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5 februari 2019: Bron: Plos medicine

Mensen van middelbare leeftijd die er een gezonde leefstijl op na houden met niet roken, veel bewegen, meer groenten eten enz. worden minder snel ziek en als ze ziek worden worden ze 9 jaar later pas ziek en leven gemiddeld 6 jaar langer dan mensen die wel roken, overgewicht hebben, te hoge bloeddruk hebben en het niet zo nauw nemen met het eten enz. Dat blijkt uit een Nederlandse bevolkingsstudie in de wijk Ommoord in Rotterdam uitgevoerd door het Erasmus Medisch Centrum.

90 procent van de gezonde 45-plussers wordt later getroffen door een ernstige ziekte. Dat zegt hoogleraar Epidemiologie Arfan Ikram in een toelichting in het Algemeen DagbladRoken, een hoge bloeddruk en overgewicht spelen daarbij een een grote rol, vooral bij kanker en diabetes-2.  

Onderzoekers van de Erasmus volgden tussen juli 1989 en 31 december 2011 9,061 mensen (gemiddelde leeftijd 63.9 jaar, waarvan 60.1% vrouw) die 45 jaar of ouder waren en bij de start van de studie gezond waren. De onderzoekers registreerden bij heel veel mensen gedurende de studieperiode 1 of meerdere ernstige aandoeningen maar bij de mensen die er een gezonde leefstijl op na hielden trad een ernstige ziekte pas 9 jaar later op in vergeljking met mensen die er een ongezonde leefstijl op na hielden.

En de gemiddelde levensduur was voor de mensen met een gezonde leefstijl 6 jaar langer dan die uit de groep mensen die er een ongezonde leefstijl op na hielden. Zoals gezegd roken, overgewicht en voedingspatroon sprongen er daarbij uit als voornaamste boosdoeners.

De onderzoekers zagen minder diabetes-2, minder longziekten en minder hart- en vaatziektes bij mensen met een gezonde levensstijl. Hoe ouder mensen werden hoe vaker er wel dementie optreed los van leefstijl. Mannen hadden eerder kans op een hartaandoening en vrouwen een hoger risico op dementie en parkinson. Waarom dat zo is konden de onderzoekers niet zeggen

Van alle deelnemers werd ca. 35 procent ziek vóór zijn of haar 65ste. Van de meeste deelnemers die slechts 1 ziekte kregen was dat bij een derde kanker. Ca. 25 procent kreeg een ernstige hartaandoening.  

    Het volledige studierapport met veel grafieken: Lifetime risk and multimorbidity of non-communicable diseases and disease-free life expectancy in the general population: A population-based cohort study is gratis in te zien.

    Hier het abstract van de studie zoals gepubliceerd in PLOS medicine met referentielijst:

    Absence of smoking, hypertension, and overweight is associated with a longer overall life expectancy, and most of this increase is due to an extension of disease-free life expectancy. This means that individuals without these risk factors not only live longer than individuals with these risk factors, but also spend less of their lifetime after the onset of symptomatic disease (which is referred to as compression of morbidity).

    Lifetime risk and multimorbidity of non-communicable diseases and disease-free life expectancy in the general population: A population-based cohort study

    • Silvan Licher,

      Roles Data curation, Formal analysis, Investigation, Methodology, Visualization, Writing – original draft, Writing – review & editing

      Affiliation Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • Alis Heshmatollah,

      Roles Data curation, Formal analysis, Investigation, Resources, Visualization, Writing – review & editing

      Affiliations Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands, Department of Neurology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • Kimberly D. van der Willik,

      Roles Data curation, Writing – review & editing

      Affiliations Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands, Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands

    • Bruno H. Ch. Stricker,

      Roles Data curation, Writing – review & editing

      Affiliation Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • Rikje Ruiter,

      Roles Data curation, Writing – review & editing

      Affiliation Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • Emmely W. de Roos,

      Roles Data curation, Writing – review & editing

      Affiliations Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands, Department of Respiratory Medicine, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • Lies Lahousse,

      Roles Data curation, Writing – review & editing

      Affiliations Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium

    • Peter J. Koudstaal,

      Roles Data curation, Writing – review & editing

      Affiliation Department of Neurology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • Albert Hofman,

      Roles Conceptualization, Writing – review & editing

      Affiliation Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America

    • Lana Fani,

      Roles Data curation, Writing – review & editing

      Affiliation Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • Guy G. O. Brusselle,

      Roles Data curation, Writing – review & editing

      Affiliations Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands, Department of Respiratory Medicine, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands, Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium

    • Daniel Bos,

      Roles Methodology, Writing – review & editing

      Affiliations Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America, Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • Banafsheh Arshi,

      Roles Data curation, Writing – review & editing

      Affiliation Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • Maryam Kavousi,

      Roles Data curation, Writing – review & editing

      Affiliation Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • Maarten J. G. Leening,

      Roles Data curation, Writing – review & editing

      Affiliations Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America, Department of Cardiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    • M. Kamran Ikram ,

      Roles Conceptualization, Data curation, Methodology, Supervision, Writing – review & editing

      ‡ These authors are joint senior authors on this work.

      Affiliations Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands, Department of Neurology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

    •  [ ... ],
    • M. Arfan Ikram

      Roles Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Writing – review & editing

      m.a.ikram@erasmusmc.nl

      ‡ These authors are joint senior authors on this work.

      Affiliation Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands

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    • [ view less ]

    Lifetime risk and multimorbidity of non-communicable diseases and disease-free life expectancy in the general population: A population-based cohort study

    • Silvan Licher, 
    • Alis Heshmatollah, 
    • Kimberly D. van der Willik, 
    • Bruno H. Ch. Stricker, 
    • Rikje Ruiter, 
    • Emmely W. de Roos, 
    • Lies Lahousse,  …
    • Peter J. Koudstaal, 
    • Albert Hofman, 
    • Lana Fani
    PLOS
    x

    Abstract

    Background

    Non-communicable diseases (NCDs) are leading causes of premature disability and death worldwide. However, the lifetime risk of developing any NCD is unknown, as are the effects of shared common risk factors on this risk.

    Methods and findings

    Between July 6, 1989, and January 1, 2012, we followed participants from the prospective Rotterdam Study aged 45 years and older who were free from NCDs at baseline for incident stroke, heart disease, diabetes, chronic respiratory disease, cancer, and neurodegenerative disease. We quantified occurrence/co-occurrence and remaining lifetime risk of any NCD in a competing risk framework. We additionally studied the lifetime risk of any NCD, age at onset, and overall life expectancy for strata of 3 shared risk factors at baseline: smoking, hypertension, and overweight. During 75,354 person-years of follow-up from a total of 9,061 participants (mean age 63.9 years, 60.1% women), 814 participants were diagnosed with stroke, 1,571 with heart disease, 625 with diabetes, 1,004 with chronic respiratory disease, 1,538 with cancer, and 1,065 with neurodegenerative disease. NCDs tended to co-occur substantially, with 1,563 participants (33.7% of those who developed any NCD) diagnosed with multiple diseases during follow-up. The lifetime risk of any NCD from the age of 45 years onwards was 94.0% (95% CI 92.9%–95.1%) for men and 92.8% (95% CI 91.8%–93.8%) for women. These risks remained high (>90.0%) even for those without the 3 risk factors of smoking, hypertension, and overweight. Absence of smoking, hypertension, and overweight was associated with a 9.0-year delay (95% CI 6.3–11.6) in the age at onset of any NCD. Furthermore, the overall life expectancy for participants without these risk factors was 6.0 years (95% CI 5.2–6.8) longer than for those with all 3 risk factors. Participants aged 45 years and older without the 3 risk factors of smoking, hypertension, and overweight at baseline spent 21.6% of their remaining lifetime with 1 or more NCDs, compared to 31.8% of their remaining life for participants with all of these risk factors at baseline. This difference corresponds to a 2-year compression of morbidity of NCDs. Limitations of this study include potential residual confounding, unmeasured changes in risk factor profiles during follow-up, and potentially limited generalisability to different healthcare settings and populations not of European descent.

    Conclusions

    Our study suggests that in this western European community, 9 out of 10 individuals aged 45 years and older develop an NCD during their remaining lifetime. Among those individuals who develop an NCD, at least a third are subsequently diagnosed with multiple NCDs. Absence of 3 common shared risk factors is associated with compression of morbidity of NCDs. These findings underscore the importance of avoidance of these common shared risk factors to reduce the premature morbidity and mortality attributable to NCDs.

    Author summary

    Why was this study done?

    • The burden and preventive potential of disease is typically estimated for each non-communicable disease (NCD) separately, yet NCDs often co-occur, which hampers reliable quantification of their overall burden as well as the potential to prevent NCDs jointly in the general population.
    • Smoking, hypertension, and overweight are 3 key risk factors that are shared by all NCDs, but their effects on the lifetime risk of developing any NCD, age at onset, and overall life expectancy with and without NCDs are uncertain.

    What did the researchers do and find?

    • Between 1989 and 2012, we continuously followed 9,061 community-dwelling individuals in the Dutch population-based Rotterdam Study for occurrence of NCDs (stroke, heart disease, diabetes, chronic respiratory disease, cancer, and neurodegenerative disease).
    • Nine out of 10 community-dwelling individuals aged 45 years and older will develop any NCD during their lifetime, with a third of them developing multiple NCDs during follow-up.
    • Individuals without the 3 risk factors of smoking, hypertension, and overweight develop their first NCD on average 9 years later than those with all 3 risk factors.
    • Absence of smoking, hypertension, and overweight is associated with a longer overall life expectancy of about 6 years, and a 2-year compression in lifetime spent with NCDs.

    What do these findings mean?

    • In this western European community, we showed that the burden of NCDs in the general population is extensive and their multimorbidity is common.
    • Absence of smoking, hypertension, and overweight is associated with a longer overall life expectancy, and most of this increase is due to an extension of disease-free life expectancy. This means that individuals without these risk factors not only live longer than individuals with these risk factors, but also spend less of their lifetime after the onset of symptomatic disease (which is referred to as compression of morbidity).
    • These findings underscore the potential to substantially reduce premature NCD morbidity and mortality in the general population through prevention of smoking, hypertension, and overweight.

    Acknowledgments

    We acknowledge the dedication, commitment, and contribution of the inhabitants, general practitioners, and pharmacists of the Ommoord district who took part in the Rotterdam Study. We acknowledge Frank van Rooij as data manager and Brenda C. T. Leening-Kieboom as study coordinator. We thank Jan Heeringa and Jolande Verkroost-van Heemst for their invaluable contribution to the collection of the data.

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