eprintid: 10170958 rev_number: 7 eprint_status: archive userid: 699 dir: disk0/10/17/09/58 datestamp: 2023-06-01 09:16:29 lastmod: 2023-06-01 09:16:29 status_changed: 2023-06-01 09:16:29 type: article metadata_visibility: show sword_depositor: 699 creators_name: Rassy, Nathalie creators_name: Van Straaten, Alexis creators_name: Carette, Claire creators_name: Hamer, Mark creators_name: Rives-Lange, Claire creators_name: Czernichow, Sébastien title: Association of Healthy Lifestyle Factors and Obesity-Related Diseases in Adults in the UK ispublished: pub divisions: UCL divisions: B02 divisions: C10 divisions: D16 note: This is an open access article distributed under the terms of the CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium. You are not required to obtain permission to reuse this article content, provided that you credit the author and journal. If you are the author of this article and have questions about the Creative Commons license, please contact permissions@jamanetwork.com. abstract: Importance: A healthy lifestyle is associated with a reduced risk of cardiovascular disease in adults with obesity. Little is known about the associations between a healthy lifestyle and the risk of other obesity-attributable diseases in this population. Objective: To examine the association between healthy lifestyle factors and the incidence of major obesity-related diseases in adults with obesity compared with those with normal weight. Design, Setting, and Participants: This cohort study evaluated UK Biobank participants aged 40 to 73 years and free of major obesity-attributable disease at baseline. Participants were enrolled from 2006 to 2010 and prospectively followed up for disease diagnosis. Exposures: A healthy lifestyle score was constructed using information on not smoking, exercising regularly, no or moderate alcohol consumption, and eating a healthy diet. For each lifestyle factor, participants scored 1 if they met the criterion for a healthy lifestyle and 0 otherwise. Main Outcomes and Measures: The risk of outcomes according to the healthy lifestyle score in adults with obesity compared with those with normal weight were examined using multivariable Cox proportional hazards models with Bonferroni correction for multiple testing. The data analysis was performed between December 1, 2021, and October 31, 2022. Results: A total of 438 583 adult participants in the UK Biobank were evaluated (female, 55.1%; male, 44.9%; mean [SD] age, 56.5 [8.1] years), of whom 107 041 (24.4%) had obesity. During a mean (SD) follow-up of 12.8 (1.7) years, 150 454 participants (34.3%) developed at least 1 of the studied diseases. Compared with adults with obesity and 0 healthy lifestyle factors, individuals with obesity who met all 4 healthy lifestyle factors were at lower risk of hypertension (HR, 0.84; 95% CI, 0.78-0.90), ischemic heart disease (HR, 0.72; 95% CI, 0.65-0.80), arrhythmias (HR, 0.71; 95% 0.61-0.81), heart failure (HR, 0.65; 95% CI, 0.53-0.80), arteriosclerosis (HR, 0.19; 95% CI, 0.07-0.56), kidney failure (HR, 0.73; 95% CI, 0.63-0.85), gout (HR, 0.51; 95% CI, 0.38-0.69), sleep disorders (HR, 0.68; 95% CI, 0.56-0.83), and mood disorders (HR, 0.66; 95% CI, 0.56-0.78). The lifestyle profiles associated with the lowest risks included a healthy diet and at least 1 of the 2 healthy behaviors of physical activity and never smoking. Compared with adults with normal weight, those with obesity were at higher risk of several outcomes, irrespective of the lifestyle score (adjusted HRs ranged from 1.41 [95% CI, 1.27-1.56] for arrhythmias to 7.16 [95% CI, 6.36-8.05] for diabetes for adults with obesity and 4 healthy lifestyle factors). Conclusion and Relevance: In this large cohort study, adherence to a healthy lifestyle was associated with reduced risk of a wide range of obesity-related diseases, but this association was modest in adults with obesity. The findings suggest that although a healthy lifestyle seems to be beneficial, it does not entirely offset the health risks associated with obesity. date: 2023-05-26 date_type: published publisher: American Medical Association (AMA) official_url: http://dx.doi.org/10.1001/jamanetworkopen.2023.14741 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2026478 doi: 10.1001/jamanetworkopen.2023.14741 lyricists_name: Hamer, Mark lyricists_id: MHAME21 actors_name: Hamer, Mark actors_id: MHAME21 actors_role: owner full_text_status: public publication: JAMA Network Open volume: 6 number: 5 article_number: e2314741 issn: 2574-3805 citation: Rassy, Nathalie; Van Straaten, Alexis; Carette, Claire; Hamer, Mark; Rives-Lange, Claire; Czernichow, Sébastien; (2023) Association of Healthy Lifestyle Factors and Obesity-Related Diseases in Adults in the UK. JAMA Network Open , 6 (5) , Article e2314741. 10.1001/jamanetworkopen.2023.14741 <https://doi.org/10.1001/jamanetworkopen.2023.14741>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10170958/1/rassy_2023_oi_230451_1684340601.25814.pdf