Leefstijlfactoren en chronische ziek(t)en. Naar een integratieve preventie-strategie

The Focal Point Prevention Chronic Diseases has written 'state of the art' reports for nine chronic diseases. These are coronary heart disease, stroke, diabetes mellitus, chronic non specific lung disease, osteoporosis, rheumatoid arthritis, arthrosis, Parkinson's disease and migraine. This report gives an overview of the complex interrelations between life-style factors and the etiology and course of chronic diseases. Four life-style factors are selected i.e. physical inactivity, smoking, use of alcohol and diet. A description is given of the relations between these life-style factors and the occurrence and course of the nine chronic diseases, the prevalence of these life-style factors among the general population and among chronically ill people, and the effects of interventions on life-style factors. The prevention programs are divided in programs directed towards one life-style factor or to more life-style factors and in programs that focus on one chronic disease or on more chronic diseases. From the overview of the relation between life-style factors and the nine diseases it appears that for one disease often more life-style factors play a role in the occurrence and/or course of the disease. It also appears that several life-style factors influence the occurrence and/or course of more chronic diseases. Physical inactivity, smoking, alcohol abuse and unhealthy diet are common in the general population. In chronically ill people the prevalence of these life-style factors seems to be comparable to the general population. The best results in terms of endpoints (morbidity, mortality) can be obtained from community-based multifactorial intervention programs that combine the population-approach with the high-risk approach. Six major recommendations are made