Association between lifestyle factors and quality-adjusted life years in the EPIC-NL cohort

Lifestyle parameters of Japanese agricultural and non-agricultural workers aged 60 years or older and less than 60 years: A cross-sectional observational study

OBJECTIVES

Improving the lifestyle of occupational workers is essential for extending healthy life expectancy. We investigated various lifestyle-related items in a rural Japanese population and compared them between agricultural and non-agricultural workers.

METHODS

This cross-sectional study was conducted as a part of the "Iwaki Health Promotion Project." Lifestyle-related items such as sleep, work hours, nutrition, health-related quality of life, and proportion of time spent performing each daily activity were compared between agricultural and non-agricultural workers in the ≥60 years (n = 251) and <60 years (n = 560) age groups.

RESULTS

Agricultural workers had significantly lower Pittsburgh Sleep Quality Index total scores than non-agricultural workers in the <60 years group. The proportion of participants with more than 5 weekly working days was high among agricultural workers in both groups. Additionally, the proportion of people who worked more than 8 h per day was high among agricultural workers in both age groups. Energy intake per day was high among agricultural workers in the <60 years group. In both age groups, agricultural workers slept and woke up approximately 40 min earlier than did non-agricultural workers.

CONCLUSIONS

Agricultural workers have better sleep habits but work longer than non-agricultural workers, with some differences in energy intake and proportion of time spent on each daily activity. These differences should be considered when planning lifestyle intervention programs for agricultural workers.

Time spent walking and disability-free survival in older Japanese: The Ohsaki Cohort 2006 Study

The extent to which long disability-free survival (DFS) time can be extended according to the amount of time spent walking has not been investigated. The aim of this study was to examine the association between time spent walking per day and DFS time in older adults. We conducted a cohort study of 14 342 disability-free individuals (aged ≥ 65 years) living in Ohsaki City, Japan. The amount of time spent walking per day (<0.5 h, 0.5-1 h, ≥1 h) by each individual in 2006 was assessed by a self-reported questionnaire. Data on 11-year incident functional disability were retrieved from the public Long-Term Care Insurance database. After estimating the multivariable-adjusted hazard ratios (HRs) of the composite outcome (incident functional disability or death), the multivariable-adjusted 50th percentile differences (50th PDs; difference in the period until the first 50% of the composite outcome occurred) were estimated according to time spent walking. Among 114 764 person-years, the composite outcome occurred in 7761 persons (67.6 per 1000 person-years). The HRs (95% confidence intervals) of the composite outcome were 1.00 (reference) for <0.5 h, 0.84 (0.79, 0.88) for 0.5-1 h, and 0.78 (0.74, 0.83) for ≥1 h (p-trend < 0.001). The 50th PDs (95% confidence intervals) of DFS time were 238 (155, 322) days longer for 0.5-1 h and 360 (265, 454) days longer for ≥1 h, in comparison with <0.5 h. The results suggest that longer time spent walking per day contributes to longer DFS time.

Association between Parenthood and Health Behaviour in Later Life-Results from the Population-Based CARLA Study

Previous research has focused on comparing health behaviour between parents and non-parents at younger ages, while little is known about the impact of being a parent on health behaviours in later life. We studied whether parenthood is associated with later physical activity (PA), dietary pattern, smoking status and alcohol consumption in German adults of middle and old age. We used data from the baseline examination of the population-based CARLA-study in Halle (Saale), comprising 1779 adults aged 45-83. Linear and logistic regression analyses assessed the relationship between parenthood and health behaviours while controlling for age, partner status, education, income, occupational position, socioeconomic status in childhood, and number of chronic diseases. Of the participants, 89.1% had biological children. Being a father was associated with higher PA in sports (sport index ß = 0.29, 95% confidence interval [0.14; 0.44]), but not with PA in leisure time (excluding sports), dietary pattern, consumption of alcohol and smoking status. No associations were found between being a mother with all outcome variables. Provided that PA of fathers is typically reduced when the children are young, the development towards higher PA at later age needs to be studied in more detail.

Trends in health behaviors over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey

OBJECTIVES

This study aimed to examine the trends in health behaviors in Korean population using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

The subjects were 96,408 adults aged 19 years or older who participated in the first (1998) through seventh (2016-2018) KNHANES health interview. The prevalence of health behaviors (cigarette smoking, alcohol drinking, and physical activity) and annual percent change (APC) were estimated using SAS and the Joinpoint program.

RESULTS

The prevalence of current cigarette smoking in men decreased by 2.8%p (APC=-2.8, p<0.001) annually over the 20-year period, and the prevalence of exposure to secondhand smoke at home substantially decreased compared to 2005 (APC=-8.8, p<0.001). Compared to 2005, the prevalence of current alcohol drinking in women, but not men, increased (APC=2.0, p<0.001), and the prevalence of binge drinking decreased in men (APC=-0.7, p<0.001) and increased in women (APC=2.4, p<0.001). The prevalence of aerobic physical activity decreased from 2014 in both gendersd (p<0.001). The prevalence of healthy behaviors practice (non-smoking, alcohol abstinence, and aerobic physical activity) was down-trending (APC=-5.3, p<0.001), especially among women (APC=-6.4, p<0.001).

CONCLUSIONS

Over the past 20 years, smoking behaviors improved. However, drinking behavior was unchanged and physical activity indicators markedly decreased. More active programs are necessary for improving health behaviors, which are major risk factors linked to chronic diseases.

Impact of a Blended Periconception Lifestyle Care Approach on Lifestyle Behaviors: Before-and-After Study

Background

Periconception lifestyle behaviors affect maternal, paternal, offspring, and transgenerational health outcomes. Previous research in other target populations has shown that personalized lifestyle interventions, in which face-to-face counseling and eHealth (“blended care”) are combined, may effectively target these lifestyle behaviors.

Objective

We aimed to assess the effectiveness of a periconceptional lifestyle intervention on the improvement of specific lifestyle components.

Methods

A blended periconception lifestyle care approach was developed, combining the outpatient lifestyle counseling service “Healthy Pregnancy” with the eHealth platform “Smarter Pregnancy” (www.smarterpregnancy.co.uk) in which lifestyle was coached for 24 weeks. All couples contemplating pregnancy or already pregnant (≤12 weeks of gestation) who visited the outpatient clinics of the Department of Obstetrics and Gynecology at the Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands, between June and December 2018, were invited to participate. We measured changes in lifestyle behaviors at weeks 12 and 24 compared with baseline. Generalized estimating equations were used to analyze the changes in lifestyle behaviors over time. Subgroup analyses were performed for women with obesity (BMI ≥30 kg/m²), women pregnant at the start of the intervention, and those participating as a couple.

Results

A total of 539 women were screened for eligibility, and 450 women and 61 men received the blended periconception intervention. Among the participating women, 58.4% (263/450) were included in the preconception period. Moreover, 78.9% (403/511) of the included participants completed the online lifestyle coaching. At baseline, at least one poor lifestyle behavior was present in most women (379/450, 84.2%) and men (58/61, 95.1%). In the total group, median fruit intake increased from 1.8 to 2.2 pieces/day (P<.001) and median vegetable intake increased from 151 to 165 grams/day (P<.001) after 24 weeks of online coaching. The probability of taking folic acid supplementation among women increased from 0.97 to 1 (P<.001), and the probability of consuming alcohol and using tobacco in the total group decreased from 0.25 to 0.19 (P=.002) and from 0.20 to 0.15 (P=.63), respectively. Overall, the program showed the strongest effectiveness for participating couples. Particularly for vegetable and fruit intake, their consumption increased from 158 grams/day and 1.8 pieces/day at baseline to 190 grams/day and 2.7 pieces/day at the end of the intervention, respectively.

Conclusions

We succeeded in including most participating women in the preconception period. A high compliance rate was achieved and users demonstrated improvements in several lifestyle components. The blended periconception lifestyle care approach seems to be an effective method to improve lifestyle behaviors. The next step is to further disseminate this approach and to perform a randomized trial to compare the use of blended care with the provision of only eHealth. Additionally, the clinical relevance of these results will need to be substantiated further.

Behavioural risk factors and healthy life expectancy: evidence from two longitudinal studies of ageing in England and the US

We examined whether the co-occurrence of four behavioural risk factors (alcohol consumption, smoking, physical inactivity and obesity) is associated with disability-free and chronic disease-free life expectancy similarly in two longitudinal studies of ageing in England and the United States. Data were from 17,351 individuals aged 50+ from the US Health and Retirement Study (HRS) and, 10,388 from the English Longitudinal Study of Ageing (ELSA), from 2002 to 2013. Disability-free life expectancy was estimated using repeat measures of limitations with instrumental activities and activities of daily living and, chronic disease-free life expectancy was based on chronic health conditions. Multistate life table models were used to estimate sex-specific health expectancy at the ages of 50, 60 and 70. In both countries and at all ages, there was a clear gradient towards shorter health expectancy with increasing number of behavioural risk factors. Compared to people with 2+ behavioural risk factors, in both countries, those with no behavioural risk factors could expect to live up to 11 years longer without disability and, up to 12 years longer without chronic conditions. Individual and co-occurring behavioural risk factors were strongly associated with shorter healthy life expectancy in both countries, attesting to the robustness of the contribution of lifestyle factors on health expectancy.

Diet quality as a predictor of cardiometabolic disease-free life expectancy: the Whitehall II cohort study

BACKGROUND

Poor diet quality has been linked to increased risk of many chronic diseases and premature mortality. Less research has considered dietary habits in relation to disease-free life expectancy.

OBJECTIVES

Our objective was to investigate the association of diet quality with cardiometabolic disease-free life expectancy between ages 50 and 85 y.

METHODS

Diet quality of 8041 participants of the Whitehall II cohort study was assessed with the Alternative Healthy Eating Index 2010 (AHEI-2010) in 1991-1994, 1997-1999, and 2002-2004. The measurement of diet quality closest to age 50 for each participant was used. We utilized repeat measures of cardiometabolic disease (coronary heart disease, stroke, and type 2 diabetes) from the first observation when participants were aged ≥50 y. Multistate life table models with covariates age, gender, occupational position, smoking, physical activity, and alcohol consumption were used to estimate total and sex-specific cardiometabolic disease-free life expectancy from age 50 to 85 y for each AHEI-2010 quintile, where the lowest quintile represents unhealthiest dietary habits and the highest quintile the healthiest habits.

RESULTS

The number of cardiometabolic disease-free life-years after age 50 was 23.9 y (95% CI: 23.0, 24.9 y) for participants with the healthiest diet, that is, a higher score on the AHEI-2010, and 21.4 y (95% CI: 20.6, 22.3 y) for participants with the unhealthiest diet. The association between diet quality and cardiometabolic disease-free life expectancy followed a dose-response pattern and was observed in subgroups of participants of different occupational position, BMI, physical activity level, and smoking habit, as well as when participants without cardiometabolic disease at baseline were excluded from analyses.

CONCLUSIONS

Healthier dietary habits are associated with cardiometabolic disease-free life expectancy between ages 50 and 85.

Dose-response effect of smoking status on quality-adjusted life years among U.S. adults aged 65 years and older

Background

To estimate the impact of smoking on quality-adjusted life years (QALY) for US adults aged 65 years and older.

Methods

Using the 2003-08 National Health and Nutrition Examination Survey Linked Mortality File, we estimated the mean QALY throughout the remaining lifetime by participants' smoking status as well as smoking intensity and time since cessation.

Results

Never, former and current smokers had a mean QALY of 16.1, 12.7 and 7.3 years, respectively. Among current smokers, those who started smoking before age 18 had fewer QALYs than those who started at or after age 18 (6.0 and 8.5 years, respectively) and those smoking ≥20 cigarettes per day had fewer QALYs than those smoking <20 cigarettes per day (6.6 and 8.1 years, respectively). QALYs also declined with a longer duration of smoking and a shorter time since cessation. The potential gains if a person quit smoking would be 5.4 QALYs, and the gains would increase with a longer time since quitting as well as quitting at a younger age.

Conclusions

This study demonstrated the dose-response effect of smoking status on QALY. The results indicate the health benefits of tobacco cessation at any age and sizeable losses for former or current smokers.

Few European Adults are Living a Healthy Lifestyle

PURPOSE

This study aimed to measure healthy lifestyle for European adults.

DESIGN

Cross-sectional study.

SETTINGS

In 20 European countries.

PARTICIPANTS

A total of 34 993 (16 749 men, 18 244 women) European adults.

MEASURES

Data were from the 2014 European Social Survey (n = 34 993) on 4 modifiable behaviors (physical activity, fruit and vegetable consumption, not drinking alcohol to excess, and not smoking) as well as sleep quality.

ANALYSIS

Behaviors were combined and formed a healthy lifestyle measure. Binary logistic regression was done to determine associations of healthy lifestyle and sociodemographic characteristics.

RESULTS

Only 5.8% of the adults reported a healthy lifestyle. The prevalence of having a healthy lifestyle varied among European countries. The lowest rates were in Hungary (1.3%) and Czech Republic (1.9%). The highest rates were in United Kingdom (8.6%) and Finland (9.2%). Those who presented a higher likelihood of having a healthy lifestyle were middle age (odds ratio [OR] = 1.20), older people (OR = 1.34), having higher household income (OR = 1.33), being a student (OR = 1.38), and retired (OR = 1.31). Those less likely to have a healthy lifestyle were lived without a partner (OR = 0.82), unemployed (OR = 0.73), and lived in rural areas (OR = 0.86).

CONCLUSIONS

Few European adults were practicing 5 healthy behaviors. This should be a message for governments and be considered in the establishment of preventive public policies in the areas of health and health education.

Mediterranean diet and quality of life: Baseline cross-sectional analysis of the PREDIMED-PLUS trial

We assessed if a 17-item score capturing adherence to a traditional Mediterranean diet (MedDiet) was associated with better health-related quality of life among older Spanish men and women with overweight or obesity harboring the metabolic syndrome. We analyzed baseline data from 6430 men and women (age 55-70 years) participating in the PREDIMED-Plus study. PREDIMED-Plus is a multi-centre randomized trial testing an energy-restricted MedDiet combined with promotion of physical activity and behavioral therapy for primary cardiovascular prevention compared to a MedDiet alone. Participants answered a 36-item questionnaire about health-related quality of life (HRQoL) and a 17-item questionnaire that assessed adherence to an MedDiet. We used ANCOVA and multivariable-adjusted linear regression models to compare baseline adjusted means of the quality of life scales according to categories of adherence to the MedDiet. Higher adherence to the MedDiet was independently associated with significantly better scores in the eight dimensions of HRQoL. Adjusted differences of > = 3 points between the highest and the lowest dietary adherence groups to the MedDiet were observed for vitality, emotional role, and mental health and of > = 2 points for the other dimensions. In conclusion, this study shows a positive association between adherence to a MedDiet and several dimensions of quality of life.

Physical activity level as a predictor of healthy and chronic disease-free life expectancy between ages 50 and 75

Background

physical activity promotes healthy aging. However, little is known about the relationship between physical activity levels and healthy and chronic disease-free life expectancy (LE). The study aim was to examine healthy and chronic disease-free LE between ages 50 and 75 and across various levels of physical activity by sex and different occupational statuses.

Methods

overall, 34,379 women (mean age 53.2 (SD 2.9) years) and 8,381 men (53.6 (SD 3.2) years) from the Finnish Public Sector study were categorized into five physical activity levels (inactive to vigorously active) according to self-reported physical activity and into three occupational statuses at the first observation point. Partial LE between ages 50 and 75 based on discrete-time multistate life table models was defined using two health indicators: healthy LE based on self-rated health and chronic disease-free LE based on chronic diseases. The average follow-up time for health indicators was 6.8 (SD 5.2) years.

Results

a clear dose-response relationship between higher physical activity levels and increased healthy and chronic disease-free LE in men and women, and within occupational statuses was found. On average, vigorously active men and women lived 6.3 years longer in good health and 2.9 years longer without chronic diseases between ages 50 and 75 compared to inactive individuals. The difference in years in good health between vigorously active and inactive individuals was the largest in individuals with low occupation status (6.7 years).

Conclusion

higher levels of physical activity increase healthy and chronic disease-free years similarly in men and women, but more among persons with low than with high occupational status.

Associations between lifestyle factors and an unhealthy diet

Background

: Unhealthy dietary patterns have been associated with other unhealthy lifestyle factors such as smoking and physical inactivity. Whether these associations are similar in high- and low-educated individuals is currently unknown.

Methods

We used information of the EPIC-NL cohort, a prospective cohort of 39 393 men and women, aged 20-70 years at recruitment. A lifestyle questionnaire and a validated food frequency questionnaire were administered at recruitment (1993-97). Low adherence to a Mediterranean-style diet was used to determine an unhealthy dietary pattern. Lifestyle-related factors included body mass index, waist circumference, smoking status, physical activity level, dietary supplement use and daily breakfast consumption. Multivariate logistic regression analyses were performed for the total population and by strata of educational level.

Results

In total 30% of the study population had an unhealthy dietary pattern: 39% in the lowest educated group and 20% in the highest educated group. Physical inactivity, a large waist circumference, no dietary supplement use and skipping breakfast were associated with an unhealthy dietary pattern in both low and high educated participants. Among low educated participants, current smokers had a greater odds of an unhealthy diet compared with never smokers: OR 1.42 (95% CI: 1.25; 1.61). This association was not observed in the high educated group.

Conclusions

Most associations between lifestyle-related factors and unhealthy diet were consistent across educational levels, except for smoking. Only among low educated participants, current smokers reported an unhealthier dietary pattern in comparison to never smokers. These results can be used in the development of targeted health promotion strategies.

Hypertension, diabetes and lifestyle in the long-term - Results from a Swiss population-based cohort

Healthy lifestyles are integral in preventing and treating common cardiovascular and metabolic diseases. The aim of this study was to observe smoking habits, alcohol intake, physical activity and body mass index over a 10-year period in a population-based cohort, particularly focusing on participants with hypertension and type 2 diabetes mellitus. Included were 4155 participants from the first (2001-2003) and second (2010-2011) follow-ups of the Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults (SAPALDIA). Information was collected via health questionnaire; height and weight were measured. In a healthy lifestyle score one point was attributed per criterion; non-smoking, low risk alcohol consumption, BMI<25kg/m², and regular physical activity. Overall in 2010-2011, 16.4% were smokers, 7.7% had at risk alcohol consumption, 25.5% were physically inactive and 57.8% were overweight or obese. Both those with hypertension and diabetes had lower mean healthy lifestyle scores than those without disease. Women with incident hypertension from 2001 to 2011 had lower odds of improving their healthy lifestyle score during this time period compared to those without this disease. In contrast, women with incident diabetes had higher odds of lifestyle score improvement. In men, neither hypertension nor diabetes was associated with change in lifestyle score. Our findings suggest that, irrespective of disease status, preventative attention is needed, particularly in regards to physical activity and bodyweight. These needs could be met by population-based interventions, a necessary and suitable option in both preventing and treating the non-communicable disease epidemic which currently faces countries worldwide.

Body mass index as a predictor of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study

BACKGROUND

While many studies have shown associations between obesity and increased risk of morbidity and mortality, little comparable information is available on how body mass index (BMI) impacts health expectancy. We examined associations of BMI with healthy and chronic disease-free life expectancy in four European cohort studies.

METHODS

Data were drawn from repeated waves of cohort studies in England, Finland, France and Sweden. BMI was categorized into four groups from normal weight (18.5-24.9 kg m^-2) to obesity class II (⩾35 kg m^-2). Health expectancy was estimated with two health indicators: sub-optimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years for each BMI category.

RESULTS

The proportion of life spent in good perceived health between ages 50 and 75 progressively decreased with increasing BMI from 81% in normal weight men and women to 53% in men and women with class II obesity which corresponds to an average 7-year difference in absolute terms. The proportion of life between ages 50 and 75 years without chronic diseases decreased from 62 and 65% in normal weight men and women and to 29 and 36% in men and women with class II obesity, respectively. This corresponds to an average 9 more years without chronic diseases in normal weight men and 7 more years in normal weight women between ages 50 and 75 years compared to class II obese men and women. No consistent differences were observed between cohorts.

CONCLUSIONS

Excess BMI is associated with substantially shorter healthy and chronic disease-free life expectancy, suggesting that tackling obesity would increase years lived in good health in populations.

Smoking, physical inactivity and obesity as predictors of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study

Background: Smoking, physical inactivity and obesity are modifiable risk factors for morbidity and mortality. The aim of this study was to examine the extent to which the co-occurrence of these behaviour-related risk factors predict healthy life expectancy and chronic disease-free life expectancy in four European cohort studies.

Methods: Data were drawn from repeated waves of four cohort studies in England, Finland, France and Sweden. Smoking status, physical inactivity and obesity (body mass index ≥30 kg/m²) were examined separately and in combination. Health expectancy was estimated by using two health indicators: suboptimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years.

Results: Compared with men and women with at least two behaviour-related risk factors, those with no behaviour-related risk factors could expect to live on average8 years longer in good health and 6 years longer free of chronic diseases between ages 50 and 75. Having any single risk factor was also associated with reduction in healthy years. No consistent differences between cohorts were observed.

Conclusions: Data from four European countries show that persons with individual and co-occurring behaviour-related risk factors have shorter healthy life expectancy and shorter chronic disease-free life expectancy. Population level reductions in smoking, physical inactivity and obesity could increase life-years lived in good health.

Physical Functioning and Prediction of Physical Activity After Total Hip Arthroplasty: Five-Year Followup of a Randomized Controlled Trial

OBJECTIVE

To examine whether the 1-year effects from a previous walking skill training program on walking and stair climbing still persist 5 years following total hip arthroplasty (THA), to examine recovery of physical functioning from before to 5 years after surgery, and to identify predictors of physical activity 5 years after THA from preoperative measures.

METHODS

We performed a 5-year followup of a randomized controlled trial and a longitudinal study. Sixty participants with a mean age of 70 years (range 50-87 years; 95% confidence interval 68, 72 years) were assessed. Outcome measures were the 6-minute walk test, the stair climbing test (SCT), active hip range of motion (ROM), self-efficacy, Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), and University of California, Los Angeles (UCLA) activity scale. Data were analyzed by Student's t-tests, generalized linear model, and multivariate regression analyses.

RESULTS

The training and control groups were approximately equal on outcome measures of physical functioning, pain, and self-efficacy at 5 years (P > 0.05). In the total group, the recovery course was unchanged from 1 to 5 years (P > 0.05), except for 9% improvement in ROM (P < 0.001) and an increase in time on SCT of 18% (P = 0.004). Preoperative HOOS pain (P = 0.022) and HOOS sport (P = 0.019) predicted UCLA activity scale 5 years after THA.

CONCLUSION

At 5 years after THA, the control group had caught up with the training group on physical functioning, and the participants led an active lifestyle. Those with worse preoperative scores on pain and physical functioning in sport were at risk of being less physically active in the long term following THA.

A healthy lifestyle composite measure: Significance and potential uses

OBJECTIVES

Our objective was to create and explore potential uses of a composite "Healthy Lifestyle" measure based on Healthy People 2020 (HP2020) Objectives for behaviors shown to be associated with morbidity and mortality.

METHODS

Data were from the 2013 Behavioral Risk Factor Surveillance System (N=412,942) on five modifiable behaviors with HP2020 Objectives (leisure time exercise, eating fruits and vegetables 5 or more times/day, getting ≥7h of sleep/24h, not smoking and not drinking excessively). These indicators were combined to form an all-or-none composite Healthy Lifestyle (HLS) measure. Associations between the HLS measure and demographic and other measures, plus details of component measures, were reported.

RESULTS

Results indicated that only 7.7% of adults reported a HLS with wide variation among states and demographic groups. Both unadjusted and logistic regression results found associations between a HLS and better health, lower rates of chronic disease and better access to health care. Over one fourth of all respondents (28.0%) needed to only improve fruit and vegetable consumption to be practicing a HLS.

CONCLUSIONS

In conclusion, few adults were practicing five behaviors that are generally recognized as healthy. All-or-none metrics like this HLS measure offer a fresh perspective on modifiable behaviors and the need for improvement. Examination of measure components can help explain demographic differences and identify strategies for improvement.

Dietary patterns in relation to quality-adjusted life years in the EPIC-NL cohort

BACKGROUND

Dietary patterns have been associated with the incidence or mortality of individual non-communicable diseases, but their association with disease burden has received little attention.

OBJECTIVE

The aim of our study was to relate dietary patterns to health expectancy using quality-adjusted life years (QALYs) as outcome parameter.

METHODS

Data from the EPIC-NL study were used, a prospective cohort study of 33,066 healthy men and women aged 20-70 years at recruitment. A lifestyle questionnaire and a validated food frequency questionnaire were administered at study entry (1993-1997). Five dietary patterns were studied: three a priori patterns (the modified Mediterranean Diet Score (mMDS), the WHO-based Healthy Diet Indicator (HDI) and the Dutch Healthy Diet index (DHD-index)) and two a posteriori data-based patterns. QALYs were used as a summary health measure for healthy life expectancy, combining a person's life expectancy with a weight reflecting loss of quality of life associated with having chronic diseases.

RESULTS

The mean QALYs of the participants were 74.9 (standard deviation 4.4). A higher mMDS and HDI were associated with a longer life in good health. Participants who had a high mMDS score (6-9) had 0.17 [95% CI, 0.05; 0.30] more QALYs than participants with a low score (0-3), equivalent to two months longer life in good health. Participants with a high HDI score also had more QALYs (0.15 [95% CI, 0.03; 0.27]) than participants with a low HDI score.

CONCLUSION

A Mediterranean-type diet and the Healthy Diet Indicator were associated with approximately 2months longer life in good health.