• Liz Ruiz-Estigarribia, Miguel Á Martínez-González, Jesús Díaz-Gutiérrez, Alfredo Gea, Anaïs Rico-Campà, and Maira Bes-Rastrollo.
• Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.
• Am J Prev Med. 2020 Aug 1; 59 (2): e59-e67.

IntroductionLifestyle-related habits have a strong influence on morbidity and mortality worldwide. This study investigates the association between a multidimensional healthy lifestyle score and all-cause mortality risk, including in the score some less-studied lifestyle-related factors.MethodsParticipants (n=20,094) of the Seguimiento Universidad de Navarra cohort were followed up from 1999 to 2018. The analysis was conducted in 2019. A 10-point healthy lifestyle score previously associated with a lower risk of major cardiovascular events was applied, assigning 1 point to each of the following items: never smoking, moderate-to-high physical activity, moderate-to-high Mediterranean diet adherence, healthy BMI, moderate alcohol consumption, avoidance of binge drinking, low TV exposure, short afternoon nap, time spent with friends, and working ≥40 hours per week.ResultsDuring a median follow-up of 10.8 years, 407 deaths were documented. In the multivariable adjusted analysis, the highest category of adherence to the score (7-10 points) showed a 60% lower risk of all-cause mortality than the lowest category (0-3 points) (hazard ratio=0.40, 95% CI=0.27, 0.60, p<0.001 for trend). In analyses of the healthy lifestyle score as a continuous variable, for each additional point in the score, a 18% relatively lower risk of all-cause mortality was observed (adjusted hazard ratio=0.82, 95% CI=0.76, 0.88).ConclusionsAdherence to a healthy lifestyle score, including some less-studied lifestyle-related factors, was longitudinally associated with a substantially lower mortality rate in a Mediterranean cohort. Comprehensive health promotion should be a public health priority.Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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