Solja T. Nyberg (E-mail: (, Archana Singh-Manoux, Jaana Pentti, et. al.


Nyberg ST, Singh-Manoux A, Pentti J, et al. Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases. JAMA Intern Med. Published online April 06, 2020. doi:10.1001/jamainternmed.2020.0618

JAMA Internal Medicine
Release date

Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases

Original investigation

Key Points


Are different combinations of lifestyle factors associated with years lived without chronic diseases?


In a multicohort study of 116, 043 participants, a statistically significant association between overall healthy lifestyle score and an increased number of disease-free life-years was noted.

Of 16 different lifestyle profiles studied, the 4 that were associated with the greatest disease-free life years included body mass index lower than 25 and at least 2 of 3 factors: never smoking, physical activity, and low-dose alcohol consumption.


Various healthy lifestyle profiles appear to be associated with extended gains in life lived without type 2 diabetes, cardiovascular and respiratory diseases, and cancer.



It is well established that selected lifestyle factors are individually associated with lower risk of chronic diseases, but how combinations of these factors are associated with disease-free life-years is unknown.


To estimate the association between healthy lifestyle and the number of disease-free life-years.

Design, Setting, and Participants

A prospective multicohort study, including 12 European studies as part of the Individual-Participant-Data Meta-analysis in Working Populations Consortium, was performed.

Participants included 116, 043 people free of major noncommunicable disease at baseline from August 7, 1991, to May 31, 2006. Data analysis was conducted from May 22, 2018, to January 21, 2020.


Four baseline lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) were each allocated a score based on risk status:

  • optimal (2 points),
  • intermediate (1 point), or
  • poor (0 points), resulting in an aggregated lifestyle score ranging from 0 (worst) to 8 (best).

Sixteen lifestyle profiles were constructed from combinations of these risk factors.

Main Outcomes and Measures

The number of years between ages 40 and 75 years without chronic disease, including type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease.

Measure for alcohol consumption:

Alcohol consumption (total number of alcoholic drinks a participant consumed in a week; 1 drink being equivalent to 10 g of ethanol):

  • 1 to 14 (women) or 1 to 21 (men) drinks per week (optimal),
  • no alcohol (intermediate),and
  • greater than or equal to 15 (women) or greater than or equal to 22 (men) drinks per week (poor).

In a sensitivity analysis, the researchers included never and moderate drinkers in the optimal alcohol consumption category.


Of the 116 ,043 people included in the analysis, the mean  age was 43.7  years and 70, 911 were women (61.1%). During 1.45 million person-years at risk, 17, 383 participants developed at least 1 chronic disease.

There was a linear association between overall healthy lifestyle score and the number of disease-free years, such that a 1-point improvement in the score was associated with an increase of 0.96 disease-free years in men and 0.89 years in women.

Comparing the best lifestyle score with the worst lifestyle score was associated with 9.9 additional years without chronic diseases in men and 9.4 additional years in women.

All of the 4 lifestyle profiles that were associated with the highest number of disease-free years included

  • a body-mass index less than 25 (calculated as weight in kilograms divided by height in meters squared) and
  • at least 2 of the following factors: never smoking, physical activity, and low-dose alcohol consumption.

Participants with 1 of these lifestyle profiles reached age 70.3 to 71.4 years disease free depending on the profile and sex.

Conclusions and Relevance

In this multicohort analysis, various healthy lifestyle profiles appeared to be associated with gains in life-years without major chronic diseases.

The results of this study suggest a consistent dose-response association of a higher number of healthy lifestyle factors with the number of disease-free years both in men and women and across the socioeconomic strata, and that various healthy lifestyle profiles, particularly those including a BMI less than 25, are associated with a prolonged health span. These findings may be useful for prevention, strengthening the evidence base for actions to support healthy choices in everyday life.

Source Website: JAMA Network