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Findings From the European Prospective Investigation Into Cancer and Nutrition–Potsdam Study

Earl S. Ford, MD, MPH; Manuela M. Bergmann, PhD; Janine Kröger; Anja Schienkiewitz, PhD, MPH; Cornelia Weikert, MD, MPH; Heiner Boeing, PhD, MSPH

Arch Intern Med. 2009;169(15):1355-1362.

Background  Our objective was to describe the reduction in relative risk of developing major chronic diseases such as cardiovascular disease, diabetes, and cancer associated with 4 healthy lifestyle factors among German adults.

Methods  We used data from 23 153 German participants aged 35 to 65 years from the European Prospective Investigation Into Cancer and Nutrition–Potsdam study. End points included confirmed incident type 2 diabetes mellitus, myocardial infarction, stroke, and cancer. The 4 factors were never smoking, having a body mass index lower than 30 (calculated as weight in kilograms divided by height in meters squared), performing 3.5 h/wk or more of physical activity, and adhering to healthy dietary principles (high intake of fruits, vegetables, and whole-grain bread and low meat consumption). The 4 factors (healthy, 1 point; unhealthy, 0 points) were summed to form an index that ranged from 0 to 4.

Results  During a mean follow-up of 7.8 years, 2006 participants developed new-onset diabetes (3.7%), myocardial infarction (0.9%), stroke (0.8%), or cancer (3.8%). Fewer than 4% of participants had zero healthy factors, most had 1 to 3 healthy factors, and approximately 9% had 4 factors. After adjusting for age, sex, educational status, and occupational status, the hazard ratio for developing a chronic disease decreased progressively as the number of healthy factors increased. Participants with all 4 factors at baseline had a 78% (95% confidence interval [CI], 72% to 83%) lower risk of developing a chronic disease (diabetes, 93% [95% CI, 88% to 95%]; myocardial infarction, 81% [95% CI, 47% to 93%]; stroke, 50% [95% CI, –18% to 79%]; and cancer, 36% [95% CI, 5% to 57%]) than participants without a healthy factor.

Conclusion  Adhering to 4 simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases.

Author Affiliations: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Ford); Department of Epidemiology, German Institute of Human Nutrition (Deutsches Institut für Ernährungsforschung), Potsdam-Rehbrücke, Germany (Drs Bergmann, Schienkiewitz, Weikert, and Boeing and Ms Kröger).

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