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Cited by 927Cardiovascular Health and Risk FactorsHealth and Lifestyle StudiesNutritional Studies and Diet

Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population

Open access
Li, Yanping, Pan, An, Wang, Dong D., Liu, Xiaoran, Dhana, Klodian, Franco, Oscar H., Kaptoge, Stephen, Di Angelantonio, Emanuele +3 more·2018·Circulation
DOI 10.1161/circulationaha.117.032047PMC PMC6207481
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Abstract

Background: Americans have a shorter life expectancy compared with residents of almost all other high-income countries. We aim to estimate the impact of lifestyle factors on premature mortality and life expectancy in the US population. Methods: Using data from the Nurses’ Health Study (1980–2014; n=78 865) and the Health Professionals Follow-up Study (1986–2014, n=44 354), we defined 5 low-risk lifestyle factors as never smoking, body mass index of 18.5 to 24.9 kg/m 2 , ≥30 min/d of moderate to vigorous physical activity, moderate alcohol intake, and a high diet quality score (upper 40%), and estimated hazard ratios for the association of total lifestyle score (0–5 scale) with mortality. We used data from the NHANES (National Health and Nutrition Examination Surveys; 2013–2014) to estimate the distribution of the lifestyle score and the US Centers for Disease Control and Prevention WONDER database to derive the age-specific death rates of Americans. We applied the life table method to estimate life expectancy by levels of the lifestyle score. Results: During up to 34 years of follow-up, we documented 42 167 deaths. The multivariable-adjusted hazard ratios for mortality in adults with 5 compared with zero low-risk factors were 0.26 (95% confidence interval [CI], 0.22–0.31) for all-cause mortality, 0.35 (95% CI, 0.27–0.45) for cancer mortality, and 0.18 (95% CI, 0.12–0.26) for cardiovascular disease mortality. The population-attributable risk of nonadherence to 5 low-risk factors was 60.7% (95% CI, 53.6–66.7) for all-cause mortality, 51.7% (95% CI, 37.1–62.9) for cancer mortality, and 71.7% (95% CI, 58.1–81.0) for cardiovascular disease mortality. We estimated that the life expectancy at age 50 years was 29.0 years (95% CI, 28.3–29.8) for women and 25.5 years (95% CI, 24.7–26.2) for men who adopted zero low-risk lifestyle factors. In contrast, for those who adopted all 5 low-risk factors, we projected a life expectancy at age 50 years of 43.1 years (95% CI, 41.3–44.9) for women and 37.6 years (95% CI, 35.8–39.4) for men. The projected life expectancy at age 50 years was on average 14.0 years (95% CI, 11.8–16.2) longer among female Americans with 5 low-risk factors compared with those with zero low-risk factors; for men, the difference was 12.2 years (95% CI, 10.1–14.2). Conclusions: Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults.

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Crossref · 10.1161/circulationaha.117.032047

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42 of 42 references verified0 citation errors · 0 not checkable

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  • During up to 34 years of follow-up, the most physically active cohorts of men and women demonstrated 7- to 8-year gains in life expectancy.

    “During up to 34 years of follow-up, the most physically active cohorts of men and women demonstrated 7- to 8-year gains in life expectancy!”

    From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [12]

    The Methods describe follow-up from 1980 to 2014, and the Results say increased exercise was associated with longer life expectancy. But our copy does not report 7- to 8-year gains for the most physically active men and women; the quantified gains of 14.0 years for women and 12.2 years for men compare people with all five low-risk lifestyle factors against those with none (Results; page unavailable). (LLM, conf=0.88)

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  • Maintaining a healthy lifestyle, such as adequate nutrition, moderate exercise, and good mental state, can effectively delay aging.

    “More and more research has proven that maintaining a healthy lifestyle, such as adequate nutrition,321 moderate exercise,322 and good mental state323 can effectively delay aging.”

    From Inflammation and aging: signaling pathways and intervention therapies (2023) · cites this paper as [322]

    The citation follows “adequate nutrition.” The Discussion (page not provided) reports that a healthy diet pattern was associated with lower premature-mortality risk, supporting a link between diet and longevity. The paper does not show that nutrition delays biological aging, and its findings are associations rather than proof of an effective anti-aging intervention. (LLM, conf=0.85)

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  • People with obesity are at increased risk for hypertension, dyslipidemia, type 2 diabetes mellitus, cardiovascular disease, and several cancers.

    “People with obesity are at increased risk for a variety of medical disorders including hypertension, dyslipidemia, type 2 diabetes mellitus, cardiovascular disease (CVD), and several cancers [4–6]”

    From Mediterranean Diet and Obesity-related Disorders: What is the Evidence? (2022) · cites this paper as [4]

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2 retracted

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1 of the 43 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [1]Woolf SH Aron L US Health in International Perspective: Shorter Lives, Poorer Health Washington (DC) 2013 24006554
  2. [46]Behrens G Fischer B Kohler S Park Y Hollenbeck AR Leitzmann MF Healthy lifestyle behaviors and decreased risk of mortality in a large prospective study of U.S. women and men Eur J Epidemiol 2013 28 361 372 23532745

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Authors
Li, Y., Pan, A., Wang, D. D., Liu, X., Dhana, K., Franco, O. H., Kaptoge, S., Di Angelantonio, E., Stampfer, M., Willett, W. C., & Hu, F. B.
Affiliations
  • Departments of Nutrition (Y.L., D.D.W., X.L., K.D., M.S., W.C.W., F.B.H.)
  • Harvard University (US)
  • Erasmus MC (NL)
  • University of Cambridge (GB)
  • Department of Public Health and Primary Care University of Cambridge, United Kingdom (S.K., E.D.A.).
  • Brigham and Women's Hospital (US)
Corresponding author
  • Li, Yanping
  • Pan, An
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-07-24
Volume
138
Issue
4
Pages
345-355
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.117.032047
PMC
PMC6207481
OpenAlex
W2802410718
Cited by
927
References
43
Citations by year
2026: 107 · 2025: 130 · 2024: 129 · 2023: 136 · 2022: 145 · 2021: 119 · 2020: 76 · 2019: 53 · 2018: 29 · 2017: 1 · 2013: 1
FWCI
52.32
Type
journal article
Language
en
Update notices
correction (2018-07-23)
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Apollo (University of Cambridge) (submittedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • Apollo
Funders
  • National Institute for Health and Care Research (NF-SI-0617-10113, NF-SI-0512-10165)
  • British Heart Foundation (RG/13/13/30194)
  • Centers for Disease Control and Prevention
  • Medical Research Council (MR/L003120/1)
  • National Heart, Lung, and Blood Institute (R01HL060712, R01HL035464, R01HL034594, R01HL088521)
  • National Cancer Institute (P01CA087969, UM1CA186107, UM1CA167552)
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 › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
healthy lifestyle factors, life expectancy, premature mortality, all-cause mortality, cancer mortality, cardiovascular mortality, physical activity, alcohol consumption, diet quality, lifestyle score, population attributable risk, sex differences, life table method, NHANES, United States population, mortality projections, health equity
MeSH terms
Healthy Lifestyle, Diet, Healthy, Non-Smokers, Adult, Aged, Aged, 80 and over, Alcohol Drinking, Cause of Death, Female, Health Personnel, Health Status, Humans, Life Expectancy, Male, Middle Aged, Nurses, Nutrition Surveys, Risk Factors, Time Factors, United States, Exercise, Body Mass Index, Databases, Factual, Risk Reduction Behavior, Protective Factors

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