Download Amer J of Epidemiology

Eight Weeks to Wellness
Week 1:
Healthy Lifestyle
Prepared by
Don Hall, DrPH, CHES and
Gerard McLane, DrPH, CHES
Health Research
Four large studies attempt to answer this question
1. Cancer Prevention 2 Study
1 million people studied for 6+ years
2. Alameda County Good Health Practices Study
6,900 people studied for 9+ years
3. Adventist Health Study
34,192 people studied for 12+ years
4. Healthy People 2020 Priority Health Goals
Consensus of leading health authorities and government agencies
4 Lifestyle Factors Predict Good Health
1.
2.
3.
4.
Never smoking
Maintaining a healthy weight,
(BMI <30)
Physically active (3.5 hours/week,
30 min/day)
Healthy eating habits (three
markers)
– High intake of whole grain breads
and cereals
– High intake of fruits and vegetables
– A low red meat consumption
Archives of Internal Medicine 2009;169(15):1355-1162
Risk of diabetes, heart attack,
stroke, or cancer (RR)
Lifestyle and Risk of Serious Disease
23,153 people, ages 35-65,
8 year study
1.00
1.00
0.75
0.50
0.51
0.37
0.25
0.28
0.22
0.00
0
1
2
3
4
Number of Healthy Living Factors
(never smoking, regular exercise, healthy eating, healthy weight)
Archives of Internal Medicine 169(15):1355-1162
7 Health Practices Related To Longevity
1.
2.
3.
4.
5.
6.
7.
Get adequate rest
Get regular physical activity
Choose healthy fats such as eating nuts daily
Eat more whole-grain breads and cereals
Maintain a healthy weight
Eat more plant based foods
Be free of dependence on tobacco, alcohol,
and illicit drugs
Adequate Sleep: Goal #1
Individuals who get 7-8 hours sleep
daily have:
– Better physical health -- the body’s
health and reserves are restored
during rest
– Better mental/emotional health
– Higher energy levels and
productivity
– Lower mortality rates than those
who get less than this amount
Breslow and Belloc, Alameda County Health Study
Rest and Relaxation
Healthy Living Goal – 1
•
•
In addition to getting
adequate sleep, take
time daily to relax,
have fun, and let the
mind and body
unwind.
Short naps can also
help you relax and
restore energy
levels.
Good Health Practices Study
Regular Exercise: Goal #2
• In most studies, regular physical activity is the best predictor
of longevity.
• On average, every hour you exercise increases your life span
by two hours (Harvard alumni study)
• Active people:
– sick less often
– have more energy
– are more successful at weight management
– cope better with stress and pressures
– have less depression and a more positive self-image
– and live longer, healthier lives
Source: U.S. Surgeon General’s Report on Physical Activity and Health
Exercise and Longevity
Mortality rate for all causes, Men (%)
14
12
12.4
10
9.8
8
6
4
5.9
2
0
active
moderate
inactive
Physical Activity Level
Good Health Practices Study
In this large study of
over 5,000 people,
men who were
physically active cut
their risk of dying
from any cause by
more than half
compared to inactive
men during the 9
year study.
Exercise and Longevity
Mortality rate for all causes, Women (%)
9
9.0
6
5.2
3
2.9
0
active
moderate
inactive
Physical Activity Level
Good Health Practices Study
Women who were
least active had a
mortality rate 3
times greater than
those who were
most active.
In this study, physical
activity was the best
predictor of
longevity of all
health practices
studied.
Too Much Sitting Also Increases Mortality
All cause mortality (RR)
1.50
17,013 men & women,
12 year study
1.54
1.36
1.25
1.11
1.00
1.00
1.00
0.75
0.50
Least 25%
50%
75%
Most
In this study, researchers
found a strong association
with sitting time daily and risk
of mortality.
As sitting time increased to
50% or more of each day, the
risk of death from any cause
increased by 11-54%.
In addition to regular exercise,
don’t sit for long periods of
time. Take frequent activity
breaks to lower your risk.
Sitting time each day
Medicine and Science in Sports and Exercise 41:998-1005
Sedentary Time Increases Risk
Conclusion: Sedentary time is associated
with an increased risk of diabetes,
cardiovascular disease, and all-cause
mortality.
Diabetologia, 55 (11): 2895
Researchers studied sedentary
levels of 794,577 people.
When comparing people with
high sedentary (sitting) time to
a low sedentary time, they
found:
• Diabetes increased by 2.12
times
• Mortality from
cardiovascular disease
increased by 1.90 times
• And all cause mortality
increased by 1.49 times
12
Choose healthy fats: Goal #3
Eat healthy fats daily:
•
Non-hydrogenated
vegetable oils
•
Healthy fat foods:
nuts, olives, avocado,
flax seed, soy
And limit all animal and
solid fats.
Coronary Artery
Moderate atherosclerosis
This is what
your arteries
begin to look
like if you
have a high
saturated or
animal fat
intake.
Notice the
thickness of
the artery
wall on the
right.
Nut Consumption and Heart Disease
• Nuts are an example of a
healthy fat. Frequent
consumption of nuts
protects against risk of
heart attacks.
• People who ate nuts
frequently (5+ times/week)
had a 51% reduction in
heart attacks and a 48%
reduction in death from
heart attacks compared to
those who seldom ate nuts.
Relative risk of heart attack
100
100
80
76
60
52
40
20
0
< 1/wk
1-4/wk
5+/wk
Servings of Nuts per Week
Arch Intern Med, Vol. 152, p. 1416
Eat Nuts and Seeds Daily
Examples
• Almonds, walnuts, cashews,
Brazil nuts, hazelnuts,
pecans, peanuts
• Sunflower seeds, flax seed,
pumpkin seeds, sesame
• Peanut and almond butter,
tahini
Eat at Least 5 servings of nuts and seeds
weekly.
Other Healthy Fats
Examples
• Unhydrogenated vegetable
oils such as canola, soy, and
olive
• Margarines free of trans
fatty acids
• Olives, avocado, nuts,
seeds, hummus, and nut
butters
Example of a trans fat free margarine
Whole Grains: Goal #4
• Eat more
whole grain
breads and
cereals
• At least
3 servings daily
Whole-Wheat Bread and Heart Disease
Relative Risk of Heart Attack, n=26,437
1.00
Study Findings:
People eating
whole grain
breads, vs white
bread, had nearly
half the risk of a
heart attack
during the study.
1.00
0.75
0.50
0.59
0.56
Mixed
Whole-wheat
bread
0.25
0.00
White bread
Kind of Bread Eaten
Arch Intern Med Vol 152 P.1416
Whole Grains and Risk of Stroke
Risk of Stroke (RR)
1.00
All women
Never smoked
1.00 1.00
0.75
0.69 0.68
0.50
0.57
0.50
0.25
0.00
72,488, women
12 yr follow-up
None
1/day
3+/day
Whole-grains, Servings/day
JAMA Sep 27, 2000; 284:1534-40
Choose a Variety of Grains
• Whole-grain breads
• Multi-grain breads
• Oatmeal breads
and cereals
• Whole-grain rye
• High fiber cereals
• Brown rice
• Pasta
• Barley cereal
Aim for at least three or more
servings of whole grains daily.
Healthy Weight: Goal #5
Achieve and maintain a
healthy weight
• Body Mass Index: BMI < 25
• Waist girth
Men, no more than 37 in.
Women no more than 32 in.
Measure waist at level of
navel with abdomen
relaxed.
American Journal of Clinical Nutrition
Weight Ranges Based on BMI
Ht (in)
58 in.
60
62
64
66
68
70
72
74
76
BMI 20
96 lb
102
109
116
124
131
139
147
155
164
BMI 25* BMI 30**
119 lb
143 lb
128
153
136
164
145
174
155
186
164
197
174
209
184
221
194
233
205
246
* People with a BMI less than 25 live the longest
** Obesity is defined as a BMI of 30+
Overweight and Health Risks
10
8
BMI 22
BMI 30
6
4
2
0
Heart disease
High BP
New England Journal of Medicine
Gallbladder
Diabetes
The Good News About Weight
• If you need to lose weight, even
a loss of 10-15 pounds can make
big improvements to your health
– Improved glucose levels
– Improved blood fat levels
– Improved blood pressure
– Significant decrease in health risks
Be Active
If you can’t get skinny, at least
get fit!
– Besides burning calories,
exercise reduces your risk of
diabetes, heart problems, and
even cancer
– Physical activity counteracts
most of the health problems of
excess fat weight
Choose Lower Calorie Foods
• Fresh fruits
• Vegetables and salads
• Non or low fat dairy or
low sugar soy milk
• Choose whole-grains
– whole-wheat breads
– whole grain cereals
– brown rice
Weight Management Principles
1. Avoid crash diets. Adopt a healthy
lifestyle that you can follow for life.
A weight loss of no more than 1/2
to 1 lb/week is recommended.
2. Choose foods low in animal fats.
3. Limit desserts, snacks, and foods
high in sugar.
4. Eat more fruits and vegetables; 5+
servings per day are
recommended.
5. Choose whole-grain breads and
cereals.
Weight Management Principles
6. Don’t skip meals—it leads to
bingeing later on.
7. Eat a good breakfast, a moderate
dinner, and avoid late night
snacks.
8. Be physically active 30-60 minutes
daily.
9. Get adequate rest and keep stress
manageable.
10. Enlist the help of family, friends,
and support groups.
Eat More Plants: Goal #6
Eat more whole
plant based foods
More vegetables,
fruits, legumes, nuts,
and whole grains
 Less fatty meats and
high cholesterol foods

Vegetable and Fruit Consumption
Women, probability of dying, mid-life, ages 35-69
As the intake
of vegetables
and fruits goes
from high to
low intake, the
risk of
mortality for
women
increased 38%.
9
8
7
6
5
5th
High
intake
4th
3rd
2nd
Intake by Quintiles
J of Hlth Educ, Vol 28, No. 5, 298-307
1st
Low
intake
Vegetable and Fruit Consumption
Men, probability of dying mid-life, ages 35-69
As the intake
of vegetables
and fruits goes
from high to
low intake, the
risk of
mortality for
men increased
by 30%.
20
n=200,000
18
16
14
12
5th
High
intake
4th
3rd
2nd
Intake by Quintile
J of Hlth Educ, Vol 28, No. 5, 298-307
1st
Low
intake
Vegetable and Fruit Consumption
Risk of stroke in men, incidence per 1,000
125
121
Ischemic
100
Hemorrhagic
75
67
50
51
42
25
15
12
0
0- 2
5
8+
Servings of Fruits and Vegetables per Day
Framingham Study, JAMA, Vol 273, No. 14, pp1113-17
Study included 832
men followed for 20
years looking at diet
and stroke.
For each increment
of 3 servings of fruits
or vegetables per
day, there was a 45%
decrease in the risk
of death from stroke.
Free from Dependencies: Goal #7
• Free of
dependence
on tobacco,
alcohol, and
illicit drugs
Smoking and Health
• Smoking is the single greatest
preventable cause of death.
• 20% of all deaths in the US are
smoking related – causing 443,000
deaths/year.
• On average, adults who smoke die
14 years earlier than nonsmokers.
• Smoking increases the risk of heart
disease, cancer, stroke, emphysema,
and the common colds.
• In pregnancy, smoking causes birth
defects (physical and mental).
Source: CDC Fact Sheet, Tobacco-Related Mortality
Good News about Quitting
• People who quit, regardless
of age, live longer than
people who continue to
smoke.
• Smokers who quit before
age 50 cut their risk of dying
in half over the next 15
years compared to those
who continue to smoke.
Source: ACS, Cancer Facts and Figures
Health Benefits of Quitting
Quitting …
20 minutes
12 hours
1-2 months
1-9 months
1 year
5 years
10 years
15 years
Results in these benefits:
Heart rate and blood pressure drop.
Carbon monoxide in blood drops to normal.
Circulation and lung function improve.
Cilia lining air passageways regain normal
function allowing lungs to clean its self,
coughing and shortness of breath decrease.
Risk of a coronary is cut in half.
Risk of stroke is the same as a non-smoker.
Lung cancer risk is cut in half.
Risk of coronary heart disease is nearly the same
as a nonsmoker’s.
American Cancer Society
Alcohol
• Alcohol is responsible for:
– 80,000 excess deaths per year
from cancer, high blood pressure,
accidents, suicides, and homicide
• Alcohol consumption is not
recommended
– If consumed at all, limit alcoholic
drinks to no more than …
• two drinks per day for men, and
• one for women
American Institute for Cancer Research, World Cancer Research Fund, and NIH
Drug Abuse
• Street drugs …
– Kill initiative,
– Lead to dependence,
– Damage physical and
mental health,
– Are a major source of
crime in America.
• 37,485 people die from drug
overdose each year (street
drugs and prescription
narcotics)
• Drug overdose deaths have
tripled since 1990 causing 100
deaths daily in the U.S.
• Drug deaths now out
number deaths from motor
vehicle accidents in the U.S.
• Annual costs to society for
street drug use is more than
$181 billion per year in
– Lost productivity (69%)
– Health care costs and
treatment (9%)
– Criminal justice system
and welfare costs (22%)
NIH, National Institute on Drug Abuse, and CDC
Summary GHP Study
In the Good Health Practices Study:
– Life expectancy was directly related
to the number of good health
practices followed.
– With changes, the average person
could potentially add 5 years to their
life expectancy.
– Those following all of the good health
practices lived 10-12 years longer
than those who didn’t.
– And, enjoyed a level of health
equivalent to someone 20-30 years
younger.
Good Health Practices Study
Summary of Cancer Prevention 2 Study
Probability of dying mid-life from any cause (%), n=550,000
Persons with
4 unhealthy
behaviors
had a
mortality rate
4 times
higher than
those
following all
the good
health
practices.
Smoking, overweight, physical inactivity, low intake of fruits and vegetables
Cancer Prevention 2 Study
J of Hlth Educ, Vol 28 (5):298-307
Summary of Adventist Health Study
People who …
– Maintained a healthy weight
– Got regular, moderate activity, and
– Ate the most fruits and vegetables in their diet, limited their
meat intake, and ate nuts daily
Lived an extra 10 years compared to those who …
– Were overweight
– Sedentary, and
– Regularly ate meats and fatty foods, ate fewer fruits and
vegetables, and seldom ate nuts
Adventist Health Study I
The Blue Zones
Places In the World Where People Live to 100
and Stay Healthy. The five blue zones are as
follows:
• The Italian island of Sardinia
• Okinawa, Japan
• Loma Linda, California
• Costa Rica’s isolated Nicoya Peninsula
• Ikaria, an isolated Greek island
Summary by U.S. News and World Report
11 Habits to Live to 100
• Don’t retire – stay active physically and mentally to prevent chronic disease
• Move around – Exercise is the only real fountain of youth
• Eat a fiber-rich diet cereal for breakfast – helps older folks maintain
stable blood sugars
• Get at least 6 hours of sleep - Sleep is one of the most important
functions that our body uses to regulate and heal cells
• Consume whole foods, not just supplements - Avoid nutrientlacking white foods and embrace colorful fruits and vegetables, and dark wholegrain breads and cereals.
• Floss every day – You only have to floss the teeth you want to keep
US News and World Report
11 Habits to Live to 100
• Be less neurotic - don’t dwell on problems or internalize things and
manage stress
• Live like a Seventh-day Adventist - no smoking, alcohol abuse, or
overindulging in sweets. Followers typically get plenty of exercise, are
vegetarian, and make family and community a focus.
• Be a creature of habit - live by strict routines. When your equilibrium
is thrown off, your immunity can weaken, leaving you more susceptible to
circulating flu viruses or bacterial infections.
• Stay connected - Having regular social contacts with friends and loved
ones is key to avoiding depression, which can lead to premature death
• Be conscientious - being prudent, persistent, and well-organized, is a
strong personality predictor of a long life. Conscientious types are more
inclined to choose a healthy lifestyle and follow their doctors’ orders, take the
right medicines at the right doses, and undergo routine checkups.
The Next Steps
8 Weeks to Wellness will take you
step by step in the coming weeks to
help you achieve a healthier lifestyle:
• Be more active
• Eat healthier meals
• Manage your weight
• Cope better with stress
• Have a positive outlook on life
• And get good preventive care
So you can be more fit, feel your best,
and enjoy lifelong health!
Quiz
1. At least ___ hours of sleep are recommended daily.
2. ___ hours of walking weekly cuts heart attack risk in half.
3. Every hour of exercise increases your life span by ___ hrs.
4. Inactivity increases mortality rate ___ times v. being active.
5. You need to eat at least ___ servings of whole grains daily.
6. Persons with the best longevity have a BMI less than ___.
7. People who ate ___ servings of fruits and vegetables daily had
the lowest risk of stroke (Framingham study).
8. ______ is the single greatest cause of preventable death.
9. Alcohol is responsible for about ______ deaths annually.
10. A healthy lifestyle can add ___ or more years to your life.
Week 1 Assignments
1. Read “Getting Started” and Week 1: “Developing a
Healthy Lifestyle”
2. Complete “How Healthy is Your Lifestyle?”
3. Fill out your starting “Personal Health Information”
4. This week, focus on three good health habits:
•
•
•
Getting 7-8 hours of sleep daily
Drinking 6-8 glasses of water daily
Walk 15-30 minutes, 3 or more days this week (or equivalent)
5. Select a special Personal Goal you want to work on all 8
weeks (weight loss, blood pressure, breakfast, etc.)
6. Each day write down your exercise minutes and
wellness points. Review these with your “Health Buddy.”
Be*Healthy Health Assessment
• Use the iPhone App called
Be*Healthy to get a more
accurate estimate of your:
– Health status and wellness
score
– Health age appraisal
– Projected life expectancy
– Guidelines for adding years
to your life
– Watch slide shows to know
how to make changes Track
your progress all year
Available from the Apple App Store
Plan for Good Health
Invest in your
health every day.
You will never be
sorry later in life
that you took the
time to take good
care of yourself.
Thank you for your attention
A LifeLong Health Presentation
Enjoy Your Adventure
to Better Health
www.myLifeLongHealth.Org
Additional Slides
Slides listed below are from other studies and
are included because they show how a healthy
lifestyle prolongs life. They are only there for use
if you desired to add one or two to your
presentation. It is not intended that all be used.
Risk Factors and Mortality
• Study participants
–
–
–
–
50,112
Ages 35-55 at start
18 years of follow-up
4,893 deaths
• Researchers were
studying the association
of lifestyle and dietary
factors with mortality
and longevity.
Amer J of Epidemiology 173:319-329
Study found 12 Key Indicators of Mortality
Increases Risk of Mortality
• Personal history of
diabetes
• High blood pressure
• Smoking
• Excess body weight
• High glycemic load
• High cholesterol intake
• High alcohol intake
• Family history of early
heart disease
Amer J of Epidemiology 173:319-329
Decreases Risk of Mortality
• Physical activity, 30+
minutes daily
• Eating nuts, 5 or more
times per week
• Eating whole grains high
in fiber, 3 or more
servings daily
• Choosing healthy fats
high in polyunsaturated
fats
Smoking
• Serious smokers were
twice as likely to die
during the study.
• Even light smokers had
nearly a 50% increased
risk of dying.
• Smoking kills over
467,000 people yearly
• If you smoke, stop. Get
help from your doctor or
health coach.
Mortality Rate (RR)
2.5
2.08
2.0
1.48
1.5
1.0
1.0
0.5
0.0
No
Yes
Yes, 20+ yrs
Do you smoke?
Amer J of Epidemiology 173:319-329
High Blood Pressure
• As blood pressure goes up,
so does the risk of mortality
for any cause.
• High blood pressure
increases risk of death by
22-49%.
• High blood pressure is the
2nd leading cause of early
death in the U.S. resulting in
395,000 early deaths per
year.
Mortality Rate (RR)
1.50
1.22
1.25
1.00
1.49
1.0
0.75
0.50
120
140
160
What is your systolic BP?
Amer J of Epidemiology 173:319-329
Lowering Blood Pressure
• Maintain healthy weight,
losing in 10-15 lbs. helps
• Be physically active
• Eat more fruits and
vegetables, 8-10/day
• Limit saturated fat foods
• Limit sodium/salt 1,500
mg/day
• Avoid/limit alcohol
NIH, National High BP Education Program
Excess Body Weight
• As weight went up, so
did the risk of mortality
from all causes
• People overweight at
age 18, or those who
gained significant
weight after age 18 (23
kg)had significantly
higher mortality rates.
Mortality Rate (RR)
1.23
1.25
1.00
1.00
0.75
0.50
BMI 7 Points Increase
Amer J of Epidemiology 173:319-329
High Dietary Cholesterol Intake
• As you eat more
cholesterol, the risk of
mortality increases.
• For every 210 mg of
dietary cholesterol
eaten, your risk of
death from any cause
increases by 17%.
Based on eating 2000 cal/day
Mortality Rate (RR)
1.25
1.00
1.17
1.00
0.75
0.50
Increase for every 210 mg/day
Amer J of Epidemiology 173:319-329
Family History CHD Before Age 60
Increases Risk
Mortality Rate (RR)
If you have a parent,
brother, or sister who
had a heart attack before
age 60, your risk for early
mortality was increased
by 14%.
1.25
1.14
1.00
1.00
0.75
0.50
No
Yes
Family History CHD
Amer J of Epidemiology 173:319-329
High Alcohol Intake
• People with a high
alcohol intake, more than
2 drinks in a day, had a
higher risk of dying early.
• Alcohol is responsible for
over 64,000 early deaths
each year (even after
adjusting for a lower risk
of CHD in moderate
drinkers).
Amer J of Epidemiology 173:319-329
Regular Physical Activity
Mortality Rate (RR)
• Regular exercise cut the
risk of mortality from
any cause.
• Aim for at least 30
minutes of moderate
physical activity, 5+ days
per week.
1.0
1.0
0.87
0.8
0.5
No
Amer J of Epidemiology 173:319-329
Yes
Eating Nuts Cuts Risk of Early Mortality
Decreases Risk
• Eating nuts
• For every 2 servings per
week, your risk for
early mortality dropped
by 14%
• Eat nuts daily for best
health
Amer J of Epidemiology 173:319-329
Whole Grains Reduces Risk of Early Mortality
Decreases Risk
• Eating whole grains
• For every 4 grams of
fiber from whole grains
daily, the risk of early
mortality dropped by
16%.
Amer J of Epidemiology 173:319-329
Healthy Fats Reduces Risk of Early Mortality
Decreases Risk
• Eating healthy fats, high
in polyunsaturated fats
• For every 3% increase in
polyunsaturated fat in
the diet, risk of early
mortality dropped by
15%.
• Eat healthy fats at every
meal.
Amer J of Epidemiology 173:319-329
Risk Combinations and Mortality
Mortality Rates (RR)
24.1
25
20
12.3
15
10
5
5.7
1.0
0
No Cancer All
CVD
risks deaths deaths deaths
---- Risks Present ----Amer J of Epidemiology 173:319-329
Comparing mortality rates
of people with no risks
with those who have all
the risks.
- Cancer mortality
increased by 5.7 times
- Deaths from any cause
increased by 12.3 times
- Deaths from cardiovascular disease was
24.1 times higher
Nutrition Information
For further information
on healthy eating, go to
ChooseMyPlate.gov on
the web.
US Department of Agriculture
68