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Four Lifestyle Factors Prevent Cancer, Diabetes, and CVD: never smoking/BMI<30/3.5 hrs exercise weekly/healthy diet Reduced risk by 78% of chronic illness disease
  By Kristina Fiore, Staff Writer, MedPage Today
Published: August 10, 2009
Yet another study has confirmed that a healthy lifestyle can reduce the risk of chronic disease, researchers say.
German patients who adopted four healthy lifestyle choices had a nearly 80% reduced risk of major chronic illness including cardiovascular disease, diabetes, and cancer, compared with those who adopted none, according to Earl S. Ford, MD, MPH, a medical officer in the U.S. Public Health Service at the CDC, and colleagues.
They reported their findings in the Aug. 10/24 issue of Archives of Internal Medicine.
The researchers focused on four factors tied to reduced disease risk: never smoking, having a body mass index (BMI) lower than 30, performing at least 3.5 hours per week of physical activity, and following a healthy diet.
"The message from our analysis . . . is clear," the researchers said. "Adopting a few healthy lifestyle factors can have a major impact on the risk of morbidity."
David L. Katz, MD, of Yale, wrote in an accompanying editorial that the findings "fundamentally reaffirm what we already know" about healthy habits.
Numerous other studies have yielded similar conclusions, and the new findings further solidify public health recommendations for healthy living, Ford said. For their prospective study, the researchers looked at data from 23,153 German patients ages 35 to 65 from the European Prospective Investigation Into Cancer and Nutrition (EPIC)-Potsdam study.
In picking their healthy lifestyle factors, researchers said they chose not to include alcohol because of the "well-documented harms caused by alcohol abuse." The study enrolled men ages 40 to 65 and women ages 35 to 65 between 1994 and 1998. About 4% followed no healthy factors at baseline, while most had one to three healthy factors, and 9% followed all four.
During a mean follow-up of 7.8 years, the researchers found that 3.7% of participants developed diabetes, 0.9% developed myocardial infarction, 0.8% developed stroke, and 3.8% developed cancer.
Those who followed all four lifestyle factors had a 78% lower risk (P<0.001) of developing a chronic disease than those with no healthy factors. The decreased risks of individual diseases associated with keeping all four lifestyle factors were as follows:
· 93% lower risk of diabetes
· 81% lower risk of myocardial infarction
· 50% lower risk of stroke
· 36% lower risk of cancer
Ford said he didn't know why cancer was so much less sensitive to lifestyle choices than the other conditions.
"There is undoubtedly some difference in the strength of the associations between the various healthy lifestyle factors and different chronic diseases," he said. For example, he noted, obesity is not a powerful risk factor for cancer.
The researchers said that having all four factors prevented 75% of diabetes cases, 45% of myocardial infarction, 18% of stroke, and 19% of cancer cases. Reductions in risk were similar for men and women (P<0.001), and the risk of developing disease decreased progressively as the number of healthy factors increased, they said.
Having a BMI lower than 30 exerted the largest reduction in risk, the researchers said, followed by never smoking, physical activity, and following a healthy diet. BMI was a particularly strong protective factor for incident diabetes, they added.
While those who had all four factors had the smallest risk of disease, those who never smoked and had a BMI under 30 had a risk of the same order of magnitude, pointing to the importance of those two factors, they said.
The potential for preventing morbidity and mortality from cardiovascular disease, diabetes, and cancer through healthy living is "enormous," the researchers said, potentially yielding dramatic reductions "in the onset of major chronic diseases such as cardiovascular disease, diabetes, and cancer." In his analysis of the study, Katz said that the difference between "life and death and health and illness is substantially dictated by just three behaviors," noting that obesity is largely a byproduct of eating poorly and being physically inactive.
He added that "the hegemony of lifestyle over health warrants particular attention at the dawn of the genomic age," since even gene expression "submits to lifestyle."
The researchers noted that the study may have been limited by self-reported data and by the fact that it may not be generalizable outside of the German population.
But Katz said it's true limitation "is that it teaches us nothing about how to get those not already choosing health on their own to join those who are."
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