The document summarizes evidence from the Caerphilly Cohort Study of over 1,000 men in Wales which found that adopting a healthy lifestyle with four to five healthy behaviors (non-smoking, normal weight, regular exercise, healthy diet, low alcohol) was associated with significant reductions in incident disease compared to an unhealthy lifestyle. Specifically, it found reductions of up to 72% for diabetes, 67% for heart disease and stroke, 35% for cancer, and 64% for dementia. Adopting healthy behaviors was also found to delay onset of diseases and reduce disease burden in the community. Promoting even one additional healthy behavior could result in substantial healthcare savings.

1. HEALTHY AGEING
Better than any pill… and no side effects!
The benefits of a healthy lifestyle
Peter Elwood
Cochrane Institute of Primary Care and Public Health

2. EVIDENCE FROM WALES:
The Caerphilly Cohort Study

3. EVIDENCE FROM a representative population Welsh sample:
THE CAERPHILLY PROSPECTIVE STUDY 1979……
2,500 men aged 45-59 yrs; 90% response rate
The Caerphilly Cohort Study

4. EVIDENCE FROM WALES:
THE CAERPHILLY PROSPECTIVE STUDY 1979……
2,500 men aged 45-59 yrs; 90% response rate
questioned and re-examined every five years since baseline
The Caerphilly Cohort Study

5. EVIDENCE FROM WALES:
THE CAERPHILLY PROSPECTIVE STUDY 1979……
2,500 men aged 45-59 yrs; 90% response rate
questioned and re-examined every five years since baseline
INCIDENT DISEASE during the following 35 years
Detailed clinical data collected from primary care and hospital records
and standard diagnostic criteria applied.
The Caerphilly Cohort Study

6. EVIDENCE FROM WALES:
Over 400 papers published
initially on factors relevant to ischaemic heart disease,
then ischaemic stroke and diabetes,
then other diseases, cognitive decline and dementia….
The Caerphilly Cohort Study

7. EVIDENCE FROM WALES:
Over 400 papers published
initially on factors relevant to ischaemic heart disease,
then ischaemic stroke and diabetes,
then other diseases, cognitive decline and dementia……..
healthy behaviours and reductions in disease
The Caerphilly Cohort Study

8. The five
healthy behaviours
The five ‘Healthy behaviours’
Non smoking
A low body weight - BMI 18-25
Activity - ½ hour walking five+ days per week
A plant-based diet – ‘five a day’ fruit and veg.
Low alcohol - consumption within the guidelines
Healthy ageing

9. The five healthy
behaviours…..
- non-smoking
- a low body weight
- regular exercise
- a healthy diet
- a low alcohol intake
Healthy ageing
UNHEALTHY LIFESTYLE
None or one behaviour
HEALTHY LIFESTYLE
Four or five behaviours

10. The five healthy
behaviours…..
- non-smoking,
- a low body weight
- regular exercise
- a healthy diet
- a low alcohol intake
Healthy ageing
- Diabetes
- Heart disease & stroke
- Cancer
- Dementia
and incident
disease
Detailed clinical data collected from primary care and hospital records and
standard diagnostic criteria applied.

11. HEALTHY
BEHAVIOURS Diabetes Vasc. disease Cancer Dementia
‘Unhealthy’
(None or one
healthy behaviour)
Any two
Any three
‘Healthy’
(Four or five healthy
behaviours)
100 100 100 100
REDUCTIONS*
* Reductions based on Odds Ratios, adjusted for age, social class,
and, for dementia, a base-line cognitive function test (NART)

12. HEALTHY
BEHAVIOURS* Diabetes Vasc. disease Cancer Dementia
‘Unhealthy’
(None or one
healthy behaviour)
Any two
Any three
‘Healthy’
(Four or five healthy
behaviours)
100 100 100 100
REDUCTIONS
- This presentation is limited to men whose lifestyles were consistent
- The dietary criterion had to be reduced to three portions of fruit & veg/day

13. HEALTHY
BEHAVIOURS*
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
(None or one
healthy behaviour)
Any two
Any three
‘Healthy’
(Four or five healthy
behaviours)
100
-35%
-66%
-72%
100
-17%
-34%
-67%
100
-3%
-5%
-35 %
100
-39%
-68%
-64%
REDUCTIONS**
* Confined to men who followed the behaviours consistently
**Reductions based on odds ratios and adjusted for age and social class
and for dementia, a base-line cognitive function test

14. HEALTHY
BEHAVIOURS Diabetes
214 men
Vasc. Disease
752 men
Cancer
648 men
Dementia
121 men
‘Unhealthy’
(None or one
healthy behaviour)
Any two
Any three
‘Healthy’
(Four or five healthy
behaviours)
100
-35%
-66%
-72%
100
-17%
-34%
-67%
100
-3%
-5%
-35 %
100
-39%
-68%
-64%
REDUCTIONS
* Confined to men who followed the behaviours consistently
**Reductions based on odds ratios and adjusted for age and social class
and for dementia, a base-line cognitive function test

15. HEALTHY
BEHAVIOURS*
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
(None or one
healthy behaviour)
Any two
Any three
‘Healthy’
(Four or five healthy
behaviours)
100
-35%
-66%
-72%
100
-17%
-34%
-67%
100
-3%
-5%
-35 %
100
-39%
-68%
-64%
Significance of trend
0.001 0.0005 0.88 0.02
REDUCTIONS
* Confined to men who followed the behaviours consistently
**Reductions based on odds ratios and adjusted for age and social class
and for dementia, a base-line cognitive function test

16. HEALTHY
BEHAVIOURS*
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
(None or one
healthy behaviour)
Any two
Any three
‘Healthy’
(Four or five healthy
behaviours)
100
-35%
-66%
-72%
100
-17%
-34%
-67%
100
-3%
-5%
-35 %
100
-39%
-68%
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
In the 85,000 women in the US WHS, 61% reduction in type 2 diabetes
was attributable to a low BMI alone. Hu et al. N Engl J Med 2001; 345:790-7.
In Caerphilly 69% of diabetes was attributable to a low BMI alone..

17. HEALTHY
BEHAVIOURS*
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
(None or one
healthy behaviour)
Any two
Any three
‘Healthy’
(Four or five healthy
behaviours)
100
-35%
-66%
-72%
100
-17%
-34%
-67%
100
-3%
-5%
-35 %
100
-39%
-68%
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
US Health Professionals who had adopted the five healthy behaviours experienced
an 87% reduction in heart disease (RR: 0.13 CI: 0.09-0.19) [Circulation 2006;114:160-7]
The 84,000 women in the US Nurses’ Health Study the risk of coronary events
was reduced 85% (RR: 0.17; 95% CI: 0.07-0.41) by following the five behaviours
[Stampfer et al. N Engl J Med 2000;343:16-22]
In a study of 4,886 British adults, following four healthy behaviours led to a
reduction of 70% (HR 0.29; 95% CI: 0.19, 0.43) for cardiovascular disease. [Kvaavik et al. E.
Arch Intern Med 170: 711-8]

18. HEALTHY
BEHAVIOURS*
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
(None or one
healthy behaviour)
Any two
Any three
‘Healthy’
(Four or five healthy
behaviours)
100
-35%
-66%
-72%
100
-17%
-34%
-67%
100
-3%
-5%
-35 %
100
-39%
-68%
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
In some studies the reduction in cancer is large, up to about 70% (HR 0.30 95% CI: 0.15,
0.60) [Ford et al. Arch Intern Med 169: 1355-1362. ]
In 112,000 non-smoking subjects, subjects with a healthy lifestyle showed a
reduction of 14% in incident cancer (RR: 0.86; 95% CI: 0.78, 0.94) [McCullough et al. Cancer
Epidemiol Biomarkers Prev 20: 1089-1097. ]

19. HEALTHY
BEHAVIOURS*
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
(None or one
healthy behaviour)
Any two
Any three
‘Healthy’
(Four or five healthy
behaviours)
100
-35%
-66%
-72%
100
-17%
-34%
-67%
100
-3%
-5%
-35 %
100
-39%
-68%
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
In the Honolulu-Asia Aging Study a healthy lifestyle was related to a
64% reduction in dementia (OR 0.36, 95 % CI 0.15, 0.84) [J Am Geriatr Soc 60: 118-123. ]
Several studies, including the Whitehall cohort, have reported associations
in cognitive function. [Br J Psychiatry 203:120-5 and Neurology 79: 755-62]

20. Men with
‘Consistent’
Lifestyles
Diabetes
214 men
Vasc, disease
752 men
Cancer
648 men
Dementia
121 men
‘Unhealthy’
None or one behaviour
‘Healthy’
Four or five behaviours
100
-72%
100
-67%
100
-35 %
100
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
US Health Professionals who had adopted the five healthy behaviours experienced an 87% reduction in heart
disease (Relative risk (RR): 0.13 CI: 0.09-0.19) [Chiuve et al. Circulation 2006;114:160-7]
The 84,000 women in the US Nurses’ Health Study the risk of coronary events was reduced 85% (RR: 0.17; 95%
CI: 0.07-0.41) by following the five behaviours [Stampfer et al. N Engl J Med 2000;343:16-22] .
In a study of 4,886 adult British subjects, the following of four healthy behaviours led to hazard ratios of 0.29 (95%
CI: 0.19, 0.43) for cardiovascular disease. [Kvaavik et al. E. Arch Intern Med 170: 711-8]
in some studies the reduction in cancer is large, up to a hazard ratio of 0.30 (95% CI: 0.15, 0.60) [Ford et al. Arch
Intern Med 169: 1355-1362. ]
In another. 112,000 non-smoking subjects, the 4% of subjects who achieved a high score based on body weight,
activity, diet and alcohol intake, showed a reduction of only 14% in incident cancer (RR: 0.86; 95% CI: 0.78,
0.94) [McCullough et al. Cancer Epidemiol Biomarkers Prev 20: 1089-1097]
In the Honolulu-Asia Aging Study a healthy lifestyle was related to reduced risk of dementia over 25 years
(OR 0.36, 95 % CI 0.15, 0.84) [Gelber et al. J Am Geriatr Soc 60: 118-123. ]
Within the Whitehall study obesity, alcohol and smoking have been show to affect cognitive decline over 10 yrs
[Hagger-Johnson et al. Br J Psychiatry 203: 120-5; Singh-Manoux et al. Neurology 79: 755-62]

21. Men with
‘Consistent’
Lifestyles
Diabetes
214 men
Vasc, disease
752 men
Cancer
648 men
Dementia
121 men
‘Unhealthy’
None or one behaviour
‘Healthy’
Four or five behaviours
100
-72%
100
-67%
100
-35 %
100
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
Better than any drug….
and no side effects!

22. 1,023
‘CONSISTENT’
Men**
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
‘Healthy’
100
-72%
100
-67%
100
-35 %**
100
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
BENEFITS OF A HEALTHY LIFESTYLE:
1. Reductions in incident disease:
- up to 70% less diabetes
- up to 60% less heart disease and stroke
- up to 35% less cancer
- up to 60% less dementia

23. 1,023
‘CONSISTENT’
Men**
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
‘Healthy’
100
-72%
100
-67%
100
-35 %**
100
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
BENEFITS OF A HEALTHY LIFESTYLE:
1. Reductions in incident disease
2. Delayed onset of disease (rate advancement):
- vascular disease events delayed by up to 13 years
- dementia delayed by up to 6 years
- death from any cause by up to 6 years

24. 1,023
‘CONSISTENT’
Men**
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
‘Healthy’
100
-72%
100
-67%
100
-35 %**
100
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
BENEFITS OF A HEALTHY LIFESTYLE:
1. Reductions in incident disease
2. Delayed onset of disease
3. Disease burden in the community reduced

25. 1,023
‘CONSISTENT’
Men**
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
‘Healthy’
100
-72%
100
-67%
100
-35 %**
100
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
BENEFITS OF A HEALTHY LIFESTYLE:
1. Reductions in incident disease
2. Delayed onset of disease
3. Disease burden in the community reduced
- if the subjects in the Caerphilly cohort had each
been urged to take up one additional healthy behaviour….

26. 1,023
‘CONSISTENT’
Men**
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
‘Healthy’
100
-72%
100
-67%
100
-35 %**
100
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
BENEFITS OF A HEALTHY LIFESTYLE:
1. Reductions in incident disease
2. Delayed onset of disease
3. Disease burden in the community reduced
- if the subjects in the Caerphilly cohort had each been urged
to take up one additional healthy behaviour….
If only half had done so, there would have been…..
12% less diabetes
6% less vascular disease
13% less dementia

27. 1,023
‘CONSISTENT’
Men**
Diabetes Vascular
disease
Cancer Dementia
‘Unhealthy’
‘Healthy’
100
-72%
100
-67%
100
-35 %**
100
-64%
Significance of trend 0.001 0.0005 0.88 0.02
REDUCTIONS
BENEFITS OF A HEALTHY LIFESTYLE:
1. Reductions in incident disease
2. Delayed onset of disease
3. Disease burden in the community reduced
- if the subjects in the Caerphilly cohort had each been urged
to take up one additional healthy behaviour….
If half had done so, there would have been…..
12% less diabetes equivalent, across Wales, to £23M/yr
6% less vascular disease £10M/yr
13% less dementia £27M/yr
http://wales.gov.uk/statistics-and-research/nhs-expenditure-programme-budgets/?lang=en

28. The uptake of a healthy lifestyle

29. The uptake of a healthy lifestyle
Lifestyle
Men 45-59 yrs
in Caerphilly
1979
UNHEALTHY
None or one
healthy behaviour
HEALTHY
Four or five healthy
behaviours
40%
8%

30. The Welsh Health Survey
An interview survey of
15,000 people across Wales
each year (2009-2013)

31. The Welsh Health Survey
Lifestyle
Men 45-59 yrs
in Wales
1979
Men 45-59 yrs
in Wales
2013
UNHEALTHY
None or one
healthy behaviour
HEALTHY
Four or five healthy
behaviours
40%
8%
41%
5%

32. The Welsh Health Survey
Lifestyle
All adults
in Wales
2013
UNHEALTHY
None or one
healthy behaviour
HEALTHY
Four or five healthy behaviours
44%
5%

33. A wake-up call to Wales

34. A wake-up call to Wales
“The NHS and others must do all we can to
create the conditions in which people are able
to protect their health,
but people – individuals, communities,
families across Wales - must also face
up to the challenge.”
Professor Mark Drakeford AM
Minister for Health and Social Security

35. A wake-up call to Wales
The challenge from Caerphilly:
‘Take up one additional healthy behaviour’
…there will be….
- reductions in disease
- delays in the onset of disease
- disease burden in the community reduced
- large NHS savings