavorable lifestyle and a high PRS had the highest risk of PC (HR, 2.84; 95% CI, 2.22–3.62). Additionally, when stratified by age, a favorable lifestyle was most pronounced associated with a lower risk of PC among participants aged ≤ 60 years (HR, 0.35; 95% CI, 0.23–0.54). However, the absolute risk reduction was more pronounced among those aged > 70 years (ARR, 0.19%, 95% CI, 0.13%–0.26%). A high PRS was more strongly associated with PC among participants aged ≤ 60 years (HR, 1.89; 95% CI, 1.30–2.73). Furthermore, we observed a significant multiplicative interaction and several significant additive interactions.ConclusionsA healthy lifestyle was associated with a lower risk of PC, regardless of the participants' age, sex, or genetic risk. Importantly, our findings indicated the age-dependent association of lifestyle and genetic factors with PC, emphasizing the importance of early adoption for effective prevention and potentially providing invaluable guidance for setting the optimal age to start preventive measures.