# Thirteen simple lifestyle scores and risk of cancer, cardiovascular disease, diabetes, and mortality: Prospective cohort study in the UK Biobank

## TL;DR

This study shows that lifestyle scores can predict risks for cancer, heart disease, diabetes, and mortality, with scores including smoking and BMI being most effective.

## Contribution

The study demonstrates that lifestyle scores designed for single diseases can also predict multiple non-communicable diseases and mortality.

## Key findings

- Higher lifestyle scores were generally associated with reduced risks of non-communicable diseases and mortality.
- Lifestyle scores including both smoking and BMI showed the strongest associations with overall NCD outcomes.
- The Healthy Lifestyle Score and Chronic Disease Risk Index were the best-performing scores for predicting NCD risk and mortality.

## Abstract

Numerous simple lifestyle scores have been developed for specific non‐communicable diseases (NCDs). This research aimed to investigate and compare the associations of various lifestyle scores with the incidence and mortality of NCDs. In 76,399 participants from the UK Biobank, we investigated the associations of 13 lifestyle scores with the incidence and mortality of cancer, cardiovascular disease (CVD), type 2 diabetes (T2D), and a composite of these NCDs. Cox proportional‐hazards regression models were used to estimate hazard ratios (HRs) for associations between lifestyle scores and NCD outcomes. During a median follow‐up time of 10.5 years, 12,214 incident NCD cases and 2250 NCD deaths were documented. Higher lifestyle scores were generally associated with a reduced risk of overall NCDs (HRs ranging from 0.65 to 0.89) and NCD mortality (0.51–0.92). Cancer (HRs ranging from 0.72 to 0.98) and CVD (0.55–0.87) risk were less dependent on lifestyle behaviors than T2D (0.18–0.74). Notably, the top three scores associated with cancer outcomes included smoking as a component, and those for T2D included body mass index (BMI). For overall NCD outcomes, lifestyle scores including both smoking and BMI showed the strongest associations. Healthy Lifestyle Score and the Chronic Disease Risk Index were the overall best‐performing scores to predict NCD risk and mortality. These findings suggest that the use of lifestyle scores designed for a single disease group can be extended for predicting multiple NCDs and mortality. Both smoking and BMI should be included in lifestyle scores aiming to predict overall NCD risk and mortality for future research and recommendations.

Cancer, cardiovascular disease, and type 2 diabetes share common lifestyle‐related risk factors. This large‐scale prospective cohort study examined and compared the associations between 13 simple lifestyle scores and these major non‐communicable diseases. The results suggest that the use of lifestyle scores designed for a single disease group can be extended for predicting the incidence and mortality of multiple non‐communicable diseases. The study highlights the value of collaborative efforts to develop shared lifestyle recommendations and a common lifestyle score to reduce the burden of non‐communicable diseases. The inclusion of both smoking and body mass index as lifestyle factors is essential.