Association of Healthy Lifestyle with the Incidence of the Risk of Developing a Broad Range of Diseases: A Prospective Cohort Study
Authors: Zhao Yujie , Zhang Bei , Sahakian Barbara J. , Langley Christelle , Zhang Ruo-Han , Li Yuzhu , Yu Jin-Tai , Feng Jianfeng , Cheng Wei 
Published: April 2024

Abstract
Background
Individual lifestyle choices undeniably influence the risk of developing both somatic and brain diseases. Exploring the impact of multidimensional lifestyle factors on various diseases has the potential to provide evidence-based recommendations for treatments and prevention conditions by targeting modifiable health behaviours. This study aims to investigate the impact of both combined and individual lifestyle factors on an extensive range of diseases, and to further explore the effects across populations with different genetic profiles and socio-demographic statuses.
Methods
This prospective analysis used data from the UK biobank. Exposures include seven lifestyle behaviours (such as smoking, physical activity, alcohol consumption, diet, sleep duration, sedentary behaviour, and social connection) and their combined score. This combined lifestyle score was subsequently categorized as favourable (5 to 7 healthy lifestyle factors), intermediate (2 to 4 healthy lifestyle factors), and unfavourable (0 to 1 healthy lifestyle factor) lifestyle classes. Outcomes include diagnoses of 45 diseases across eight categories (including cardiovascular disease, brain disorders, endocrine disease, respiratory disease, immune disease, digestive disease, genitourinary system disease, and cancer). Multivariate Cox models were used to estimate hazard ratios for all incident diseases adjusting for age, sex, BMI, deprivation, and education.
Results
Over a median follow-up period spanning from 13.60 to 13.84 years, there were a range of 285,681 to 394,038 participants with diagnostic records for 45 diseases, of whom 108 to 47,695 individuals experienced the onset of a specific disease. The findings demonstrated the protective roles of seven lifestyle factors and combined lifestyle on the comprehensive disease profiles, with respiratory diseases (representative of lung diseases) (HR range: 0.10–0.59), brain disorders (representative of schizophrenia, multiple sclerosis, bipolar disorder, and depression) (0.23–0.69), cancer (representative of lung and liver cancers) (0.18–0.84) and digestive diseases (representative of liver diseases) (0.17–0.83) standing out as the top four categories exhibiting the most prominent protective effects. For representative diseases in the four categories, a favourable lifestyle was associated with adjusted hazard ratio (aHR) of 0.10 (95% CI: 0.09–0.12) for emphysema, aHR of 0.17 (0.14–0.20) for chronic liver disease, aHR of 0.18 (0.14–0.21) for lung cancer, and aHR of 0.24 (0.14–0.40) for schizophrenia. Integrating genetic risk and lifestyle classifications across 17 diseases, the study highlighted the consistent lifestyle-disease prospective associations across populations with diverse genetic risk profiles. Stratified analyses revealed the prospective associations of lifestyle with the risk of developing the majority of the diseases were significant, however the risk varied by sociodemographic status.
Conclusions
These results from a longitudinal study of very large cohort discovered that despite genetic vulnerability, having a healthy lifestyle can greatly reduce the risk of developing a wide range of diseases, including somatic and brain diseases.