Paper Information

Journal:   ARCHIVES OF IRANIAN MEDICINE   November 2016 , Volume 19 , Number 11; Page(s) 752 To 761.
 
Paper: 

The Combined Effects of Healthy Lifestyle Behaviors on All-Cause Mortality: The Golestan Cohort Study

 
DOI: 

0161911/AIM.003

 
Author(s):  FAZELTABAR MALEKSHAH AKBAR, ZAROUDI MARSA, ETEMADI ARASH, ISLAMI FARHAD, Sepanlou Sadaf, SHARAFKHAH MARYAM, KESHTKAR ABBAS ALI, KHADEMI HOOMAN, POUSTCHI HOSSEIN, HEKMATDOOST AZITA, POURSHAMS AKRAM, Feiz Sani Akbar, JAFARI ELHAM, DAWSEY SANFORD M., ABNET CHRISTIAN C., PHAROAH PAUL D., BOFFETTA PAOLO, Malekzadeh Reza*
 
* Shariati Hospital, North Kargar St. Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
 
Abstract: 
Objectives: The aim of this study was to examine the association between combined lifestyle scores and risk of all-cause and cause-􀁖 􀁓 􀁈 􀁆 􀁌 􀂿 􀁆 mortality for the 􀂿 􀁕 􀁖 􀁗 time among Iranian adults. Methods: The study population included 50, 045 Iranians, 40 – 75 years of age, who were enrolled in the Golestan Cohort Study, between 2004 and 2008. The lifestyle risk factors used in this study included cigarette smoking, physical inactivity, and Alternative Healthy Eating Index. The lifestyle score ranged from zero (non-healthy) to 3 (most healthy) points. From the study baseline up to analysis, a total of 4691 mortality cases were recorded. Participants with chronic diseases at baseline, outlier reports of calorie intake, missing data, and body mass index of less than 18. 5 were excluded from the analyses. Cox regression models were 􀂿 􀁗 􀁗 􀁈 􀁇 to establish the association between combined lifestyle scores and mortality outcomes. Results: After implementing the exclusion criteria, data from 40, 708 participants were included in analyses. During 8. 08 years of followup, 3, 039 cases of all-cause mortality were recorded. The adjusted hazard ratio of a healthy lifestyle score, compared with non-healthy lifestyle score, was 0. 68 (95% CI: 0. 54, 0. 86) for all-cause mortality, 0. 53 (95% CI: 0. 37, 0. 77) for cardiovascular mortality, and 0. 82 (95% CI: 0. 53, 1. 26) for mortality due to cancer. When we excluded the 􀂿 􀁕 􀁖 􀁗 two years of follow up from the analysis, the protective association between healthy lifestyle score and cardiovascular death did not change much 0. 55 (95% CI: 0. 36, 0. 84), but the inverse association with all-cause mortality became weaker 0. 72 (95% CI: 0. 55, 0. 94), and the association with cancer mortality 􀁚 􀁄 􀁖 􀀃 􀁑 􀁒 􀁑 􀀐 􀁖 􀁌 􀁊 􀁑 􀁌 􀂿 􀁆 􀁄 􀁑 􀁗 0. 92 (95% CI: 0. 58, 1. 48). In the gender-􀁖 􀁗 􀁕 􀁄 􀁗 􀁌 􀂿 􀁈 􀁇 analysis, we found an inverse strong association between adherence to healthy lifestyle and mortality from all causes and cardiovascular disease in either gender, but no 􀁖 􀁌 􀁊 􀁑 􀁌 􀂿 􀁆 􀁄 􀁑 􀁗 relationship was seen with mortality from cancer in men or women. 􀀶 􀁗 􀁕 􀁄 􀁗 􀁌 􀂿 􀁈 􀁇 analysis of BMI status revealed an inverse 􀁖 􀁌 􀁊 􀁑 􀁌 􀂿 􀁆 􀁄 􀁑 􀁗 association between adherence to healthy lifestyle and mortality from all causes, cardiovascular disease and cancer among non-obese participants. Conclusion: We found evidence indicating that adherence to a healthy lifestyle, compared to non-healthy lifestyle, was associated with decreased risk of all-cause mortality and mortality from cardiovascular diseases in Iranian adults.
 
Keyword(s): Alternative healthy eating index,Golestan cohort study,life style score,mortality
 
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