摘要：Objectives. We examined the relationship between 4 low-risk behaviors—never smoked, healthy diet, adequate physical activity, and moderate alcohol consumption—and mortality in a representative sample of people in the United States. Methods. We used data from 16958 participants aged 17 years and older in the National Health and Nutrition Examination Survey III Mortality Study from 1988 to 2006. Results. The number of low-risk behaviors was inversely related to the risk for mortality. Compared with participants who had no low-risk behaviors, those who had all 4 experienced reduced all-cause mortality (adjusted hazard ratio [AHR]=0.37; 95% confidence interval [CI]=0.28, 0.49), mortality from malignant neoplasms (AHR=0.34; 95% CI=0.20, 0.56), major cardiovascular disease (AHR=0.35; 95% CI=0.24, 0.50), and other causes (AHR=0.43; 95% CI=0.25, 0.74). The rate advancement periods, representing the equivalent risk from a certain number of years of chronological age, for participants who had all 4 high-risk behaviors compared with those who had none were 11.1 years for all-cause mortality, 14.4 years for malignant neoplasms, 9.9 years for major cardiovascular disease, and 10.6 years for other causes. Conclusions. Low-risk lifestyle factors exert a powerful and beneficial effect on mortality. Lifestyle behaviors lie at the root of many chronic diseases. 1 – 3 Smoking, unhealthy diets, and sedentary behavior predispose numerous people to diseases that rank among the leading causes of death such as heart disease, cancer, stroke, and diabetes. The costs associated with these behaviors are enormous. 4 – 7 Previous studies have generally examined the independent effect of these lifestyle behaviors in isolation on a variety of adverse health outcomes. Yet, optimal health is only achieved by maximizing the number of healthy behaviors. Therefore, examining the joint effect of multiple lifestyle behaviors on health outcomes yields valuable insights into the improvements in health that are potentially achievable in populations. Starting around 2000, research appeared that examined the impact of multiple low-risk lifestyle behaviors on various health outcomes including cardiovascular disease, 8 – 15 diabetes, 16 – 18 all-cause mortality, 19 – 25 and mortality from cancer. 23 – 25 Few studies relating multiple low-risk lifestyle factors to all-cause mortality have been conducted in the United States or have included substantial samples of racial/ethnic minorities. 22 , 24 Therefore, we examined the relationship between 4 lifestyle behaviors—never smoked, healthy diet, adequate physical activity, and moderate alcohol consumption—and all-cause mortality in a national sample of people in the United States.
