Lifestyle by MikeJenny

VIEWS: 30 PAGES: 10

									       Lifestyle:
    General benefits




1
            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

2
    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
      diabetes
    • 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
3
    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
4
    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

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

5
    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
                          patients‖


              Hypertension. NICE clinical guideline 34. 2006

6
    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
                                                            effective
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
7
    How does that compare with drug interventions?
         Lowering BP to prevent MI & stroke. HTA 2003;7:31




8
         Even a small change in lifestyle can make a
              significant difference to mortality
    Faculty of Public Health. Easing the pressure: tackling hypertension. 2005




9
                                 Summary
     • 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
10

								
To top