Association of a Comprehensive Healthy Lifestyle Score with Risk of All-Cause, Cancer, and Cardiovascular Mortality: Evidence from an 18-Year Cohort Study.

Men with the highest healthy lifestyle score had significantly lower risks of all-cause, cancer, and cardiovascular mortality compared to those with the lowest score.

• HR for all-cause mortality: 0.65 (95% CI: 0.53–0.80)
• HR for cancer mortality: 0.62 (95% CI: 0.46–0.85)
• HR for cardiovascular mortality: 0.34 (95% CI: 0.17–0.66)
• Comparisons were made between the highest and lowest HLS categories using multivariable-adjusted Cox proportional hazards models

Women with the highest healthy lifestyle score had significantly lower risks of all-cause, cancer, and cardiovascular mortality compared to those with the lowest score.

• HR for all-cause mortality: 0.38 (95% CI: 0.26–0.55)
• HR for cancer mortality: 0.52 (95% CI: 0.29–0.90)
• HR for cardiovascular mortality: 0.30 (95% CI: 0.11–0.84)
• The magnitude of risk reduction was generally greater in women than in men across all mortality outcomes

All five individual lifestyle components, including diet quality, were each significantly associated with lower risk of all-cause mortality.

• Diet was assessed using the unhealthful plant-based diet index (uPDI); those in quintile 5 vs. quintile 1 had HR 0.74 (95% CI: 0.66–0.83) in men and HR 0.67 (95% CI: 0.58–0.76) in women
• The five components were: never or former smoking, ≥30 min/day of moderate-to-vigorous physical activity on ≥5 days/week, alcohol intake ≤40 g/day for men and ≤20 g/day for women, BMI of 18.5–24.9 kg/m², and uPDI in the bottom 40th percentile
• Diet data were assessed using both baseline and first follow-up measurements, while other components were measured at baseline only

Excluding smoking from the healthy lifestyle score attenuated the inverse association with mortality, particularly among men.

• When smoking was removed from the HLS, the association between the composite score and all-cause mortality was weakened
• The attenuation was described as particularly pronounced among men
• This finding underscores smoking cessation as a critical component of the HLS

The inverse association between the healthy lifestyle score and mortality was stronger in older adults aged 55 years and above than in younger adults.

• Subgroup analyses by age showed a stronger protective association in participants aged ≥55 years compared to those younger than 55 years
• This age-stratified finding suggests that lifestyle adherence may be particularly impactful for older Korean adults

The study documented 5246 all-cause deaths, 2362 cancer deaths, and 815 cardiovascular deaths during 1,538,490 person-years of follow-up.

• The cohort included 111,633 participants (64.6% women) aged 40 to 85 years (mean age 55.2, SD 8.8)
• Participants were enrolled in the Korean Genome and Epidemiology Study_Health Examinees (KoGES_HEXA) between 2004 and 2013 and followed until December 2023
• The follow-up period spanned approximately 18 years

The healthy lifestyle score incorporated the unhealthful plant-based diet index (uPDI) in the bottom 40th percentile as its dietary component, reflecting traditional plant-rich Korean dietary patterns.

• A lower uPDI score indicates a more healthful (less unhealthful) plant-based diet
• The uPDI was chosen to align with the traditional plant-rich dietary pattern of Koreans
• Diet quality was measured at both baseline and first follow-up, unlike other HLS components which were measured at baseline only