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A novel evolutionary-concordance lifestyle score is inversely associated with all-cause, all-cancer, and all-cardiovascular disease mortality risk

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Abstract

Purpose

Evolutionary discordance may contribute to the high burden of chronic disease-related mortality in modern industrialized nations. We aimed to investigate the associations of a 7-component, equal-weight, evolutionary-concordance lifestyle (ECL) score with all-cause and cause-specific mortality.

Methods

Baseline data were collected in 2003–2007 from 17,465 United States participants in the prospective REasons for Geographic and Racial Differences in Stroke (REGARDS) study. The ECL score’s components were: a previously reported evolutionary-concordance diet score, alcohol intake, physical activity, sedentary behavior, waist circumference, smoking history, and social network size. Diet was assessed using a Block 98 food frequency questionnaire and anthropometrics by trained personnel; other information was self-reported. Higher scores indicated higher evolutionary concordance. We used multivariable Cox proportional hazards regression models to estimate ECL score–mortality associations.

Results

Over a median follow-up of 10.3 years, 3771 deaths occurred (1177 from cardiovascular disease [CVD], 1002 from cancer). The multivariable-adjusted hazard ratios (HR) (95% confidence intervals [CI]) for those in the highest relative to the lowest ECL score quintiles for all-cause, all-CVD, and all-cancer mortality were, respectively, 0.45 (0.40, 0.50), 0.47 (0.39, 0.58), and 0.42 (0.34, 0.52) (all P trend < 0.01). Removing smoking and diet from the ECL score attenuated the estimated ECL score–all-cause mortality association the most, yielding fifth quintile HRs (95% CIs) of 0.56 (0.50, 0.62) and 0.50 (0.46, 0.55), respectively.

Conclusions

Our findings suggest that a more evolutionary-concordant lifestyle may be inversely associated with all-cause, all-CVD, and all-cancer mortality. Smoking and diet appeared to have the greatest impact on the ECL–mortality associations.

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Data availability

This study uses data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. In order to abide by its obligations with NIH/NINDS and the Institutional Review Board of the University of Alabama at Birmingham, REGARDS facilitates data sharing through formal data use agreements. Any investigator is welcome to access the REGARDS data through this process. Requests for data access may be sent to regardsadmin@uab.edu.

Code availability

The code supporting this current study is available from the corresponding author upon request.

Abbreviations

95% CI:

95% Confidence intervals

CVD:

Cardiovascular disease

ECL:

Evolutionary-concordance lifestyle

HR:

Hazard ratios

REGARDS:

REasons for Geographic and Racial Differences in Stroke

US:

United States

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Funding

This research project is supported by cooperative agreement U01 NS041588 co-funded by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging (NIA), National Institutes of Health, Department of Health and Human Service, and by R01 HL80477 from the National Heart Lung and Blood Institute (NHLBI). Additional funding was provided by The Anne and Wilson P. Franklin Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NINDS, NIA, NHLBI, or The Anne and Wilson P. Franklin Foundation. Representatives of the NINDS were involved in the review of the manuscript but were not directly involved in the collection, management, analysis or interpretation of the data. The authors thank the other investigators, the staff, and the participants of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at: https://www.uab.edu/soph/regardsstudy/

Author information

Authors and Affiliations

  1. Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA

    Alyssa N. Troeschel, Terryl J. Hartman, W. Dana Flanders & Roberd M. Bostick

  2. Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Terryl J. Hartman, W. Dana Flanders & Roberd M. Bostick

  3. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Tomi Akinyemiju

  4. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Suzanne Judd

Authors
  1. Alyssa N. Troeschel
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  2. Terryl J. Hartman
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  3. W. Dana Flanders
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  4. Tomi Akinyemiju
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  5. Suzanne Judd
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  6. Roberd M. Bostick
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were conducted by SJ. Data analysis was performed by ANT. The first draft of the manuscript was written by ANT and all authors commented on previous versions of the manuscript. RMB provided supervision and had primary responsibility for final content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Roberd M. Bostick.

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Conflict of interest

Dr. Flanders owns “Epidemiologic Research & Methods, LLC” which does some consulting work for a variety of clients. He knows of no conflicts of interest. All other authors have no conflicts of interest to disclose.

Ethical approval

The institutional review boards of all participating institutions approved the study.

Informed consent to participate

All participants gave written, informed consent at enrollment.

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Troeschel, A.N., Hartman, T.J., Flanders, W.D. et al. A novel evolutionary-concordance lifestyle score is inversely associated with all-cause, all-cancer, and all-cardiovascular disease mortality risk. Eur J Nutr 60, 3485–3497 (2021). https://doi.org/10.1007/s00394-021-02529-9

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