Four lifestyle changes for fourteen years of life

One of the biggest problems with health messages is that there are so many of them. Even excluding the numerous scare stories, there are still a myriad of recommendations on eating, drinking, smoking, exercising and so on.

Each individual piece of advice seems obvious enough but what happens when they stack up? How do these lifestyle choices affect our health in unison? Can you afford to become a couch potato if you’re a non-smoker, or does getting your five-a-day justify quaffing alcohol by the pint?

Until now, we only had vague answers. Scientific studies have long since confirmed the benefits of individual healthy behaviours, but very few have assessed their combined effect. It’s not just a simple case of adding benefits together because the behaviours often overlap. For example, fit and active people are more likely to be non-smokers.

Enter the EPIC study. EPIC is a huge European study on diet and cancer, but also collects information on other lifestyle choices such as body weight, physical activity and smoking habits. Cancer Research UK funds the two British arms of the study, one in Oxford and one in Norfolk.

This week, the Norfolk group published a paper which showed that a combination of four healthy behaviours – not smoking, drinking alcohol moderately, keeping active and eating fruit and vegetables – can add up to 14 years onto one’s life.

The researchers studied 20,000 healthy people aged 45-79 over the course of 11 years, assessing their lifestyle choices and tracking their health. Each person was given a health score of 0 to 4, with one point for each of the following healthy behaviours:

• not smoking
• keep physically active (defined as having an active job or doing more than 30 minutes of exercise a day)
• having a moderate alcohol intake (1-14 units a week)
• eating at least five portions of fruit and vegetables a day (as measured by the amount of vitamin C in their blood)

After adjusting for the participants’ age, social class, gender and body weight, the EPIC researchers found that the combination of the four behaviours had a strong impact on their health.

Compared to people who ticked all four healthy boxes, those who scored 0 were four times more likely to have died within the 11-year period. They had a higher risk of dying from cancer and an even higher risk of dying from heart disease. Even people who scored 2 out of 4 were twice as likely to have died.

What’s more, the study found that people with scores of 0 had the same risk of dying by the end of the study as people with scores of 4 who were 14 years older. By making unhealthy choices, they had effectively lost a substantial 14 years of life.

These results are very striking, but it’s worth noting that the study had certain weaknesses.

• The four-point scale is a fairly crude measure. It gives a rough look at a person’s lifestyle but obviously, there are many degrees of inactivity or drinking.
• It did not look at obesity, a known cause of cancer, heart disease and other chronic conditions. Given that the majority of people in the study were either overweight or obese, their body weight could have a large effect on their health on top of the four behaviours that were studied.
• Increasing someone’s lifespan is an empty victory without also improving their quality of life and this study did not look at that. It would be equally important to work out how the quartet of behaviours affected their chance of developing diseases in the first place.

It will also be interesting to see if the results apply to people younger than the studied age group of 45-79. Obviously, it’s great to see that no matter how late in life, healthy behaviours can make a difference but it’s also worth knowing how beneficial they are early on in life.
Despite these issues, the study is a relatively strong one and based on its results, the benefits of making multiple healthy lifestyle changes has never been clearer.