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Just 4 healthy lifestyle factors make a big difference



two adult persons, dressed for exercising, walking on a paved track in the outdoors

From time to time I'll see an article bemoaning the complexity of health and nutrition advice:

"First low-fat is good, now it's bad."

"Red meat was bad for you, now it's not."

And from time to time a friend or patient will remark that if scientists keep changing their minds about what's healthy, why should they listen to them?

The fact is that while yes, we are still understanding the nuances around red meat (although we know that processed meats are bad for you) and which fats are good for you (some fats are definitely good) and which aren't good for you (trans-fats are definitely bad), and other foods and dietary patterns, we do have thirty-plus years of research to tell us what a healthy lifestyle looks like: don't smoke, get some exercise, maintain a healthy weight, and stay away from processed foods.

The Moli-sani Study is an Italian study that began recruiting participants at least 35 years of age from Central and Southern Italy in 2005 and eventually included over 23,000 people, with data gathering ending in 2015. Like other population-based studies, the participants filled out detailed dietary, medical, and demographic questionnaires upon recruitment and were weighed, their height and waist circumference measured, and their blood drawn for testing, including cholesterol scores and other measures of interest (J Int Med 2019;286:207-220).

The Investigators of the Moli-sani Study chose to take a high-level, more general look at the participants, identifying 4 healthy lifestyle factors and assigning each participant a point if they met the criteria.

1. Mediterranean Diet
The authors analyzed the participants' dietary questionnaires and assigned each a score of 0 to 9 based on the 9 points of the Mediterranean Diet. For the purposes of their analysis, those with a Mediterranean Diet score of 5 or more were given one healthy lifestyle point.

2. Smoking
The participants were grouped into smokers and non-smokers, with those who had quit smoking at least 1 year before recruitment being considered non-smokers. Non-smokers were given one healthy lifestyle point.

3. Exercise
The authors described this as "leisure-time physical activity" which included such activities as gardening, walking, and purposeful exercise. Those who engaged in at least 30 minutes per day (on average) of leisure-time physical activity were given one healthy lifestyle point.

4. Waist to Hip Ratio (Abdominal Obesity)
Those with a Waist to Hip Ratio less than 0.85 for women and 0.9 for men were given one healthy lifestyle point.

The authors then looked at those who passed away over the course of the study and their cause of death and compared the number of lifestyle points they had with those who did not pass away. They compared those with 4, 3, or 2 points with those with 0 (zero) or 1 point, taking into account variables such as gender; age; education; diagnosed heart disease, diabetes, cancer, or other chronic illnesses; family medical history; and more.

Compared to those with 0 or 1 healthy lifestyle points, those with 2 healthy lifestyle points were 31% less likely to die of any cause, 38% less likely to die of cancer, 38% less likely to die of heart disease, and 29% less likely to die of any other cause.

Those with 3 healthy lifestyle points were 49% less likely to die of any cause, 31% less likely to die of cancer, 46% less likely to die of heart disease, and 38% less likely to die of any other cause.

Finally, those with 4 healthy lifestyle points were 47% less likely to die of any cause, 48% less likely to die of cancer, 46% less likely to die of heart disease, and 61% less likely to die of any other cause.

What this means for you

The take-home message here should be that it does not take big changes in your life to make a big difference in your health. Remember:

Your 30 minutes of exercise each day can include walking through a parking lot (park further away than you might otherwise), walking your dog, gardening, and walking an extra block or two to work or home because you get off the bus or train a stop early.

It's pretty easy to improve your Mediterranean Diet score, and you don't have to be perfect - this study gave the participants a healthy lifestyle point when they had only 5 points on a Mediterranean Diet score (out of 9). Here's a quiz to help you assess your Mediterranean Diet Score, with tips for improving your score.

Don't smoke - not anything - and if you do smoke, quit. There are great, free resources available to help you quit.

Improving your Waist to Hip ratio is likely the "healthy lifestyle point" that will take the most dedication, but note that the difference in risk between 3 healthy lifestyle points and 4 is greatest for the risk of cancer and those causes of death other than cancer or heart disease.

Yes, if your Waist to Hip ratio is greater than the guidelines suggest it should be, then you should probably work on your Waist to Hip ratio in order to reduce the effects of body fat around your internal organs (which is what Waist to Hip ratio estimates).

That said, your body weight alone should not define your health risks: your physician should take into account your lipid (cholesterol) scores and other clinical measures in light of your overall health (are you active? eat great food? don't smoke?) and should never dismiss any of your health concerns merely because you are overweight.

First posted: November 6, 2019