| Summary: | Introduction: Lifestyle-related habits have a strong influence on morbidity and mortality world-
wide. This study investigates the association between a multidimensional healthy lifestyle score and
all-cause mortality risk, including in the score some less-studied lifestyle-related factors.
Methods: Participants (n=20,094) of the Seguimiento Universidad de Navarra cohort were fol-
lowed up from 1999 to 2018. The analysis was conducted in 2019. A 10-point healthy lifestyle score
previously associated with a lower risk of major cardiovascular events was applied, assigning 1 point
to each of the following items: never smoking, moderate-to-high physical activity, moderate-to-high
Mediterranean diet adherence, healthy BMI, moderate alcohol consumption, avoidance of binge
drinking, low TV exposure, short afternoon nap, time spent with friends, and working ≥40 hours
per week.
Results: During a median follow-up of 10.8 years, 407 deaths were documented. In the multivari-
able adjusted analysis, the highest category of adherence to the score (7−10 points) showed a 60%
lower risk of all-cause mortality than the lowest category (0−3 points) (hazard ratio=0.40, 95%
CI=0.27, 0.60, p<0.001 for trend). In analyses of the healthy lifestyle score as a continuous variable,
for each additional point in the score, a 18% relatively lower risk of all-cause mortality was observed
(adjusted hazard ratio=0.82, 95% CI=0.76, 0.88).
Conclusions: Adherence to a healthy lifestyle score, including some less-studied lifestyle-related
factors, was longitudinally associated with a substantially lower mortality rate in a Mediterranean
cohort. Comprehensive health promotion should be a public health priority.
Am J Prev Med 2020;59(2):e59−e67. © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc.
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