On the use of the healthy lifestyle index to investigate specific disease outcomes

Vivian Viallon; Heinz Freisling; Komodo Matta; Anne Østergaard Nannsen; Christina C. Dahm; Anne Tjønneland; Anne Kirstine Eriksen; Rudolf Kaaks; Verena A. Katzke; Matthias B. Schulze; Giovanna Masala; Giovanna Tagliabue; Vittorio Simeon; Rosario Tumino; Lorenzo Milani; Jeroen W.G. Derksen; Yvonne T. van der Schouw; Therese Haugdahl Nøst; Kristin Benjaminsen Borch; Torkjel M. Sandanger; J. Ramón Quirós; Miguel Rodriguez-Barranco; Catalina Bonet; Amaia Aizpurua-Atxega; Lluís Cirera; Marcela Guevara; Björn Sundström; Anna Winkvist; Alicia K. Heath; Marc J. Gunter; Elisabete Weiderpass; Mattias Johansson; Pietro Ferrari

doi:10.1038/s41598-024-66772-w

On the use of the healthy lifestyle index to investigate specific disease outcomes

Vivian Viallon^*, Heinz Freisling, Komodo Matta, Anne Østergaard Nannsen, Christina C. Dahm, Anne Tjønneland, Anne Kirstine Eriksen, Rudolf Kaaks, Verena A. Katzke, Matthias B. Schulze, Giovanna Masala, Giovanna Tagliabue, Vittorio Simeon, Rosario Tumino, Lorenzo Milani, Jeroen W.G. Derksen, Yvonne T. van der Schouw, Therese Haugdahl Nøst, Kristin Benjaminsen Borch, Torkjel M. SandangerJ. Ramón Quirós, Miguel Rodriguez-Barranco, Catalina Bonet, Amaia Aizpurua-Atxega, Lluís Cirera, Marcela Guevara, Björn Sundström, Anna Winkvist, Alicia K. Heath, Marc J. Gunter, Elisabete Weiderpass, Mattias Johansson, Pietro Ferrari

^*Corresponding author for this work

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Abstract

The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell’s C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.

Original language	English
Article number	16330
Number of pages	12
Journal	Scientific Reports
Volume	14
Issue number	1
DOIs	https://doi.org/10.1038/s41598-024-66772-w
Publication status	Published - 15 Jul 2024

Keywords

Cancer
Cardiovascular diseases
Composite score
Healthy lifestyle index
Lifestyle factors
Mortality
Type 2 diabetes

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Viallon, V., Freisling, H., Matta, K., Nannsen, A. Ø., Dahm, C. C., Tjønneland, A., Eriksen, A. K., Kaaks, R., Katzke, V. A., Schulze, M. B., Masala, G., Tagliabue, G., Simeon, V., Tumino, R., Milani, L., Derksen, J. W. G., van der Schouw, Y. T., Nøst, T. H., Borch, K. B., ... Ferrari, P. (2024). On the use of the healthy lifestyle index to investigate specific disease outcomes. Scientific Reports, 14(1), Article 16330. https://doi.org/10.1038/s41598-024-66772-w

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title = "On the use of the healthy lifestyle index to investigate specific disease outcomes",

abstract = "The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell{\textquoteright}s C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.",

keywords = "Cancer, Cardiovascular diseases, Composite score, Healthy lifestyle index, Lifestyle factors, Mortality, Type 2 diabetes",

author = "Vivian Viallon and Heinz Freisling and Komodo Matta and Nannsen, {Anne {\O}stergaard} and Dahm, {Christina C.} and Anne Tj{\o}nneland and Eriksen, {Anne Kirstine} and Rudolf Kaaks and Katzke, {Verena A.} and Schulze, {Matthias B.} and Giovanna Masala and Giovanna Tagliabue and Vittorio Simeon and Rosario Tumino and Lorenzo Milani and Derksen, {Jeroen W.G.} and {van der Schouw}, {Yvonne T.} and N{\o}st, {Therese Haugdahl} and Borch, {Kristin Benjaminsen} and Sandanger, {Torkjel M.} and Quir{\'o}s, {J. Ram{\'o}n} and Miguel Rodriguez-Barranco and Catalina Bonet and Amaia Aizpurua-Atxega and Llu{\'i}s Cirera and Marcela Guevara and Bj{\"o}rn Sundstr{\"o}m and Anna Winkvist and Heath, {Alicia K.} and Gunter, {Marc J.} and Elisabete Weiderpass and Mattias Johansson and Pietro Ferrari",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = jul,

day = "15",

doi = "10.1038/s41598-024-66772-w",

language = "English",

volume = "14",

journal = "Scientific Reports",

issn = "2045-2322",

publisher = "Nature Publishing Group",

number = "1",

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Viallon, V, Freisling, H, Matta, K, Nannsen, AØ, Dahm, CC, Tjønneland, A, Eriksen, AK, Kaaks, R, Katzke, VA, Schulze, MB, Masala, G, Tagliabue, G, Simeon, V, Tumino, R, Milani, L, Derksen, JWG , van der Schouw, YT, Nøst, TH, Borch, KB, Sandanger, TM, Quirós, JR, Rodriguez-Barranco, M, Bonet, C, Aizpurua-Atxega, A, Cirera, L, Guevara, M, Sundström, B, Winkvist, A, Heath, AK, Gunter, MJ, Weiderpass, E, Johansson, M & Ferrari, P 2024, 'On the use of the healthy lifestyle index to investigate specific disease outcomes', Scientific Reports, vol. 14, no. 1, 16330. https://doi.org/10.1038/s41598-024-66772-w

TY - JOUR

T1 - On the use of the healthy lifestyle index to investigate specific disease outcomes

AU - Viallon, Vivian

AU - Freisling, Heinz

AU - Matta, Komodo

AU - Nannsen, Anne Østergaard

AU - Dahm, Christina C.

AU - Tjønneland, Anne

AU - Eriksen, Anne Kirstine

AU - Kaaks, Rudolf

AU - Katzke, Verena A.

AU - Schulze, Matthias B.

AU - Masala, Giovanna

AU - Tagliabue, Giovanna

AU - Simeon, Vittorio

AU - Tumino, Rosario

AU - Milani, Lorenzo

AU - Derksen, Jeroen W.G.

AU - van der Schouw, Yvonne T.

AU - Nøst, Therese Haugdahl

AU - Borch, Kristin Benjaminsen

AU - Sandanger, Torkjel M.

AU - Quirós, J. Ramón

AU - Rodriguez-Barranco, Miguel

AU - Bonet, Catalina

AU - Aizpurua-Atxega, Amaia

AU - Cirera, Lluís

AU - Guevara, Marcela

AU - Sundström, Björn

AU - Winkvist, Anna

AU - Heath, Alicia K.

AU - Gunter, Marc J.

AU - Weiderpass, Elisabete

AU - Johansson, Mattias

AU - Ferrari, Pietro

PY - 2024/7/15

Y1 - 2024/7/15

N2 - The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell’s C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.

AB - The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell’s C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.

KW - Cancer

KW - Cardiovascular diseases

KW - Composite score

KW - Healthy lifestyle index

KW - Lifestyle factors

KW - Mortality

KW - Type 2 diabetes

UR - http://www.scopus.com/inward/record.url?scp=85198639440&partnerID=8YFLogxK

U2 - 10.1038/s41598-024-66772-w

DO - 10.1038/s41598-024-66772-w

M3 - Article

AN - SCOPUS:85198639440

SN - 2045-2322

VL - 14

JO - Scientific Reports

JF - Scientific Reports

IS - 1

M1 - 16330

ER -

On the use of the healthy lifestyle index to investigate specific disease outcomes

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Keywords

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