Akbar Fazel-Tabar Malekshah1, Marsa Zaroudi1, Arash Etemadi2, Farhad Islami3, Sadaf Sepanlou1, Maryam Sharafkhah1, Abbas-Ali Keshtkar4, Hooman Khademi1, Hossein Poustchi1, Azita Hekmatdoost5, Akram Pourshams1, Akbar Feiz Sani1, Elham Jafari1, Farin Kamangar6, Sanford M Dawsey7, Christian C Abnet7, Paul D Pharoah8, Paul J Berennan9, Paolo Boffetta10, Ahmad Esmaillzadeh11, Reza Malekzadeh1. 1. Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2. Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA. 3. Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, Surveillance and Health Services Research, American Cancer Society, Atlanta, USA. 4. Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran. 5. Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 6. Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA. 7. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA. 8. Departments of Oncology and Public Health and Primary Care, University of Cambridge, UK. 9. International Prevention Research Institute, Lyon, France. 10. The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, USA. 11. Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran, Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran, Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
Abstract
BACKGROUND: Most studies that have evaluated the association between combined lifestyle factors and mortality outcomes have been conducted in populations of developed countries. OBJECTIVES: The aim of this study was to examine the association between combined lifestyle scores and risk of all-cause and cause-specific mortality for the first time among Iranian adults. METHODS: The study population included 50,045 Iranians, 40 - 75 years of age, who were enrolled in the Golestan Cohort Study, between 2004 and 2008. The lifestyle risk factors used in this study included cigarette smoking, physical inactivity, and Alternative Healthy Eating Index. The lifestyle score ranged from zero (non-healthy) to 3 (most healthy) points. From the study baseline up to analysis, a total of 4691 mortality cases were recorded. Participants with chronic diseases at baseline, outlier reports of calorie intake, missing data, and body mass index of less than 18.5 were excluded from the analyses. Cox regression models were fitted to establish the association between combined lifestyle scores and mortality outcomes. RESULTS: After implementing the exclusion criteria, data from 40,708 participants were included in analyses. During 8.08 years of follow-up, 3,039 cases of all-cause mortality were recorded. The adjusted hazard ratio of a healthy lifestyle score, compared with non-healthy lifestyle score, was 0.68 (95% CI: 0.54, 0.86) for all-cause mortality, 0.53 (95% CI: 0.37, 0.77) for cardiovascular mortality, and 0.82 (95% CI: 0.53, 1.26) for mortality due to cancer. When we excluded the first two years of follow up from the analysis, the protective association between healthy lifestyle score and cardiovascular death did not change much 0.55 (95% CI: 0.36, 0.84), but the inverse association with all-cause mortality became weaker 0.72 (95% CI: 0.55, 0.94), and the association with cancer mortality was non-significant 0.92 (95% CI: 0.58, 1.48). In the gender-stratified analysis, we found an inverse strong association between adherence to healthy lifestyle and mortality from all causes and cardiovascular disease in either gender, but no significant relationship was seen with mortality from cancer in men or women. Stratified analysis of BMI status revealed an inverse significant association between adherence to healthy lifestyle and mortality from all causes, cardiovascular disease and cancer among non-obese participants. CONCLUSION: We found evidence indicating that adherence to a healthy lifestyle, compared to non-healthy lifestyle, was associated with decreased risk of all-cause mortality and mortality from cardiovascular diseases in Iranian adults.
BACKGROUND: Most studies that have evaluated the association between combined lifestyle factors and mortality outcomes have been conducted in populations of developed countries. OBJECTIVES: The aim of this study was to examine the association between combined lifestyle scores and risk of all-cause and cause-specific mortality for the first time among Iranian adults. METHODS: The study population included 50,045 Iranians, 40 - 75 years of age, who were enrolled in the Golestan Cohort Study, between 2004 and 2008. The lifestyle risk factors used in this study included cigarette smoking, physical inactivity, and Alternative Healthy Eating Index. The lifestyle score ranged from zero (non-healthy) to 3 (most healthy) points. From the study baseline up to analysis, a total of 4691 mortality cases were recorded. Participants with chronic diseases at baseline, outlier reports of calorie intake, missing data, and body mass index of less than 18.5 were excluded from the analyses. Cox regression models were fitted to establish the association between combined lifestyle scores and mortality outcomes. RESULTS: After implementing the exclusion criteria, data from 40,708 participants were included in analyses. During 8.08 years of follow-up, 3,039 cases of all-cause mortality were recorded. The adjusted hazard ratio of a healthy lifestyle score, compared with non-healthy lifestyle score, was 0.68 (95% CI: 0.54, 0.86) for all-cause mortality, 0.53 (95% CI: 0.37, 0.77) for cardiovascular mortality, and 0.82 (95% CI: 0.53, 1.26) for mortality due to cancer. When we excluded the first two years of follow up from the analysis, the protective association between healthy lifestyle score and cardiovascular death did not change much 0.55 (95% CI: 0.36, 0.84), but the inverse association with all-cause mortality became weaker 0.72 (95% CI: 0.55, 0.94), and the association with cancer mortality was non-significant 0.92 (95% CI: 0.58, 1.48). In the gender-stratified analysis, we found an inverse strong association between adherence to healthy lifestyle and mortality from all causes and cardiovascular disease in either gender, but no significant relationship was seen with mortality from cancer in men or women. Stratified analysis of BMI status revealed an inverse significant association between adherence to healthy lifestyle and mortality from all causes, cardiovascular disease and cancer among non-obese participants. CONCLUSION: We found evidence indicating that adherence to a healthy lifestyle, compared to non-healthy lifestyle, was associated with decreased risk of all-cause mortality and mortality from cardiovascular diseases in Iranian adults.
Authors: A F Malekshah; M Kimiagar; M Saadatian-Elahi; A Pourshams; M Nouraie; G Goglani; A Hoshiarrad; M Sadatsafavi; B Golestan; A Yoonesi; N Rakhshani; S Fahimi; D Nasrollahzadeh; R Salahi; A Ghafarpour; S Semnani; J P Steghens; C C Abnet; F Kamangar; S M Dawsey; P Brennan; P Boffetta; R Malekzadeh Journal: Eur J Clin Nutr Date: 2006-02-08 Impact factor: 4.016
Authors: Ute Mons; Aysel Müezzinler; Carolin Gellert; Ben Schöttker; Christian C Abnet; Martin Bobak; Lisette de Groot; Neal D Freedman; Eugène Jansen; Frank Kee; Daan Kromhout; Kari Kuulasmaa; Tiina Laatikainen; Mark G O'Doherty; Bas Bueno-de-Mesquita; Philippos Orfanos; Annette Peters; Yvonne T van der Schouw; Tom Wilsgaard; Alicja Wolk; Antonia Trichopoulou; Paolo Boffetta; Hermann Brenner Journal: BMJ Date: 2015-04-20