Influence of individual and combined healthy behaviours on successful aging - 11/01/13

Doi : 10.1503/cmaj.121080

Séverine Sabia, PhD ^a,^⁎ , Archana Singh-Manoux, PhD ^a,^b,^c, Gareth Hagger-Johnson, PhD ^a, Emmanuelle Cambois, PhD ^d, Eric J. Brunner, PhD ^a, Mika Kivimaki, PhD ^a
^a Department of Epidemiology and Public Health, University College London, London, UK
^b Inserm U1018, Institut national de la santé et de la recherche médicale, Villejuif Cedex, France
^c Centre de Gérontologie, Hôpital Ste Périne, AP-HP, France
^d Institut national d’études démographiques INED (Cambois), Paris, France

^*Correspondence to: Séverine Sabia

Contributors: Séverine Sabia drafted and wrote the manuscript and performed the statistical analyses. All of the authors contributed to the design of the study, interpreted the results, revised the manuscript and approved the final version submitted for publication.

Abstract

Background

Increases in life expectancy make it important to remain healthy for as long as possible. Our objective was to examine the extent to which healthy behaviours in midlife, separately and in combination, predict successful aging.

Methods

We used a prospective cohort design involving 5100 men and women aged 42–63 years. Participants were free of cancer, coronary artery disease and stroke when their health behaviours were assessed in 1991–1994 as part of the Whitehall II study. We defined healthy behaviours as never smoking, moderate alcohol consumption, physical activity (≥ 2.5 h/wk moderate physical activity or ≥ 1 h/wk vigorous physical activity), and eating fruits and vegetables daily. We defined successful aging, measured over a median 16.3-year follow-up, as good cognitive, physical, respiratory and cardiovascular functioning, in addition to the absence of disability, mental health problems and chronic disease (coronary artery disease, stroke, cancer and diabetes).

Results

At the end of follow-up, 549 participants had died and 953 qualified as aging successfully. Compared with participants who engaged in no healthy behaviours, participants engaging in all 4 healthy behaviours had 3.3 times greater odds of successful aging (95% confidence interval [CI] 2.1–5.1). The association with successful aging was linear, with the odds ratio (OR) per increment of healthy behaviour being 1.3 (95% CI 1.2–1.4; population-attributable risk for 1–4 v. 0 healthy behaviours 47%). When missing data were considered in the analysis, the results were similar to those of our main analysis.

Interpretation

Although individual healthy behaviours are moderately associated with successful aging, their combined impact is substantial. We did not investigate the mechanisms underlying these associations, but we saw clear evidence of the importance of healthy behaviours for successful aging.

Le texte complet de cet article est disponible en PDF.

Plan

Materials and methods

Study population

Baseline measures (1991–1994)

Outcome assessment (from 1991–1994 to 2008–2009)

Statistical analysis

Results

Interpretation

Strengths and limitations

Conclusion

Competing interests: Séverine Sabia has received grant funding from the National Institute on Aging. Archana Singh-Manoux has received grant funding from the National Institutes of Health. Gareth Hagger-Johnson is supported by grants from the National Institute on Aging, the National Institutes of Health and the National Health Service Leeds Flexibility and Sustainability fund; he has received payment for lectures from the University of Leeds and the University of Ulster; and he receives royalties from Pearson International. Mika Kivimaki receives salary support from the Medical Research Council; he has received grant funding from the National Institute on Aging; and he has received a professorial fellowship from the Economic and Social Research Council. No other competing interests were declared.
This article has been peer reviewed.
Funding: Data collection was funded by the UK Medical Research Council (G0902037), the British Heart Foundation and the US National Institute on Aging (R01AG013196). Salary support received by the investigators was obtained from the Medical Research Council (G0902037 for Eric Brunner and Mika Kivimaki), the National Institute on Aging (R01AG013196 and R01AG034454 for Séverine Sabia, Archana Singh-Manoux, Gareth Hagger-Johnson, Mika Kivimaki), a European Young Investigator Award from the European Science Foundation (Archana Singh-Manoux) and an Economic and Social Research Council professorial fellowship (Mika Kivimaki). The funders had no role in the design or conduct of the study; in the collection, analysis and interpretation of data; in the preparation or approval of the manuscript; and in the decision to submit it for publication.