Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study.
Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study.
复制标题
DOI：
10.1371/journal.pmed.0050012
复制
发表时间：
2008-01-08
期刊：
影响因子：
15.8
通讯作者：
Day N
中科院分区：
文献类型：
--
作者：
Khaw KT;Wareham N;Bingham S;Welch A;Luben R;Day N
有大量证据表明行为因素会影响健康，但它们对普通人群的综合影响却鲜有记录。我们的目的是量化四种健康行为对普通社区男性和女性死亡率的潜在综合影响。我们在一项前瞻性人口研究中检验了生活方式与死亡率之间的前瞻性关系，该研究对 20,244 名 45-79 岁的男性和女性进行了调查，这些男性和女性在 1993-1997 年的基线调查中没有已知的心血管疾病或癌症，他们生活在英国的普通社区，并随访至 2006 年。参与者为每项健康行为得分一分：当前不吸烟、不缺乏运动、适量饮酒（每天 1-14 个单位） 周）和血浆维生素 C > 50 mmol/l 表明每天至少摄入五份水果和蔬菜，总分从 0 到 4 不等。经过平均 11 年的随访，与四种健康行为相比，有 3 种、2 种、1 种和 0 种健康行为的男性和女性的全因死亡率（1,987 例死亡）的年龄、性别、体重和社会阶层调整后的相对风险（95% 置信区间）分别为 1.39 (1.21–1.60)、1.95 (1.70–-2.25)、2.52 (2.13–3.00) 和 4.04 (2.95–5.54) p < 0.001 趋势。在按性别、年龄、体重指数和社会阶层分层的亚组中，以及排除 2 年内的死亡后，这些关系是一致的。心血管原因的趋势最为强劲。与零健康行为相比，拥有 4 项健康行为的人的死亡风险相当于按实际年龄年轻 14 岁。四种健康行为相结合，预测男性和女性的总死亡率将相差 4 倍，估计影响相当于实际年龄的 14 岁。 Kay-Tee Khaw 及其同事根据一项大型前瞻性人口研究估计，四种行为（不吸烟、不缺乏运动、适量饮酒以及每天至少吃五份蔬菜）的综合影响相当于延长寿命 14 年。每天，或者看起来是这样，新的研究表明，生活方式的某些方面——体力活动、饮食、饮酒等等——都会影响健康和寿命。对于街上的人来说，所有这些信息都是令人困惑的。例如，什么是健康饮食？尽管有一些共同的主题，例如多吃水果和蔬菜的好处，但研究之间的细节往往有所不同。到底需要多少身体活动才能改善健康？每天轻柔的散步是否就足够了，还是只是做足够锻炼以产生真正影响的垫脚石？饮酒的情况同样令人困惑。少量饮酒显然可以改善健康，但大量饮酒则有害。因此，公共卫生官员可能很难找到有效的方法来鼓励科学证据表明可能影响人口健康的行为改变。还有另一个因素阻碍了官方向公众提供健康生活方式建议的努力。尽管有大量证据表明个人行为因素会影响健康，但有关其综合影响的信息却很少。如果生活方式的几个微小差异的结合可以被证明对人群的健康产生显着影响，那么说服人们改变行为以改善健康可能会更容易，特别是如果这些改变很简单并且相对容易实现的话。这项研究是欧洲癌症与营养前瞻性调查 (EPIC) 的一部分，在这项研究中，研究人员使用基于四种简单定义的行为——吸烟、体力活动、饮酒以及水果和蔬菜摄入——的健康行为评分，研究了生活方式与死亡风险之间的关系。 1993 年至 1997 年间，作为 EPIC-诺福克研究的一部分，居住在英国诺福克的约 20,000 名年龄在 45 至 79 岁之间的男性和女性（其中没有人患有癌症或心血管疾病（心脏或血液循环问题））完成了健康和生活方式调查问卷，进行了健康检查，并测量了他们的血液维生素 C 水平。每位参与者的健康行为得分在 0 到 4 之间，为以下每项健康行为打一分：当前不吸烟、不缺乏身体活动（缺乏身体活动的定义是从事久坐工作且不进行娱乐性运动）、适量饮酒（每周 1-14 单位；一单位酒精是半品脱啤酒、一杯葡萄酒或一杯烈酒）以及血液维生素 C 水平与 每天至少摄入五份水果和蔬菜。然后记录参与者的死亡情况，直到 2006 年。考虑到可能影响死亡可能性的其他因素（例如年龄）后，健康行为得分为 0 的人死亡（特别是死于心血管疾病）的可能性是得分为 4 的人的四倍。得分为 2 的人死亡的可能性是得分为 2 的人的两倍。这些研究结果表明，将四种简单定义的健康行为结合起来，可以预测中老年人平均 11 年的死亡风险会相差 4 倍。他们还表明，随着积极健康行为数量的增加，死亡风险（特别是心血管疾病）会降低。最后，它们可以用来计算出，健康评分为 0 的人与年长 14 岁、健康评分为 4 的人的死亡风险相同。这些发现需要在其他人群中得到证实，并扩展到分析这些综合健康行为如何影响生活质量以及死亡风险。尽管如此，他们强烈建议，适度且可实现的生活方式改变可能会对人们的健康产生显着影响。有了这些信息，公共卫生官员现在应该能够更好地鼓励行为改变，从而改善中老年人的健康。请通过此摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.0050012。 MedlinePlus 百科全书包含一个有关健康生活的页面（英语和西班牙语） 有关老年人健康的 MedlinePlus 页面包含许多涉及健康生活方式和长寿的网站的链接（英语和西班牙语） 欧洲癌症与营养前瞻性调查 (EPIC) 研究正在调查营养和生活方式与癌症和其他慢性病发展之间的关系；还提供有关 EPIC-诺福克研究的信息 美国疾病控制与预防中心提供老年人健康老龄化的信息，包括健康相关行为的信息（英语和西班牙语） 英国慈善机构 Age Concerns 提供有关晚年保持健康的情况说明书 伦敦健康观察站为政策制定者和从业者提供有关改善健康和医疗保健的信息，其中有一节介绍生活方式和行为如何影响健康
There is overwhelming evidence that behavioural factors influence health, but their combined impact on the general population is less well documented. We aimed to quantify the potential combined impact of four health behaviours on mortality in men and women living in the general community. We examined the prospective relationship between lifestyle and mortality in a prospective population study of 20,244 men and women aged 45–79 y with no known cardiovascular disease or cancer at baseline survey in 1993–1997, living in the general community in the United Kingdom, and followed up to 2006. Participants scored one point for each health behaviour: current non-smoking, not physically inactive, moderate alcohol intake (1–14 units a week) and plasma vitamin C >50 mmol/l indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from zero to four. After an average 11 y follow-up, the age-, sex-, body mass–, and social class–adjusted relative risks (95% confidence intervals) for all-cause mortality(1,987 deaths) for men and women who had three, two, one, and zero compared to four health behaviours were respectively, 1.39 (1.21–1.60), 1.95 (1.70–-2.25), 2.52 (2.13–3.00), and 4.04 (2.95–5.54) p < 0.001 trend. The relationships were consistent in subgroups stratified by sex, age, body mass index, and social class, and after excluding deaths within 2 y. The trends were strongest for cardiovascular causes. The mortality risk for those with four compared to zero health behaviours was equivalent to being 14 y younger in chronological age. Four health behaviours combined predict a 4-fold difference in total mortality in men and women, with an estimated impact equivalent to 14 y in chronological age. From a large prospective population study, Kay-Tee Khaw and colleagues estimate the combined impact of four behaviors--not smoking, not being physically inactive, moderate alcohol intake, and at least five vegetable servings a day--amounts to 14 additional years of life. Every day, or so it seems, new research shows that some aspect of lifestyle—physical activity, diet, alcohol consumption, and so on—affects health and longevity. For the person in the street, all this information is confusing. What is a healthy diet, for example? Although there are some common themes such as the benefit of eating plenty of fruit and vegetables, the details often differ between studies. And exactly how much physical activity is needed to improve health? Is a gentle daily walk sufficient or simply a stepping stone to doing enough exercise to make a real difference? The situation with alcohol consumption is equally confusing. Small amounts of alcohol apparently improve health but large amounts are harmful. As a result, it can be hard for public-health officials to find effective ways to encourage the behavioral changes that the scientific evidence suggests might influence the health of populations. There is another factor that is hindering official attempts to provide healthy lifestyle advice to the public. Although there is overwhelming evidence that individual behavioral factors influence health, there is very little information about their combined impact. If the combination of several small differences in lifestyle could be shown to have a marked effect on the health of populations, it might be easier to persuade people to make behavioral changes to improve their health, particularly if those changes were simple and relatively easy to achieve. In this study, which forms part of the European Prospective Investigation into Cancer and Nutrition (EPIC), the researchers have examined the relationship between lifestyle and the risk of dying using a health behavior score based on four simply defined behaviors—smoking, physical activity, alcohol drinking, and fruit and vegetable intake. Between 1993 and 1997, about 20,000 men and women aged 45–79 living in Norfolk UK, none of whom had cancer or cardiovascular disease (heart or circulation problems), completed a health and lifestyle questionnaire, had a health examination, and had their blood vitamin C level measured as part of the EPIC-Norfolk study. A health behavior score of between 0 and 4 was calculated for each participant by giving one point for each of the following healthy behaviors: current non-smoking, not physically inactive (physical inactivity was defined as having a sedentary job and doing no recreational exercise), moderate alcohol intake (1–14 units a week; a unit of alcohol is half a pint of beer, a glass of wine, or a shot of spirit), and a blood vitamin C level consistent with a fruit and vegetable intake of at least five servings a day. Deaths among the participants were then recorded until 2006. After allowing for other factors that might have affected their likelihood of dying (for example, age), people with a health behavior score of 0 were four times as likely to have died (in particular, from cardiovascular disease) than those with a score of 4. People with a score of 2 were twice as likely to have died. These findings indicate that the combination of four simply defined health behaviors predicts a 4-fold difference in the risk of dying over an average period of 11 years for middle-aged and older people. They also show that the risk of death (particularly from cardiovascular disease) decreases as the number of positive health behaviors increase. Finally, they can be used to calculate that a person with a health score of 0 has the same risk of dying as a person with a health score of 4 who is 14 years older. These findings need to be confirmed in other populations and extended to an analysis of how these combined health behaviors affect the quality of life as well as the risk of death. Nevertheless, they strongly suggest that modest and achievable lifestyle changes could have a marked effect on the health of populations. Armed with this information, public-health officials should now be in a better position to encourage behavior changes likely to improve the health of middle-aged and older people. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050012. The MedlinePlus encyclopedia contains a page on healthy living (in English and Spanish) The MedlinePlus page on seniors' health contains links to many sites dealing with healthy lifestyles and longevity (in English and Spanish) The European Prospective Investigation into Cancer and Nutrition (EPIC) study is investigating the relationship between nutrition and lifestyle and the development of cancer and other chronic diseases; information about the EPIC-Norfolk study is also available The US Centers for Disease Control and Prevention provides information on healthy aging for older adults, including information on health-related behaviors (in English and Spanish) The UK charity Age Concerns provides a fact sheet about staying healthy in later life The London Health Observatory, which provides information for policy makers and practitioners about improving health and health care, has a section on how lifestyle and behavior affect health