Association of a Healthy Lifestyle with All-Cause, Cause-Specific Mortality and Incident Cancer among Individuals with Metabolic Syndrome: A Prospective Cohort Study in UK Biobank

The association of a low-inflammatory diet with the trajectory of multimorbidity: a large community-based longitudinal study

BACKGROUND

A proinflammatory diet has been associated with a risk of individual chronic diseases, however, evidence on the association between inflammatory dietary patterns and the trajectory of chronic disease multimorbidity is sparse.

OBJECTIVES

We aimed to investigate the associations of a low-inflammatory diet with the multimorbidity trajectory.

METHODS

Within the UK Biobank, 102,424 chronic disease-free participants (mean age 54.7 ± 7.9 y, 54.8% female) were followed up to detect multimorbidity trajectory (annual change in the number of 59 chronic diseases). Baseline inflammatory diet index (IDI) and empirical dietary inflammatory pattern (EDIP) were separately calculated from the weighted sum of 32 posteriori-derived (15 anti-inflammatory) and 18 prior-defined (9 anti-inflammatory) food groups, and tertiled as low-, moderate-, and high-inflammatory diet. Data were analyzed using linear mixed effects model, Cox model, and Laplace regression with adjustment for potential confounders.

RESULTS

During the follow-up (median 10.23 y), 15,672 and 35,801 participants developed 1 and 2+ chronic conditions, respectively. Adherence to a low-inflammatory diet was associated with decreased multimorbidity risk (hazard ratio [HRIDI] = 0.84, 95% confidence interval [CI]: 0.81, 0.86; HREDIP = 0.91, 95% CI: 0.89, 0.94) and a slower multimorbidity accumulation (βIDI = -0.033, 95% CI: -0.036, -0.029; βEDIP = -0.006, 95% CI: -0.010, -0.003) compared with a high-inflammatory diet, especially in participants aged > 60 y (βIDI = -0.051, 95% CI: -0.059, -0.042; βEDIP = -0.020, 95% CI: -0.029, -0.012; both P-interactions < 0.05). The 50th percentile difference (95% CI) of chronic disease-free survival time was prolonged by 0.81 (0.64, 0.97) and 0.49 (0.34, 0.64) y for participants with a low IDI and EDIP, respectively. Higher IDI and EDIP were associated with the development of 4 and 3 multimorbidity clusters (especially for cardiometabolic diseases), respectively.

CONCLUSIONS

A low-inflammatory diet is associated with a lower risk and slower accumulation of multimorbidity (especially in participants aged > 60 y). A low-inflammatory diet may prolong chronic disease-free survival time.

Association of a Mediterranean Lifestyle With All-Cause and Cause-Specific Mortality: A Prospective Study from the UK Biobank

OBJECTIVE

To examine the association between the Mediterranean lifestyle and all-cause, cancer, and cardiovascular disease (CVD) mortality in a British population.

PATIENTS AND METHODS

We studied 110,799 individuals 40 to 75 years of age from the UK Biobank cohort, free of CVD or cancer between 2009 and 2012 who were followed-up to 2021. The Mediterranean lifestyle was assessed at baseline through the Mediterranean Lifestyle (MEDLIFE) index, derived from the lifestyle questionnaire and diet assessments and comprising three blocks: (1) "Mediterranean food consumption," (2) "Mediterranean dietary habits," and (3) "physical activity, rest, social habits, and conviviality." Death information was retrieved from death register records. Cox regression models were used to analyze the study associations.

RESULTS

During a median 9.4-year follow-up, 4247 total deaths, 2401 cancer deaths, and 731 CVD deaths were identified. Compared with the first quartile of the MEDLIFE index, increasing quartiles had HRs of 0.89 (95% CI, 0.81 to 0.97), 0.81 (95% CI, 0.74 to 0.89), and 0.71 (95% CI, 0.65 to 0.78) (P-trend<.001 for all-cause mortality). For cancer mortality, the quartiles had HRs of 0.90 (95% CI, 0.80 to 1.01), 0.83 (95% CI, 0.74 to 0.93), and 0.72 (95% CI, 0.64 to 0.82) (P-trend<.001). All MEDLIFE index blocks were independently associated with lower risk of all-cause and cancer death, and block 3 was associated with lower CVD mortality.

CONCLUSION

Higher adherence to the Mediterranean lifestyle was associated with lower all-cause and cancer mortality in British middle-aged and older adults in a dose-response manner. Adopting a Mediterranean lifestyle adapted to the local characteristics of non-Mediterranean populations may be possible and part of a healthy lifestyle.

Association of tea and coffee consumption with the risk of all-cause and cause-specific mortality among individuals with metabolic syndrome: a prospective cohort study

BACKGROUND

The relationship between tea and coffee consumption and mortality among patients with metabolic syndrome (MetS) remains barely explored. Herein, this study aimed to examine the association between tea and coffee consumption and the likelihood of all-cause and cause-specific mortality in patients with MetS.

METHODS

A total of 118,872 participants with MetS at baseline from the UK Biobank cohort were included. Information on tea and coffee consumption was obtained during recruitment using a touchscreen questionnaire. Hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were determined using Cox proportional hazards models.

RESULTS

During a median follow-up of 13.87 years, 13,666 deaths were recorded, with 5913, 3362, and 994 deaths from cancer, cardiovascular diseases (CVD), and respiratory disease (RD), respectively. This research showed a significant inverse association between tea intake and the risk of all-cause and cancer mortality, the respective HRs (95% CI) for consuming tea 2 vs. 0 cup/day were 0.89 (0.84-0.95), and 0.91 (0.83-0.99), and tea intake ≥ 4 cups/day could reduce CVD mortality by 11% (HR 0.89; 95% CI 0.81-0.98). The U-shaped nonlinear association between coffee intake and all-cause/CVD mortality was examined (all p-nonlinear < 0.001). The HRs (95% CI) for coffee consumption 1 vs. 0 cup/day were 0.93 (0.89-0.98) and 0.89 (0.80-0.99), and for ≥ 4 vs. 0 cup/day were 1.05 (1.01-1.11) and 1.13 (1.03-1.25), respectively. Notably, the combined intake of tea and coffee presented a protective effect against all-cause mortality (HR < 1).

CONCLUSIONS

The importance of daily tea and moderate coffee consumption in individuals with MetS to optimise health benefits are highlighted.

U-shaped association between sleep duration and the risk of respiratory diseases mortality: a large prospective cohort study from UK Biobank

STUDY OBJECTIVES

Our cohort study aimed to study the association between sleep duration and risk of mortality due to respiratory diseases.

METHODS

We included 498,200 participants from UK Biobank (2006-2021). We classified sleep duration as short sleep duration (< 7 hours), long sleep duration (> 9 hours for adults, > 8 hours for older adults), and midrange sleep duration (7-9 hours). We used the Cox proportional hazards model and restricted cubic spline analysis to explore the association between sleep duration and respiratory diseases mortality.

RESULTS

During a median follow-up of 12.49 years, 2,477 deaths due to respiratory diseases were recorded, of which 1,099 were deaths due to chronic lower respiratory diseases. Cox models with penalized splines showed U-shaped associations of sleep duration with mortality due to total respiratory diseases and chronic lower respiratory diseases. Compared with midrange sleep duration, short sleep duration was associated with 14% higher risk of total respiratory diseases mortality (hazard ratio = 1.14; 95% confidence interval: 1.04, 1.25), and long sleep duration was associated with 35% higher risk of total respiratory diseases mortality (hazard ratio = 1.35; 95% confidence interval: 1.19, 1.55), after adjustment of baseline characteristics, health status, and lifestyle habits. Similarly, the hazard ratios for chronic lower respiratory diseases mortality were 1.20 (95% confidence interval: 1.04, 1.38) and 1.44 (95% confidence interval: 1.19, 1.74), respectively.

CONCLUSIONS

There was a U-shaped association between sleep duration and respiratory diseases mortality. Appropriate sleep duration may improve the progress of respiratory diseases.

CITATION

Du M, Liu M, Liu J. U-shaped association between sleep duration and the risk of respiratory diseases mortality: a large prospective cohort study from UK Biobank. J Clin Sleep Med. 2023;19(11):1923-1932.

Mutual Associations of Healthy Behaviours and Socioeconomic Status with Respiratory Diseases Mortality: A Large Prospective Cohort Study

Little cohort evidence is available on the effect of healthy behaviours and socioeconomic status (SES) on respiratory disease mortality. We included 372,845 participants from a UK biobank (2006-2021). SES was derived by latent class analysis. A healthy behaviours index was constructed. Participants were categorized into nine groups on the basis of combinations of them. The Cox proportional hazards model was used. There were 1447 deaths from respiratory diseases during 12.47 median follow-up years. The hazard ratios (HRs, 95% CIs) for the low SES (vs. high SES) and the four or five healthy behaviours (vs. no or one healthy behaviour) were 4.48 (3.45, 5.82) and 0.44 (0.36, 0.55), respectively. Participants with both low SES and no or one healthy behaviour had a higher risk of respiratory disease mortality (aHR = 8.32; 95% CI: 4.23, 16.35) compared with those in both high SES and four or five healthy behaviours groups. The joint associations were stronger in men than in women, and in younger than older adults. Low SES and less healthy behaviours were both associated with an increased risk of respiratory disease mortality, which augmented when both presented together, especially for young man.

Mediation of Healthy Behaviour on the Association of Frailty with Respiratory Diseases Mortality among 0.4 Million Participants: A Prospective Cohort Study from UK Biobank

The mutual relationship between frailty and healthy behaviour and its effect on respiratory diseases mortality remains largely unknown; this study aims to supplement related analysis on it by using a large sample cohort study. We included 411,987 participants from the UK Biobank study (2006-2021), and measured participants' frailty phenotype and healthy behaviour index by using questionnaires and physical measurement. Mortality from respiratory diseases were obtained through linkage to registries. We used the cox proportional hazards model to explore the association of frailty with respiratory diseases mortality, and calculated the mediation proportion of the healthy behaviour. During a median follow-up of 12.48 years, and after adjustment for other covariates and healthy behaviour index, when compared with non-frail participants, being frail was associated with 2.68 times, 3.27 times, and 3.31 times higher risk of total respiratory diseases mortality, influenza and pneumonia mortality and chronic lower respiratory diseases mortality, respectively. The attenuated proportions mediated by healthy behaviour were 5.1% (95% CI: 4.4%, 5.9%), 3.0% (95% CI: 2.1%, 4.2%) and 6.0% (95% CI: 4.9%, 7.4%), respectively. Compared with non-frail individuals with four or five healthy behaviours, frail individuals with no or one healthy behaviour had higher risks of total respiratory diseases mortality (aHR = 4.59; 95% CI: 3.27, 6.45), influenza and pneumonia mortality (aHR = 4.55; 95% CI: 2.30, 9.03), as well as chronic lower respiratory diseases mortality (aHR = 12.70; 95% CI: 5.76, 27.96). Adherence to a healthy lifestyle therefore represents a potentially modifiable target for improving the harmful impact of frailty on reduced life expectancy as a result of respiratory diseases.

Genetic risk, incident colorectal cancer, and the benefits of adhering to a healthy lifestyle: A prospective study using data from UK Biobank and FinnGen

Background

Genetic factors increase the individual risk of colorectal cancer (CRC); however, the extent to which a healthy lifestyle can offset increased genetic risk is unknown. This study investigated whether a healthy lifestyle is associated with lower CRC risk, regardless of genetic risk.

Methods

We recruited 390,365 participants without cancer at baseline (2006-2010) from the UK Biobank. The primary outcome was CRC incidence. A healthy lifestyle score constructed using 16 factors of six dimensions (smoking, drinking, body mass index, diet, exercise, and sleep) was categorized into three risk categories: favorable, intermediate, and unfavorable. To calculate the polygenic risk scores (PRSs) of UK Biobank participants, we extracted 454,678 single nucleotide polymorphisms (SNPs) from the UK Biobank and FinnGen Biobank after quality control. Cox proportional hazards regression was performed to evaluate the associations and was expressed as hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

During a median follow-up of 10.90 years, 4,090 new CRC cases were reported in the UK Biobank. The "best-fit" PRSs were constructed using 59 SNPs based on the UK Biobank cohort and FinnGen genome-wide association study summary data (R² = 0.23%) and were divided into low (lowest quintile), intermediate (including second-fourth quintile), and high (highest quintile) genetic risk categories. The multivariate-adjusted Cox model revealed that participants with favorable lifestyles had HRs of 0.66 (95% CI = 0.60-0.72) for developing CRC vs. those with unfavorable lifestyles; low genetic risk was associated with a decreased risk of CRC (HR = 0.67, 95% CI =0.61-0.74) compared with those with high genetic risk. The HRs for low genetic risk participants with favorable lifestyles were 0.44 (95% CI =0.36-0.55) vs. participants with high genetic risk and unfavorable lifestyles. Among the participants with low, intermediate, or high genetic risk, the HRs of favorable vs. unfavorable lifestyles were 0.74, 0.64, and 0.72 (all p< 0.05).

Conclusions

Low genetic risk and a favorable lifestyle were significantly associated with a decreased risk of CRC. A favorable lifestyle was associated with a lower CRC risk, regardless of genetic risk.