Adopting 5 Healthy Habits in Midlife Could Add 10 Years of Life

Middle-aged Americans who follow a healthy diet, exercise regularly, don't smoke, drink moderate amounts of alcohol, and maintain a healthy weight could live more than a decade longer than those who don't do any of these things, a new study suggests.

The researchers defined the five good health habits as never smoking, body mass index (BMI) of 18.5 to 24.9 kg/m², 30 minutes or more of moderate to vigorous physical activity each day, a high-quality diet (top 40%), and moderate alcohol intake (5 to 15 g/day [eg, up to one glass of wine/day for women] and 5 to 30 g/day [eg, up to two glasses of wine/day] for men).

They estimate that life expectancy at age 50 years would be 14 years longer for women (age 93 vs age 79; 95% CI, 11.8 - 16.2 years) and 12.2 years longer for men (age 87.6 vs age 75.5; 95% CI, 10.1 - 14.2 years) if they had all vs none of these five healthy behaviors.

The study by Yanping Li, MD, PhD, from the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, was published online April 30 in Circulation.

Even adopting some of these healthy behaviors would help, Li stressed in an interview with theheart.org | Medscape Cardiology. "Each factor prolonged life expectancy around 2 to 3 years," she said.

This "substantial benefit" is not that hard to achieve, Li added. "I would suggest that physicians convince their patients to 'just do as much as possible.' " But if they can't, only a small step still works "to increase longevity."

"Each single lifestyle change you make will help you live longer and better," Jean-Pierre Després, PhD, cardiology research director at the Quebec Heart and Lung Institute at Laval University, Quebec, Canada, and chair of the American Heart Association (AHA) Council on Lifestyle and Cardiometabolic Health, echoed in a commentary issued with the article.

"Paying attention to very simple markers of lifestyle is something that we don't do in clinical practice," he told theheart.org | Medscape Cardiology.

"Clinicians assess the traditional risk factors, such as cholesterol, blood pressure, and glucose," he noted, "but there are no tools that are used to assess and target lifestyle."

"This paper is clearly showing that [a healthy lifestyle] could extend the life expectancy of Americans to a very substantial extent."

The healthcare systems in the United States and Canada are "geared toward disease management rather than health promotion," he noted, but "we need 'lifestyle medicine.'"

Highest Expenditures, Shorter Lifespans

From 1940 to 2014, life expectancy at birth in the United States increased from 63 to 79, but this is still less than other high-income countries. In 2015, life expectancy at birth in the United States was 31st in the world.

Meanwhile, in 2014, the United States had the world's highest healthcare spending, 17.1% of gross domestic product, largely due to spending on drug discoveries and disease treatment.

Li and colleagues examined diet and other lifestyle data from 78,865 women in the Nurses' Health Study who were followed for up to 34 years (1980 to 2014) and 44,354 men in the Health Professionals Follow-up Study who were followed for up to 28 years (1986 to 2014).

The study participants were mainly white. The women and men had a mean baseline age of 47 and 55, respectively, and they replied to questionnaires every 2 or 4 years.

During follow-up, 42,167 individuals died, including 13,953 deaths from cancer and 10,689 deaths from cardiovascular disease.

Compared with men and women who lacked any of the five healthy-lifestyle habits, those who had all five had an 82% lower risk for dying from cardiovascular disease, a 65% lower chance of dying from cancer, and a 74% lower risk of dying from all causes during follow-up

The researchers then estimated the national prevalence of these lifestyle-related factors, based on a sample of 2128 adults who were 50 to 80 years old and participated in the National Health and Nutrition Examination Surveys during 2013 to 2014.

They also determined age-specific mortality rates of Americans from the Centers for Disease Control and Prevention WONDER database.

They found that adopting one to five of the healthy lifestyle behaviors was associated with a stepwise increase in lifespan.

Only 8% of Americans Met All 5 Healthy-Lifestyle Criteria

Only 15% of Americans met all five criteria for a healthy lifestyle in 1988 to 1992, and even fewer, 8%, met all five criteria in 2001 to 2006.

"The main reason was that almost half of the people were obese," around 40% were current or past smokers, and most people were not very active, said Li.

"I think [a healthy lifestyle] should be started before they are patients," she stressed.

"I just hope both the general population and doctors realize it's not that hard" to adopt a healthier lifestyle, Li continued. "Our study highlighted that even a small progress in lifestyle could be a big achievement. Never give up."

Living a healthier lifestyle "could narrow the life-expectancy gap between the United States and other industrialized countries," according to the researchers.

"Prevention should be a top priority for national health policy" and "preventive care should be an indispensable part of the US healthcare system," they conclude.

The Nurses' Health Study and Health Professionals Follow-up study were supported by grants from the National Institutes of Health. Two coauthors from the United Kingdom received support from the British Heart Foundation and UK Medical Research Council. Li and the study authors and Despres reported no relevant financial disclosures.

Circulation. Published April 30, 2018. Full text, Commentary

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