Low-Risk Lifestyle Behaviors and All-Cause Mortality: Findings From the National Health and Nutrition Examination Survey III Mortality Study

Lifestyle behaviors lie at the root of many chronic diseases.1--3 Smoking, unhealthy diets, and sedentary behavior predispose numerous people to diseases that rank among the leading causes of death such as heart disease, cancer, stroke, and diabetes. The costs associated with these behaviors are enormous.4--7 Previous studies have generally examined the independent effect of these lifestyle be-haviors in isolation on a variety of adverse health outcomes. Yet, optimal health is only achieved by maximizing the number of healthy behaviors. Therefore, examining the joint effect of multiple lifestyle behaviors on health out-comes yields valuable insights into the im-provements in health that are potentially achievable in populations. Starting around 2000, research appeared that examined the impact of multiple low-risk lifestyle behaviors on various health outcomes including cardio-vascular disease,8--15 diabetes,16--18 all-cause mortality,19--25 and mortality from cancer.23--25 Few studies relating multiple low-risk life-style factors to all-cause mortality have been conducted in the United States or have in-cluded substantial samples of racial/ethnic minorities.22,24 Therefore, we examined the relationship between 4 lifestyle behaviors– never smoked, healthy diet, adequate physical activity, and moderate alcohol consumption– and all-cause mortality in a national sample of people in the United States