Combined impact of lifestyle factors on mortality: prospective cohort study in US women
Open accessAbstract
OBJECTIVE: To evaluate the impact of combinations of lifestyle factors on mortality in middle aged women. DESIGN: Prospective cohort study. SETTING: Nurses' health study, United States. PARTICIPANTS: 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980. MAIN OUTCOME MEASURE: Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors (cigarette smoking, being overweight, taking little moderate to vigorous physical activity, no light to moderate alcohol intake, and low diet quality score). RESULTS: 8882 deaths were documented, including 1790 from cardiovascular disease and 4527 from cancer. Each lifestyle factor independently and significantly predicted mortality. Relative risks for five compared with zero lifestyle risk factors were 3.26 (95% confidence interval 2.45 to 4.34) for cancer mortality, 8.17 (4.96 to 13.47) for cardiovascular mortality, and 4.31 (3.51 to 5.31) for all cause mortality. A total of 28% (25% to 31%) of deaths during follow-up could be attributed to smoking and 55% (47% to 62%) to the combination of smoking, being overweight, lack of physical activity, and a low diet quality. Additionally considering alcohol intake did not substantially change this estimate. CONCLUSIONS: These results indicate that adherence to lifestyle guidelines is associated with markedly lower mortality in middle aged women. Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified.
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The circadian system and its prime marker, melatonin, are considered to have antitumor effects through multiple pathways, including antioxidant activity, anti-inflammatory effects, and immune enhancement.
“The circadian system and its prime marker, melatonin, are considered to have antitumor effects through multiple pathways, including antioxidant activity, anti-inflammatory effects, and immune enhancement.33-37”
From Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night Shifts (2015) · cites this paper as [36]
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- Authors
- Dam, R. M. V., Li, T., Spiegelman, D., Franco, O. H., & Hu, F. B.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Unilever (United Kingdom) (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2008-09-16
- Volume
- 337
- Issue
- sep16 2
- Pages
- a1440-a1440
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2658866
- OpenAlex
- W2109684220
- Cited by
- 462
- References
- 54
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 10 · 2023: 14 · 2022: 19 · 2021: 28 · 2020: 23 · 2019: 30 · 2018: 28 · 2017: 25 · 2016: 42 · 2015: 34 · 2014: 29 · 2013: 37 · 2012: 31
- FWCI
- 22.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- BMJ (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- Brigham and Women's Hospital
- Peanut Research Foundation
- National Institutes of Health (CA 87969)
- National Heart, Lung, and Blood Institute (HL60712, R01HL060712)
- National Cancer Institute (CA-87969, P01CA087969)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Health Professions › General Health Professions › Health and Lifestyle Studies
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- lifestyle factors, mortality, middle-aged women, cigarette smoking, overweight, physical inactivity, alcohol consumption, diet quality, cardiovascular mortality, cancer mortality, all-cause mortality, Nurses' Health Study
- MeSH terms
- Alcohol Drinking, Cardiovascular Diseases, Chronic Disease, Diet, Female, Humans, Life Style, Middle Aged, Neoplasms, Obesity, Prospective Studies, Risk Factors, Smoking, United States, Exercise
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