Lifestyle by MikeJenny


    General benefits

            What is a healthy lifestyle?
    • Don’t smoke
    • Maintain a normal body weight for adults (BMI 18.5 to 24.9 kg/m2)
    • Eat a healthy balanced diet
        – Plenty of fruit and vegetables (at least 5 portions/day), nuts, fish and
          fibre (approx 18g/day)
        – Limited dairy products and meat
        – Avoid saturated fat – mono-unsaturated vegetable oils are preferable
        – At least 2 portions of oily fish per week
        – Limited salt intake (max 6 g/day)
        – Avoid processed foods
    • Engage in regular physical activity of moderate intensity for at least
      30 minutes per day, most days of the week
    • Limit daily alcohol consumption

    Why is a healthy lifestyle important?
              DH. Choosing Health Summaries. 2004
              Obesity. NICE clinical guideline 43. 2006
CDC. The Health Consequences of Smoking: what it means to you. 2004

    • Smoking causes cancer, respiratory diseases and CVD
    • Poor diet has been linked to around 1 in 3 deaths from
      cancer and CHD
    • Obesity is associated with cancer, CVD and type 2
    • Excessive drinking has been linked to an increased
      risk of CVD, pancreatitis and liver disease
    • Physical inactivity contributes to CVD, cancer and type
      2 diabetes

    • Following a healthy lifestyle may prevent people
      becoming patients and needing medication
    What’s more important to reduce mortality from CHD –
     reducing risk factors using lifestyle interventions or
             increasing medical interventions?
                 Kelly MP, et al. HDA Briefing. Nov 2004

    • 68,230 fewer deaths from coronary heart disease (CHD)
      In England & Wales in 2000 compared with 1981
    • 42% of the decrease was attributable to medical and
      surgical treatments
    • 58% was due to change in risk factors, particularly
      reduction in the prevalence of smoking
    • Most treatment benefits were in secondary prevention
      medications and heart failure treatments
    • Decline partially offset by increases in obesity, diabetes
      and lack of physical activity
    Reducing cholesterol, blood pressure and smoking
      prevalence could halve current CHD mortality
                  Kelly MP, et al. HDA Briefing. Nov 2004

     • If prescribing were increased so that 80% of eligible patients
       received medications, this would equate to 20,000 fewer deaths
       each year

     • Reducing average cholesterol from 5.8 to 5.2mmol/L (already
       achieved in Finland, Sweden, USA, Australia) prevents 25,000
     • Simply reducing smoking prevalence to USA levels = 17,000
       fewer deaths
     • These plus a modest reduction in population BP = 50,000 fewer
     • This would halve the current CHD mortality

    But does improving lifestyle have health benefits?

                      NICE think so…..

         ―A healthier lifestyle by lowering blood
         pressure and cardiovascular risk, may
          reduce, delay or remove the need for
             long-term drug therapy in some

              Hypertension. NICE clinical guideline 34. 2006

    What’s the effect size of lifestyle interventions on BP?
                     Hypertension. NICE full guideline 18. 2004
Intervention                     Average        % with      Other comments
                                 red’n in      10mmHg
                                  SBP &      red’n in SBP
                                   DBP         (<1 year)
Diet                             5–6mmHg         ~40%       Average weight changes were
(healthy, low-calorie)                                      from 2–9 Kg
Exercise                         2–3mmHg         ~30%
(Aerobic 30–60 min, 3–5x wk)
Relaxation therapy               3–4mmHg         ~33%       Cost in primary care unknown.
(structured)                                                Availability?
Multiple interventions           4–5mmHg         ~25%       Education alone unlikely to be
Alcohol reduction                3–4mmHg         ~30%       >21 units/week men, 14
(structured)                                                units/week women  raised BP,
                                                            poorer health
Salt reduction                   2–3mmHg         ~25%       Effects diminish over time
(<6g/day)                                                   (2–3 years)
Other: Caffeine (5 cups coffee) increase BP by ~2/1 mmHg; Smoking (per se) has no effect on
BP; Mineral supplements — no robust evidence
    How does that compare with drug interventions?
         Lowering BP to prevent MI & stroke. HTA 2003;7:31

         Even a small change in lifestyle can make a
              significant difference to mortality
    Faculty of Public Health. Easing the pressure: tackling hypertension. 2005

     • We have good observational and some RCT evidence that
       improving lifestyle improves health or protects against disease
     • So following a healthy lifestyle — not smoking, eating a
       balanced diet, limiting alcohol intake and exercising regularly —
       would seem to be sensible
     • It may help to
         –   Reduce the risks of becoming ill
         –   Modify risk factors
         –   Control disease
         –   Reduce mortality
         –   Avoid the need for drug treatment and the associated risks
     • On a population basis small changes are likely to have the
       biggest benefits
     • Although the evidence for multiple interventions is limited small
       changes in several areas may improve health outcomes further
     • It’s never too late to adopt a healthy lifestyle

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