and the PREVENTION of CHRONIC DISEASE*
Many of the major chronic diseases, such as cardiovascular disease (CVD), cancer and diabetes, which together comprise the overwhelming burden of mortality, are in large part preventable. An impressive body of research has implicated modifiable lifestyle factors such as smoking, physical activity, diet and body weight in the causes of these diseases.
How important are the 4 lifestyle factors - smoking status, body mass index, physical activity and diet - in the prevention of disease?
My March 2008 newsletter Prevention of Cancer - Food, Nutrition, Physical Activity and the Prevention of Cancer, sets out the 10 recommendations from a panel of expert academics following a meta-analysis of 7,000 publications on cancer. They underscored the importance of being thin, “be thin, be very thin”, of exercise and healthy diet (plant based, mainly fruit and vegetables with little meat and avoiding processed and refined foods) in the prevention of cancer.
How effective are such lifestyle recommendations in the prevention of chronic diseases such as cancer, CVD and diabetes?
The European Prospective Investigation into Cancer and Nutrition
In the Archives of Internal Medicine, Vol. 169 No. 15, 2009, the findings from The European Prospective Investigation into Cancer and Nutrition-Potsdam Study, are published, “Healthy Living Is the Best Revenge”.
The objective of the authors (Earl S. Ford, et al) was “to describe the reduction in relative risk of developing major chronic diseases such as cardiovascular disease, diabetes, and cancer associated with 4 healthy lifestyle factors among German adults.”
The authors, recognising that other lifestyle choices can affect the risk of future chronic disease, elected to limit their analyses to not smoking, being physically active, adhering to healthy dietary principles, and avoiding excess body weight because these “4 healthy lifestyle factors” constitute a core set included in previous studies examining the effect of healthy lifestyles on morbidity and mortality.
The European Prospective Investigation into Cancer and Nutrition (EPIC-Potsdam) study is part of the multi-centre prospective cohort EPIC study. In Potsdam, Germany, men aged 40 to 65 years and women aged 35 to 65 from the general population were invited to join the study, between 1994 and 1998. 23,153 participants (8,965 men and 14,188 women) were included in the analysis.
End points included confirmed incident type 2 diabetes, myocardial infarction, stroke and cancer.
The 4 factors were:
· Never smoking
· Having a body mass index lower than 30 (calculated as weight in kilograms divided by height in meters squared)
· Performing 3.5 hours per week or more of physical activity
· Adhering to healthy dietary principals (high intake of fruits, vegetables, and whole grain bread and low meat consumption).
The 4 factors (healthy, 1 point; unhealthy, 0 points) were summed to form an index that ranged from 0 to 4.
Physical activity included the time spent doing sports and bicycle riding (common in the Potsdam area). The consumption of fruits and vegetables, whole grain bread and red meat reported on a food frequency questionnaire were used to construct a dietary score. The food frequency questionnaire used in the EPIC-Potsdam study has been shown to have satisfactory reliability and validity.
The mean (standard deviation) age of the sample was 49.3 (8.8) years [men, 51.2 (7.9) years; women, 48.2 (9.1) years] at baseline.
The mean and median follow-up times were 7.8 years and 8.2 years respectively.
“In all, 2006 participants (1081 men and 925 women) were clinically diagnosed as having 1 of the 4 study outcomes: 1868 participants had 1 event, 134 had 2 events, and 4 had 3 events. 871 had diabetes (43.4%), 214 had a myocardial infarction (10.7%), 195 had a stroke (9.7%), and 868 had cancer (43.2%).”
In summary: “During a mean follow-up of 7.8 years [of the 23,153 participants], 2006 participants developed new-onset diabetes (3.7%), myocardial infarction (0.9%), stroke (0.8%) or cancer (3.8%).”
“Approximately 84% of participants had a BMI lower than 30, 48% had never smoked, 50% had a healthy score for diet and 32% participated in physical activity for at least 3.5 hours per week. Approximately 4% of participants had zero healthy factors at baseline, most had 1 to 3 healthy factors, and approximately 9% had 4 factors.”
“After adjusting for age, sex, educational status and occupational status, the hazard ratio for developing a chronic disease decreased progressively as the number of healthy factors increased. Participants with all 4 factors at baseline had a 78% (95% confidence interval [CI], 72% to 83%) lower risk of developing a chronic disease (diabetes, 93% [95% CI, 88% to 95%]; myocardial infarction, 81% [95% CI, 47% to 93%]; stroke, 50% [95% CI, -18% to 79%]; and cancer,36% [95% CI, 5% to 57%]) than participants without a healthy factor.”
Each healthy lifestyle factor was associated with a reduction in risk of any chronic disease. A BMI lower than 30 exerted the largest reduction in risk, followed by never smoking, physical activity for 3.5 hours per week or more, and adhering to good dietary principles. Never smoking exerted a stronger protective effect on incident myocardial infarction and diabetes than on stroke and cancer. A BMI lower than 30 was a particularly strong protective factor for incident diabetes. Physical activity for 3.5 hours per week or more was a stronger protective factor for incident diabetes and myocardial infarction than cancer. Finally, adhering to good dietary principles provided a similar degree of protection for incident diabetes, stroke and cancer.
The authors of the study made the following comment:
“The message from our analysis of the data from the EPIC-Potsdam study is clear: adopting a few healthy behaviours can have a major impact on the risk of morbidity. The participants with all 4 healthy lifestyle factors had a reduced risk of major chronic diseases of almost 80% compared to those with none. These results applied equally to men and women.
Our results reinforce current public health recommendations to avoid smoking, to maintain a healthy weight, to engage in physical activity appropriately, and to eat adequate amounts of fruits and vegetables and foods containing whole grains and to partake of red meat prudently.”
The above study confirms the recommendations referred to above in my March 2008 newsletter Prevention of Cancer. Not only are the ten recommendations relevant to the prevention of cancer, but they are also relevant for cardiovascular disease (heart attacks and strokes) and diabetes.
It should be noted that a BMI of 30 or higher is obesity. 25 to 30 is overweight. The ideal BMI is in the region of 21 and it is abundantly clear that the lower the BMI the greater is the protection against diabetes, cancer, heart attacks (myocardial infarction) and stroke.
Adhering to 4 simple healthy lifestyle factors can have a strong impact on the prevention of chronic disease.
· September 2005 newsletter Acid / Alkaline Balance - The Ideal Diet.
· March 2008 newsletter Prevention of Cancer. Food, Nutrition, Physical Activity and the Prevention of Cancer.
· June 2008 newsletter Health Benefits of Weight Reduction and Exercise - The Cuban Experience.
· March 2009 newsletter Foods for Health.
· January 2010 newsletter Smoking Statistics- and How to Quit Forever.
· November 2010 newsletter The Health Benefits of Exercise.
· My book How to Live to 100+, Free from Symptoms and Disease. Dietary Guidelines (see home page).
*Copyright 2011: The Huntly Centre.
Disclaimer: All material in the huntlycentre.com.au website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.
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