It seems like common sense but a new study adds empirical weight to commonly held beliefs about health:

1) Don't smoke
2) Exercise
3) Moderate alcohol intake
4) Eating 5 servings of fruits and vegetables per day

People who do those four things live on average an additional fourteen years of life compared with people who adopt none of these behaviors, according to a study published in PLoS Medicine.

The results of this study need to be confirmed in other populations and an analysis of how the combined health behaviors affect quality of life is also needed but the results of the study suggest that these four achievable lifestyle changes could have a marked improvement on the health of middle-aged and older people.

Rather than focusing on how each individual factor is related to health, the study calculates the combined impact of these four simply-defined forms of behavior. The results suggest that making these small changes in lifestyle could have a marked impact on the health of populations.

Evidence regarding lifestyles like smoking, diet and physical activity tell us they influence health and longevity but there is little information about their combined impact. Plus, studies can often be confusing for public health professionals and for the general public, since they say small amounts of alcohol appear to be related to lower risk of cardiovascular disease health but don't know the overall impact on longevity.

In order to examine this combined impact, Kay-Tee Khaw and colleagues from the University of Cambridge and the Medical Research Council used a health behavior score that is easy to understand in order to assess the participants in the study from Norfolk, United Kingdom.

Between 1993 and 1997, 20,000 men and women between the ages of 45 and 79, none of whom had known cancer or heart or circulatory disease, completed a questionnaire that resulted in a score between 0 and 4. A point was awarded for each of the following: not currently smoking; not being physically inactive (physical inactivity was defined as having a sedentary job and not doing any recreational exercise); a moderate alcohol intake of 1-14 units a week (a unit is half a pint of beer or a glass of wine); and a blood vitamin C level consistent with eating five servings of fruit or vegetables a day. Deaths among the participants were recorded unti l 2006.

After factoring in age, the results showed that over an average period of eleven years people with a score of 0 – i.e. those who did not undertake any of these healthy forms of behavior – were four times more likely to have died than those who had scored 4 in the questionnaire.

Furthermore, the researchers calculate that a person who has a health score of 0 has the same risk of dying as someone 14 years older who had scored 4 in the questionnaire (i.e. someone engaging in all four healthy forms of behavior). This was independent of social class and body mass index. The study forms part of the European Prospective Investigation into Cancer and Nutrition (EPIC), conducted across ten European countries, the largest study of diet and health ever undertaken.

Citation: Khaw KT, Wareham N, Bingham S, Welch A, Luben R, et al. (2008) Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk Prospective Population study. PLoS Med 5(1): e12.