Dietary Quality and Lifestyle Factors in Relation to 10-Year Mortality in Older Europeans: The SENECA Study

The single and combined effects of three healthy lifestyle behaviors—nonsmoking, being physically active, and having a highquality diet—on survival were investigated among older people in the SENECA Study. This European longitudinal study started with baseline measurements in 1988–1989 and lasted until April 30, 1999. The study population consisted of 631 men and 650 women aged 70–75 years from Belgium, Denmark, Italy, The Netherlands, Portugal, Spain, and Switzerland. A lifestyle score was calculated by adding the scores of the lifestyle factors physical activity, dietary quality, and smoking habits. The single lifestyle factors and the lifestyle score were related to mortality. Even at ages 70–75 years, the unhealthy lifestyle behaviors smoking, having a low-quality diet, and being physically inactive were singly related to an increased mortality risk (hazard ratios ranged from 1.2 to 2.1). The risk of death was further increased for all combinations of two unhealthy lifestyle behaviors. Finally, men and women with all three unhealthy lifestyle behaviors had a three- to fourfold increase in mortality risk. These results underscore the importance of a healthy lifestyle, including multiple lifestyle factors, and the maintenance of it with advancing age.