Lifestyle as a multi-organ target to improve health outcomes

In a new era of an ageing population and successful treatment of chronic disease, multimorbidity is the challenge for the future. Already at the age of 50, 43% of people are affected in 2 or more disease domains. (1) As multimorbidity becomes more common, so does polypharmacy and its subsequent complications in terms of drug-drug interactions, a multiplicity of side effects and incompatible guidelines for drug prescriptions. In addition to treatment with drugs, lifestyle changes are important in the prevention of disease and comorbidities. A healthy lifestyle may contribute to the prevention or delay in the age of onset of the disease, increasing the number of healthy years.

Lifestyle medicine has proven itself in the prevention and early treatment of type 2 diabetes. Currently, lifestyle programs are reimbursed for those at high risk of type 2 diabetes. Of course it is well recognized that smoking increases the risk of lung disease, like chronic obstructive pulmonary disease (COPD). However, lifestyle medicine from a broader perspective, i.e. including more modifiable factors and outcomes, has high potential for prevention, for example to prevent renal disease, mental disease and gastro-intestinal disease, and potentially for reducing the incidence of dementia. It can also have a role in the treatment and management of chronic diseases.(2) The focus on lifestyle in prevention and care is also part of a development where optimal care for people with multimorbidity requires a person-centred approach, with care that is focused on patient outcomes, rather than disease outcomes. Despite these developments, not many studies investigate the association between multiple lifestyle factors, alone and in concert, and multiple outcomes. The multi-disciplinary nature of the LifeLines cohort, covering a broad range of health outcomes and health-related behaviors, will be ideal to address this topic.

Lifestyle factors have been shown to impact a range of chronic diseases. (3) The major burden of chronic disease is found in cardiovascular disease, with cardiovascular mortality having the largest proportion of total non-communicable disease deaths under the age of 70 years (37%), followed by malignancies (27%), respiratory disease (8%) and diabetes (4%). (3) Lifestyle is regarded as a key target to delay the age of onset of disease, and diminish its incidence. Most studies consider a healthy diet, sufficient physical activity and non-smoking as important health behaviours, often combined with criteria for a healthy body weight. It has been shown that the less people adhere to these healthy lifestyle factors, the higher their risk for multi-morbidity, for example in a cross-sectional analysis in 1196 adults from Quebec, Canada. (4) Several studies also take alcohol intake into account. Other factors, like sleep, sedentary behavior, psychological stress and social support are recognized as important lifestyle factors, or important modifiable factors related to lifestyle, but are only taken into account in studying lifestyle profiles in very recent studies. (5, 6)