A healthy lifestyle can help ex-smokers reduce their risk of death from all causes

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Thursday, September 22, 2022

Former smokers who follow a healthy lifestyle have a lower risk of dying from all causes than those who do not follow healthy habits, according to a new study by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health. The reduced risk of death was seen for specific causes, including cancer and heart and lung disease. Lifestyle interventions have not been studied in depth in ex-smokers, and these new findings could have important implications for the 52 million ex-smokers in the United States.

Maintaining a healthy lifestyle—defined as doing things like being physically active and eating a healthy diet—was associated with a 27 percent lower risk of death over the 19-year follow-up period, compared to not maintaining a healthy lifestyle.

The findings, which appeared on September 22, 2022, at JAMA Network Openare from an analysis of a large cohort of ex-smokers who participated in the NIH-AARP Nutrition and Health Study.

“I was surprised to see the strong associations [with lifestyle]said Maki Inoue-Choi, Ph.D., of the Division of Cancer Epidemiology and Genetics at NCI, lead author of the paper. “Ex-smokers who complied with evidence-based recommendations for body weight, diet, physical activity, and alcohol intake had a lower risk of mortality than ex-smokers who did not comply with these recommendations.”

Quitting smoking is widely known to have many health benefits, but ex-smokers are still at higher risk of disease and premature death than people who have never smoked.

Previous studies have shown that people who follow healthy lifestyle recommendations, such as maintaining a healthy weight, being physically active, eating a healthy diet and limiting alcohol consumption, may have a lower risk of disease and death. However, few studies have examined the benefit of such adherence among ex-smokers.

The current analysis included 159,937 former smokers who completed questionnaires about lifestyle, demographics, and other health-related information between 1995 and 1996 when they participated in the NIH-AARP Diet and Health Study. The participants, whose average age at study entry was 62.6 years, were followed for about 19 years. During the follow-up period, which extended to 2019, 86,127 participants died. Death information, including cause of death, was obtained from the National Death Index.

For each participant, the researchers calculated an overall adherence score ranging from no adherence to complete adherence. The overall compliance score incorporated individual scores for body mass index, based on World Health Organization guidelines. on diet quality, based on the Dietary Guidelines for Americans, 2010-2015. for physical activity, based on the second edition of the Physical Activity Guidelines for Americans; and for alcohol use, based on the Dietary Guidelines for Americans, 2020-2025.

Former smokers who had the highest overall adherence scores had a 27% lower risk of death from any cause than those with the lowest scores. In addition, participants with the highest scores had a 24% reduction in the risk of death from cancer, a 28% reduction in the risk of death from cardiovascular disease, and a 30% reduction in the risk of death from respiratory disease. The reductions in the risk of death were seen regardless of health status, other health conditions, how many cigarettes the participants smoked per day, years since they quit, and the age at which they started smoking.

The researchers also assessed the benefit of following individual lifestyle recommendations. In each case, those with the highest scores had a lower risk of death than those with the lowest scores: 17% lower for physical activity, 14% lower for body weight, 9% lower for diet quality, and 4% lower for alcohol intake. .

“To get the most benefit, it’s best to follow many lifestyle recommendations,” noted Dr. Inoue-Choi. “But even those who adopted just one lifestyle recommendation had benefits.”

The researchers cautioned that studies based on self-reported data can only show associations, not establish cause and effect. Although the researchers controlled for many factors that could have confounded the associations, they said they could not rule out the possibility that other factors may have influenced the associations they observed.

The researchers also noted that more studies are needed to investigate associations between adherence to lifestyle recommendations and risk of death among ex-smokers in more diverse populations.

“The NIH-AARP study is a predominantly white population with relatively high socioeconomic status,” said Dr. Inoue-Choi. “These research questions need to be extended to other populations.”

For National Cancer Institute (NCI): NCI leads the National Cancer Program and NIH efforts to dramatically reduce the prevalence of cancer and improve the lives of people with cancer. NCI supports a wide range of extracorporeal cancer research and education through grants and contracts. NCI’s intramural research program conducts innovative, interdisciplinary basic, translational, clinical, and epidemiologic research on cancer causes, pathways for prevention, risk prediction, early detection, and treatment, including research at the NIH Clinical Center—the world’s largest research hospital . Learn more about NCI’s intramural research from the Center for Cancer Research and the Division of Cancer Epidemiology and Genetics. For more information about cancer, visit the NCI website at cancer.gov or call the NCI Contact Center at 1-800-4-CANCER (1-800-422-6237).

About the National Institutes of Health (NIH):NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the US Department of Health and Human Services. NIH is the primary federal agency that conducts and supports basic, clinical, and translational medical research and investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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