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Lifestyle changes at middle age and mortality: a population-based prospective cohort study
  1. Paula Berstad1,2,
  2. Edoardo Botteri1,3,
  3. Inger Kristin Larsen1,
  4. Magnus Løberg4,5,
  5. Mette Kalager4,6,
  6. Øyvind Holme4,7,
  7. Michael Bretthauer4,5,6,
  8. Geir Hoff1,2,4,5
  1. 1Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
  2. 2Telemark Hospital, Skien, Norway
  3. 3Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
  4. 4Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
  5. 5Department of Transplantation Medicine, K. G. Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway
  6. 6Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  7. 7Sørlandet Hospital, Kristiansand, Norway
  1. Correspondence to Dr Paula Berstad, Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, Oslo 0304, Norway; paula.berstad{at}


Background The effect of modifying lifestyle at middle age on mortality has been sparsely examined.

Methods Men and women aged 50–54 years randomised to the control group (no intervention) in the population-based Norwegian Colorectal Cancer Prevention trial were asked to fill in lifestyle questionnaires in 2001 and 2004. Lifestyle scores were estimated ranging from 0 (poorest) to 4 (best) based on health recommendations (non-smoking, daily physical activity, body mass index <25.0 kg/m2 and healthy diet). Outcomes were all-cause, cancer and cardiovascular mortality before 31 December 2013.

Results Of the 6886 attainable individuals included in the study, 4211 (61%) responded to the baseline questionnaire in 2001. After a median follow-up of 12.3 years, 226 (5.4%) of the baseline questionnaire responders died; 110 (49%) from cancer and 32 (14%) from cardiovascular disease. For each increment in lifestyle score in 2001, a 21% lower all-cause mortality was observed (HR 0.79, 95% CI 0.67 to 0.94, adjusted for age, sex, occupational working hours and chronic disease or pain during 3 years before enrolment). A one-point increase in lifestyle score from 2001 to 2004 was associated with a 38% reduction in all-cause mortality (adjusted HR 0.62, CI 0.45 to 0.84). The group reporting lifestyle change from score 0–1 (unfavourable) in 2001 to score 2–4 (favourable) in 2004 had 4.8 fewer deaths per 1000 person years, compared with the group maintaining an ‘unfavourable’ lifestyle (adjusted HR 0.31, CI 0.13 to 0.70 for all-cause mortality).

Conclusions Favourable lifestyle changes at age 50–60 years may prevent early death.

Trial registration NCT00119912; pre-results.

  • Cohort studies

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  • Contributors GH is the principal investigator of the main NORCCAP trial. PB and GH wrote the grant application. IKL conducted data collection in 2001 and 2004. PB wrote the first draft of the manuscript and is the guarantor of the study. EB conducted the data analysis. All authors discussed data analyses and interpretation and contributed to subsequent versions of the manuscript. All authors critically revised the manuscript and approved the final version of the manuscript.

  • Funding This study was funded by the South-Eastern Norway Regional Health Authority, grant 2012094.

  • Competing interests None declared.

  • Ethics approval South-Eastern Norway Research Ethics Committee and the Norwegian Data Protection Authority.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Study protocol is available from the corresponding author. Please contact the corresponding author to discuss de-identified data requests.