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A cross-national comparison of lifestyle between China and the United States, using a comprehensive cross-national measurement tool of the healthfulness of lifestyles: the Lifestyle Index.

BACKGROUND: Extensive studies have revealed the importance of a healthy lifestyle and the role of each lifestyle factor in health. However, lifestyle factors have rarely been studied simultaneously. The authors propose an integrated approach to summarize total healthfulness of lifestyles and to enhance understanding of lifestyle patterns across countries. METHODS: The authors created an overall measure of lifestyle called the Lifestyle Index (LI), integrating diet, physical activity, smoking, and alcohol use to provide a global tool of monitoring healthfulness and patterns of lifestyles. Using the LI, the authors conducted a cross-national comparison between China (n = 8352) and the United States (n = 9750). RESULTS: The LI effectively reflected the healthfulness of lifestyle components in both countries. The mean of the LI scores was slightly higher in China than the US. Scores of diet quality, physical activity, and smoking were higher in China, but scores of alcohol behavior were higher in the US. Similar lifestyle patterns but different unhealthy behaviors were identified in these countries. CONCLUSIONS: An assessment of total healthfulness of lifestyles and a better understanding of lifestyle patterns across countries using the LI can provide practical guidance to developing and targeting public health promotion activities to improve global public health.

Adult↗

The use of the terms 'lifestyle medicines' or 'lifestyle drugs'.

AIM: over the last 10 decades, 'lifestyle medicines' or 'lifestyle drugs' have been used with increasing frequency by journalists, politicians, authorities and to some extent by scientists. The objective of this paper is to analyse the quantity and quality of the use of these terms and discuss the implications associated with the labelling of indications and products as lifestyle medicines or lifestyle drugs. METHODS: The findings in this paper are based on an extensive literature review in the databases Medline, Pubmed, Embase and the two most frequently used search engines altavista.com and google.com, as well as the media database LexisNexis. RESULTS: In the period 1978 to August 2003, the term 'lifestyle medicines/drugs' has appeared 3174 times in English language media. In total, 23 different definitions are presented in the scientific literature. CONCLUSIONS: The review of the scientific literature shows that no widely accepted definition of the terms 'lifestyle medicines' or 'lifestyle drugs' exists. Nevertheless the terms have appeared more than 3000 times in the media (2600 times since 1998), which means that in most cases, the use of the terms 'lifestyle medicines' or 'lifestyle drugs' are based on the authors' own assumptions and values. This is problematic, not only in terms of a discourse, where no one knows what forms the basis of the discussion, but also because this at best leads to an uninformed discussion and at worst to harmful conclusions that might stigmatise and discriminate patients. Based on these findings, this paper argues that a clear, widely accepted definition of the terms 'lifestyle medicines' or 'lifestyle drugs' is essential to avoid potential misunderstandings that might lead to discrimination in the rationing of healthcare resources or stigmatisation of patients.

Denmark↗

Relationship between ethanol consumption level and lifestyle status: excessive ethanol consumption can account for the prevalence of lifestyle-related diseases.

BACKGROUND: Diseases caused by unhealthful lifestyles, namely lifestyle-related diseases demands prompt solutions including preventive measures and effective treatment, especially in the developed countries. To that effect, clear understandings of such syndromes are required. Our recent observations have indicated that insulin resistance could, at least in part, account for the pathogenesis of lifestyle-related diseases. The aim of this study was to clarify whether excessive ethanol consumption could also be another cause of such diseases. METHOD: Lifestyle status was assessed based on Breslow's questionnaires of lifestyle index in 519 Japanese males aged 30 to 65 years. Averaged ethanol consumption level was determined by additional questionnaires and insulin resistance level was estimated by homeostasis model assessment. RESULTS: Ethanol consumption level was inversely associated with the total score on Breslow's lifestyle index. Improper drinking manner was associated with improper habit of smoking and proper habit of eating snacks among six lifestyle factors induced in Breslow's index. CONCLUSION: Subjects with more unhealthful lifestyles consumed greater amount of ethanol, suggesting that excessive ethanol consumption could be one of causes of lifestyle-related diseases. In addition to insulin resistance syndrome, alcohol-related diseases should be cared to address the issues of lifestyle-related diseases.

Adult↗

Wellness lifestyles II: Modeling the dynamic of wellness, health lifestyle practices, and Network Spinal Analysis.

OBJECTIVE: Empirical application of a theoretical framework linking use of Network Spinal Analysis (NSA; a holistic, wellness-oriented form of complementary and alternative medicine [CAM]), health lifestyle practices, and self-reported health and wellness. DESIGN: Cross-sectional self-administered survey study. RESPONDENTS: Two thousand five hundred and ninety-six (2596) patients from 156 offices of doctors who were members of the Association for Network Chiropractic (currently titled Association for Network Care); estimated response rate was 69%. MEASURES: Exogenous variables entered into the structural equation model include gender, age, education, income, marital status, ailments, life change, and trauma. A wellness construct consisted of calculated difference scores between two referents, "presently" and "before Network" care, for self-reported items representing wellness domains of physical state, mental-emotional state, stress evaluation, and life enjoyment. Positive reported change in nine items assembled into dietary practices, health practices, and health risk dimensions serve as indicators of the construct of changes in health lifestyle practices. The NSA care construct consisted of duration of care in months, awareness of energy and awareness of breathing since beginning Network care. RESULTS: Of the exogenous variables only gender, age, and education remain in the final parsimonious structural equation model in these data. Reported wellness benefits accrue to individuals along a direct path from both self-reported positive lifestyle change (0.22), and from NSA care (0.43). The path (0.65) from NSA care to positive health lifestyle changes indicates that NSA care also has an indirect effect on wellness through changes in health lifestyle practices. CONCLUSIONS: The Structural Equation model tested in these analyses lends support to our theoretical framework linking wellness, health lifestyles, and CAM. This study provides further evidence that our measurements of health and wellness are particularly appropriate for investigating wellness-oriented CAM. There is a positive relationship between the experience of NSA care and self-reported improvements in wellness as well as self-reported changes in lifestyle practices. NSA care users tend toward the practice of a positive health lifestyle, which also has a direct effect on reported improvements in wellness. These empirical links are discussed relative to the sociodemographic characteristics of this population and show that use of NSA care is an aspect of a wellness lifestyle.

Adult↗

The Berne-Munich Lifestyle Panel. Background and baseline results from a longitudinal health lifestyle survey.

The Berne-Munich Lifestyle Panel (BMLP) studies health relevant lifestyles among some 2000 adults in Switzerland and Germany. This paper introduces the theoretical background and empirical concept of the BMLP. Sociological theory provided the guidelines for the development of an empirical model that measures structures and dynamics of health lifestyles. Health lifestyles are explained as the product of the complex interplay between health related behaviours, orientations and social resources. Residents of Berne (Switzerland) and Munich (Germany) in the age between 55 and 65 years were contacted in 12 months periods and interviewed by telephone (CATI). The questionnaire comprised some 200 questions on selected aspects of health lifestyles and health status. Interviews were conducted in two waves in Munich (1996 and 1997) and three waves in Berne (1996/97/98). The paper reports findings from baseline data analysis and explores cultural differentiations with respect to the distribution of 1. health relevant behaviours, orientations and social resources, 2. triggers of lifestyle change (life events), 3. mediating factors (Health Locus of Control, Sense of Coherence). Initial results from the search for patterns of health behaviours are also reported. The findings show considerable differences but also impressive similarities in health lifestyle elements across the two samples. There is also preliminary evidence for meaningful patterns of health behaviours in the cohort under investigation. Moreover, the findings clearly demonstrate the need for a gender specific approach in the analysis of cultural differences in health behaviours and lifestyles.

Adult↗

Lifestyle and the right to clean air in public places (RCA) (Part 3). Relationship between opinions concerning RCA and personal lifestyle.

As a preliminary study to evaluate the possible roles of health education (education to acquire a healthy lifestyle) in supporting the development of a smokeless society, the relationship between opinions concerning the right to clean air in public places (RCA) and personal lifestyle as well as the relationships among three aspects of RCA and personal lifestyle were investigated in a randomly-selected sample (n = 887) of a population using a self-administered questionnaire. Relationships between opinions concerning RCA and lifestyle were analyzed within four subgroups of subjects defined by smoking status and sex. The results of these analyses indicated that opinions concerning RCA among women are related to knowledge of RCA and personal lifestyle while male opinions concerning RCA bear no statistical relationship to personal lifestyle. These results imply the possibility that knowledge of RCA and opinions concerning RCA among women can be effectively promoted by health education. The results of our analyses concerning the three aspects of RCA and personal lifestyle also indicate that attitudes toward RCA are positively correlated with factors other than knowledge and opinions concerning RCA; this implies the possibility that health education has but a limited impact on attitudes toward RCA.

Adult↗

Metformin & lifestyle intervention prevent Type 2 diabetes: lifestyle intervention has the greater effect.

Diabetes mellitus is now occurring in epidemic proportions in many countries. Owing to the limited effectiveness of drug prophylaxis of diabetic complications after diabetes has developed, it may be more appropriate to investigate ways to prevent the onset of diabetes. A recent trial published by the Diabetes Prevention Programme Research Group investigated whether lifestyle changes or metformin were effective in delaying the onset of diabetes in subjects with impaired glucose tolerance. The goals of the intensive lifestyle intervention were to achieve and maintain a weight reduction of 7% through a low-calorie, low-fat diet and to engage in physical activity of moderate intensity, such as brisk walking, for at least 150 min/week. The effectiveness of the intensive lifestyle intervention on body weight was initially quite good but decreased over time. Metformin caused some weight loss but to a lesser extent than the intensive lifestyle intervention. Both therapies decreased the fasting plasma glucose levels to a similar extent initially. The intensive lifestyle intervention decreased plasma glycosylated haemoglobin levels to a greater extent than metformin. Both intensive lifestyle intervention and metformin reduced the incidence of diabetes, with the lifestyle intervention having the greater effect.

Clinical Trials as Topic↗

Influence on lifestyle measures and five-year coronary risk by a comprehensive lifestyle intervention programme in patients with coronary heart disease.

BACKGROUND: Lifestyle measures of coronary heart disease (CHD) prevention have been overshadowed by the efficacy of drug treatments. This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering, anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials. Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects. OBJECTIVES: The objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years. In addition, an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study. DESIGN: A total of 197 patients with proven coronary heart disease were included and randomised to a lifestyle intervention programme or to usual care. Follow-up was after a period of two years. METHODS: Intervention comprised a low fat diet, regular exercise, smoking cessation, psychosocial support and education, delivered by nurses on the rationale for pharmacological and lifestyle measures. Usual care comprised follow-up in the routine outpatient clinic. Both groups were given the same comprehensive medication according to recent guidelines. RESULTS: Patients in the lifestyle intervention group reduced the intake of saturated fat, sugar and cholesterol (P<0.001), increased their exercise level (P<0.01) and stopped smoking (P<0.05) when compared with the usual care group. A sub-analysis of the influence of five-year CHD calculated risk in males resulted in a relative risk reduction of 22% (95% confidence intervals 9-35). Although significant, this result must be interpreted with caution due to poor statistical power and reproducibility of the method. CONCLUSIONS: In the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet, exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males.

Blood Glucose↗

An inverse association between serum gamma glutamyl transpeptidase activity and Breslow's Lifestyle Index; its practical application for screening of subjects with unhealthy lifestyles.

We examined whether serum gammaGTP activity (gammaGTP) is associated with Breslow's lifestyle index and whether it could be used as a tool to detect subjects with unhealthy lifestyles. To that effect, 724 male Japanese workers excluding patients suffering from hepatitis virus infection, autoimmune liver diseases and apparently active bile duct diseases were cross-sectionally examined. gammaGTP was inversely associated with the total score of Breslow's index for all subjects (lambda=30.643) and in subjects aged 40 or more (lambda=37.073). The association was consistent even after adjustments of subjects' ages and levels of triglycerides, total cholesterol and uric acid (p=0.0001). Among the seven lifestyle factors comprising Breslow's index, improper habits of drinking (p<0.0001), smoking (p=0.0204), exercise (p=0.0189) and body weight control (p<0.0001), were associated with increased gammaGTP. Even in a survey in which subjects who had proper habits of drinking and body weight control were selectively examined, improper habits of smoking and exercise still tended to be associated with increased gammaGTP. Receiver operating characteristic curves indicated that gammaGTP was beneficial for detecting subjects who scored two or less on Breslow's index, at least in subjects aged 40 or more. gammaGTP was associated with insulin resistance level estimated by the homeostasis model assessment (p<0.0001), which was inversely associated with Breslow's index (p=0.0040). gammaGTP could be used as an objective substitute of Breslow's index, allowing us to identify subjects with low scores on Breslow's index, at least after sorting subjects properly. Such screening would enable interventions to correct subjects' unhealthy lifestyles, helping to solve lifestyle-related disease issues.

Adult↗

Wellness lifestyles I: A theoretical framework linking wellness, health lifestyles, and complementary and alternative medicine.

Scholarship concerning complementary and alternative medicine (CAM) practices within the United States could benefit from incorporating sociological perspectives into the development of a comprehensive research agenda. We review the literature on health and wellness emphasizing definitions and distinctions, the health lifestyles literature emphasizing issues of both life choices and life chances, and studies of CAM suggesting utilization as an aspect of a wellness lifestyle. This review forms the foundation of a new theoretical framework for CAM research based on the interrelationship of CAM with health promotion, wellness, and health lifestyles. To date, few studies have sought to bring these various elements together into a single, comprehensive model that would enable an assessment of the complexity of individual health and wellness in the context of CAM. We argue that attention to literatures on health measurement and health lifestyles are essential for exploring the effectiveness and continuing use of CAM.

Complementary Therapies↗

Lifestyle effect on total IgE. Lifestyles have a cumulative impact on controlling total IgE levels.

Recent studies have demonstrated an increasing number of cases of allergy in economically developed societies. Many of these allergic reactions are mediated by IgE antibodies whose levels are under genetic control. However, this large increase of allergy prevalence cannot be explained by genetic mutations; comprehensive lifestyles may also play roles in determining total IgE levels. Total IgE levels were determined from serum samples taken from 706 hard metal workers who responded to a questionnaire including 17 items related to physical and mental health practices. Five factors tending to normalize IgE upward and three tending to normalize IgE downward when we keep good lifestyles were extracted using MANOVA analysis. We therefore constructed a Health Practice Index in Allergic reactions (HPIA); eight physical and mental health practices were significantly (P less than 0.05) associated with cumulative elevations or suppressions of total IgE levels when sex, age and environmental factors were controlled for. Multivariate analyses demonstrated a dramatic synergism (Relative Risk greater than 2.0, P less than 0.05) of unhealthy lifestyles determining a bipolar high risk for elevated or suppressed IgE levels which in turn may result in allergic diseases or immuno-suppression. Maintenance of healthy lifestyles may prove beneficial for reducing the prevalence of allergic disorders.

Adolescent↗

Modifiable lifestyle factors and the metabolic syndrome in older men: Effects of lifestyle changes.

OBJECTIVES: To examine the influence of lifestyle factors and changes in these factors on risk of the metabolic syndrome in elderly men. DESIGN: Cross-sectional and longitudinal analyses of cohort study. SETTING: General practices in 24 British towns. PARTICIPANTS: Three thousand fifty-one men aged 60 to 79 with no diabetes mellitus or diagnosis of coronary heart disease. MEASUREMENTS: Lifestyle factors (smoking, physical activity, alcohol intake, body weight, dietary fat and carbohydrate intake) including recent changes in the previous 3 years (physical activity and body weight); metabolic syndrome. RESULTS: After adjustment for each of the other modifiable lifestyle factors, overweight/obesity and physical inactivity were associated with a significantly higher risk of the metabolic syndrome, as were cigarette smoking and a high-carbohydrate diet (>57% of energy). Alcohol intake and dietary fat intake were not related to the metabolic syndrome. Long-term ex-smokers showed similar risk to never smokers. Taking up physical activity and losing weight in the previous 3 years were associated with a reduction in risk of the metabolic syndrome. CONCLUSION: Overweight/obesity, physical inactivity, a high-carbohydrate diet, and cigarette smoking are associated with higher risk of the metabolic syndrome in elderly men. Modification of lifestyle factors, even later in life, has considerable potential for primary prevention of the metabolic syndrome.

Aged↗

Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project.

The Multicenter Lifestyle Demonstration Project was designed to determine if comprehensive lifestyle changes can be a direct alternative to revascularization for selected patients without increasing cardiac events. A total of 333 patients completed this demonstration project (194 in the experimental group and 139 in the control group). We found that experimental group patients were able to avoid revascularization for at least 3 years by making comprehensive lifestyle changes at substantially lower cost without increasing cardiac morbidity and mortality. These patients reported reductions in angina comparable with what can be achieved with revascularization.

Controlled Clinical Trials as Topic↗

Project lifestyle: developing positive health lifestyles for schoolchildren in Antigua.

Countries of the English-speaking Caribbean are in epidemiological transition. Following 30 years of socioeconomic change, obesity and chronic diseases have almost replaced malnutrition and infectious diseases as major health problems. Major risk factors for this modern epidemic are lifestyle-related. Project Lifestyle seeks to develop positive health lifestyles in schoolchildren gradually, sequentially, and systematically from grades 1-12 and throughout the school system on the island of Antigua. The four health habits addressed include weighing right, eating right, doing daily physical exercise, and having a positive self-concept. Since risk interventions with schoolchildren have produced positive results in several developed countries, this project developed an intervention methodology in the Caribbean context.

Adolescent↗

Leisure-time physical activity and related lifestyle characteristics among middle-aged Japanese. Japan Lifestyle Monitoring Study Group.

The present study describes leisure-time physical activity status and related lifestyle factors in middle-aged Japanese. Data were obtained from 1,893 (905 men, 988 women) participants aged 40-69 years who had either been selected from a public registry or who had visited a healthcare facility. Subjects responded to a self-administered questionnaire and were interviewed using an assessment method for leisure-time and on-the-job physical activity within the last 12 months by trained interviewers. According to the leisure-time physical activity score, men and urban residents tended to engage in more leisure-time physical activity than did women and rural residents, respectively. Leisure-time physical activity tended to be inversely associated with on-the-job physical activity in all cases aside from women in urban regions, and also to be associated with higher levels of education in rural regions. Subjects engaging in more leisure-time physical activity had higher odds ratios of certain lifestyle factors, indicating a healthy lifestyle that included a variety of foods in their diet and a subjective sense of wellness in both men and women, in addition to non-smoking and drinking milk in men. These results suggested that leisure-time physical activity is influenced by socio-environmental factors, and that it is accompanied by other healthy behavior.

Adult↗

Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial.

In a prospective, randomised, controlled trial to determine whether comprehensive lifestyle changes affect coronary atherosclerosis after 1 year, 28 patients were assigned to an experimental group (low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise) and 20 to a usual-care control group. 195 coronary artery lesions were analysed by quantitative coronary angiography. The average percentage diameter stenosis regressed from 40.0 (SD 16.9)% to 37.8 (16.5)% in the experimental group yet progressed from 42.7 (15.5)% to 46.1 (18.5)% in the control group. When only lesions greater than 50% stenosed were analysed, the average percentage diameter stenosis regressed from 61.1 (8.8)% to 55.8 (11.0)% in the experimental group and progressed from 61.7 (9.5)% to 64.4 (16.3)% in the control group. Overall, 82% of experimental-group patients had an average change towards regression. Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs.

Adult↗

Short term efficacy of a lifestyle intervention programme on cardiovascular health outcome in overweight Indigenous Australians with and without type 2 diabetes mellitus. The healthy lifestyle programme (HELP).

We aim to examine the short-term efficacy of a lifestyle intervention programme on cardiovascular risk factors in overweight urban Indigenous Australians with and without type 2 diabetes mellitus. One hundred and one urban Indigenous Australians in Queensland voluntarily participated in a culturally appropriate lifestyle intervention programme based on improving physical activity and dietary intake; 44 had type 2 diabetes, 11 had impaired fasting glucose and 46 were euglycaemic. Efficacy of the intervention on biochemical and physical markers of cardiovascular outcome will be monitored over 2 years. Diabetic subjects were overweight with good but suboptimal control of cardiovascular risk factors (mean systolic blood pressure 132 mmHg, diastolic blood pressure 85 mmHg, LDL cholesterol 2.8mM and urine albumin to creatinine ratio 10.8) at baseline. At the 6 months follow up, there were significant reductions in waist circumference (3.1cm, P=0.01) and diastolic blood pressure (4.6 mmHg, P=0.01). Although modest, these changes may improve clinical outcome if sustained.

Cohort Studies↗

Are general practitioners doing enough to promote healthy lifestyle? Findings of the Medical Research Council's general practice research framework study on lifestyle and health.

The health survey questionnaire was used to collect information about cigarette smoking, alcohol consumption, physical exercise, and dieting and weight. Completed questionnaires were received from 25,496 men and 36,657 women registered with 47 group practices in England and Scotland. The proportions of respondents who stated that they had a problem ranged from 1% (women and drinking, n = 406) to 34% (women and weight, n = 12,526). Between 49% (women and drinking, n = 18,048) and 67% (men (n = 17,095) and women (n = 24,550) and weight) thought that their general practitioners should be interested in their lifestyle. The proportions who could recall having received relevant advice ranged from 2% (women and drinking, n = 591) to 24% (women and weight, n = 8946). Advice about smoking had been given to 4055 (40%) of the women and 2941 (39%) of the men who smoked. Only 96 (10%) of the 989 women and 331 (17%) of the 1948 men who drank excessively could recall having received advice about alcohol consumption. These results suggest that patients are concerned about their lifestyle, that most would welcome relevant counselling, and that doctors should become more concerned with prevention of this kind.

Alcohol Drinking↗