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      Health Practices and Mortality in Japan: Combined Effects of Smoking, Drinking, Walking and Body Mass Index in the Miyagi Cohort Study

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          Abstract

          BACKGROUND: Evidence is limited regarding the association between the combinations of multiple health practices and mortality.

          METHODS: In 1990, 28,333 men and women in Miyagi Prefecture in rural northern Japan (40-64 year of age) completed a self-administered questionnaire. A lifestyle score was calculated by adding the number of high-risk practices (smoking, consuming ≥22.8 g alcohol/d, walking <1 hr/d, body mass index <18.5 or ≥30.0). Cox regression was used to estimate relative risk (RR) of mortality according to the lifestyle score, with adjustment for age, education, marital status, past history of diseases, and dietary variables. During 11 years of follow-up, 1,200 subjects had died.

          RESULTS: We observed linear increase in risk of death associated with increasing number of high-risk practices: compared with men who had no high-risk practices, multivariate RRs for men who had 1 to 4 practices were 1.20, 1.66, 1.94, and 3.96, respectively (P for trend<0.001), and corresponding RRs for women were 1.31, 2.14, 3.98, 5.56, respectively (P for trend<0.001). A unit increase in the number of high-risk practices corresponded to being 2.8 and 4.8 years older for men and women, respectively.

          CONCLUSONS: In this prospective cohort study of middle-aged men and women in rural Japan, a larger number of high-risk practices was associated with linear increase in risk of all-cause mortality.

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          Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women.

          D N Wentworth, D B Garside, P Greenland … (1999)
          Three major coronary risk factors-serum cholesterol level, blood pressure, and smoking-increase incidence of coronary heart disease (CHD) and related end points. In previous investigations, risks for low-risk reference groups were estimated statistically because samples contained too few such people to measure risk. To measure long-term mortality rates for individuals with favorable levels for all 3 major risk factors, compared with others. Two prospective studies, involving 5 cohorts based on age and sex, that enrolled persons with a range of risk factors. Low risk was defined as serum cholesterol level less than 5.17 mmol/L (<200 mg/dL), blood pressure less than orequal to 120/80 mm Hg, and no current cigarette smoking. All persons with a history of diabetes, myocardial infarction (MI), or, in 3 of 5 cohorts, electrocardiogram (ECG) abnormalities, were excluded. In 18 US cities, a total of 72144 men aged 35 through 39 years and 270671 men aged 40 through 57 years screened (1973-1975) for the Multiple Risk Factor Intervention Trial (MRFIT); in Chicago, a total of 10025 men aged 18 through 39 years, 7490 men aged 40 through 59 years, and 6229 women aged 40 through 59 years screened (1967-1973) for the Chicago Heart Association Detection Project in Industry (CHA) (N = 366559). Cause-specific mortality during 16 (MRFIT) and 22 (CHA) years, relative risks (RRs) of death, and estimated greater life expectancy, comparing low-risk subcohorts vs others by age strata. Low-risk persons comprised only 4.8% to 9.9% of the cohorts. All 5 low-risk groups experienced significantly and markedly lower CHD and cardiovascular disease death rates than those who had elevated cholesterol level, or blood pressure, or smoked. For example, age-adjusted RRs of CHD mortality ranged from 0.08 for CHA men aged 18 to 39 years to 0.23 for CHA men aged 40 through 59 years. The age-adjusted relative risks (RRs) for all cardiovascular disease mortality ranged from 0.15 for MRFIT men aged 35 through 39 years to 0.28 for CHA men aged 40 through 59 years. The age-adjusted RR for all-cause mortality rate ranged from 0.42 for CHA men aged 40 through 59 years to 0.60 for CHA women aged 40 through 59 years. Estimated greater life expectancy for low-risk groups ranged from 5.8 years for CHA women aged 40 through 59 years to 9.5 years for CHA men aged 18 through 39 years. Based on these very large cohort studies, for individuals with favorable levels of cholesterol and blood pressure who do not smoke and do not have diabetes, MI, or ECG abnormalities, long-term mortality is much lower and longevity is much greater. A substantial increase in the proportion of the population at lifetime low risk could contribute decisively to ending the CHD epidemic.
          Article 0 comments Cited 78 times – based on 0 reviews     Review now
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            Dietary quality and lifestyle factors in relation to 10-year mortality in older Europeans: the SENECA study.

            Merete Osler, , L Ceballos … (2002)
            The single and combined effects of three healthy lifestyle behaviors-nonsmoking, being physically active, and having a high-quality diet-on survival were investigated among older people in the SENECA Study. This European longitudinal study started with baseline measurements in 1988-1989 and lasted until April 30, 1999. The study population consisted of 631 men and 650 women aged 70-75 years from Belgium, Denmark, Italy, The Netherlands, Portugal, Spain, and Switzerland. A lifestyle score was calculated by adding the scores of the lifestyle factors physical activity, dietary quality, and smoking habits. The single lifestyle factors and the lifestyle score were related to mortality. Even at ages 70-75 years, the unhealthy lifestyle behaviors smoking, having a low-quality diet, and being physically inactive were singly related to an increased mortality risk (hazard ratios ranged from 1.2 to 2.1). The risk of death was further increased for all combinations of two unhealthy lifestyle behaviors. Finally, men and women with all three unhealthy lifestyle behaviors had a three- to fourfold increase in mortality risk. These results underscore the importance of a healthy lifestyle, including multiple lifestyle factors, and the maintenance of it with advancing age.
            Article 0 comments Cited 38 times – based on 0 reviews     Review now
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              Health practices and disability: some evidence from Alameda County.

              N Breslow, Jan Breslow (1992)
              With greater longevity people are increasingly concerned about how to avoid disability during their longer lives. Policy decisions concerning ways to extend health as well as life have become part of the nation's health agenda. Opportunity to examine that issue has arisen in the Alameda County Human Population Laboratory. Earlier studies there established seven health practices as risk factors for higher mortality: excessive alcohol consumption, smoking cigarettes, being obese, sleeping fewer or more than 7-8 hours, having very little physical activity, eating between meals, and not eating breakfast. Observation now reveals that, taking into account age, gender, physical health status, and social network index in 1965, the occurrence of disability was only about one-half as great among the cohort survivors in 1974 who reported good health practices in 1965 as among those with poor health practices; those with an intermediate level of health practices experienced about two-thirds the relative disability risk of those with poor health practices. Essentially similar relationships prevailed for the 1982/1983 survivors of the original (1965) cohort who, upon requestioning, had been found to be without disability in 1974.
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Epidemiol
                Journal ID (iso-abbrev): J Epidemiol
                Journal ID (publisher-id): JE
                Title: Journal of Epidemiology
                Publisher: Japan Epidemiological Association
                ISSN (Print): 0917-5040
                ISSN (Electronic): 1349-9092
                Publication date (Electronic): 18 March 2005
                Publication date Collection: 2004
                Volume: 14
                Issue: Suppl I
                Pages: S39-S45
                Affiliations
                [1 ]Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine.
                [2 ]Department of Public Health, Yamagata University School of Medicine.
                Author notes

                Address for Correspondence: Yoshitaka Tsubono, MD, Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan

                Article
                Publisher ID: 14.S39
                DOI: 10.2188/jea.14.S39
                PMC ID: 8828279
                PubMed ID: 15143877
                SO-VID: 587a332b-d194-404d-8cfe-9ccf6ac29cb3
                Copyright © © 2004 Japan Epidemiological Association.
                License:

                This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 28 October 2003
                Date accepted : 25 December 2003
                Categories
                Subject: Original Article

                Keywords: smoking,alcohol,walking,body mass index,mortality
                Data availability:
                Keywords: smoking, alcohol, walking, body mass index, mortality

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