Skip to main content
SpringerLink
Log in

Epidemiology and Population Health

Associations between a protective lifestyle behaviour score and biomarkers of chronic low-grade inflammation: a cross-sectional analysis in middle-to-older aged adults

  • Article
  • Published:
International Journal of Obesity Submit manuscript

Abstract

Background/objectives

Certain lifestyle behaviours may have a protective effect against low-grade systemic inflammation, which is linked to chronic disease. Our objective was to examine associations between a five-component protective lifestyle behaviour (PLB) score and a range of pro-inflammatory cytokines, adipocytokines, acute-phase response proteins, coagulation factors and white blood cells.

Subjects/methods

This was a cross-sectional study of 2045 middle-to-older aged men and women. Low-risk behaviours included never smoking, moderate alcohol intake, moderate-to-vigorous physical activity, a high-quality diet (upper 40% Dietary Approaches to Stop Hypertension score) and a normal body mass index (BMI) (18.5–24.9 kg/m2). Linear and logistic regression analyses tested individual protective behaviour and PLB score associations with biomarkers.

Results

Analysis of individual low-risk behaviours revealed varied associations depending on the biomarker, with normal BMI showing the most consistent associations. Examination of the PLB score showed that compared to subjects with 4–5 protective behaviours, those with 0–1 protective behaviours had 1.4–3.8 increased odds of having a less favourable inflammatory profile. Following adjustment for BMI, significant trend relationships were observed between the number of protective behaviours and complement component 3 (P < 0.001), c-reactive protein (P < 0.001), interleukin 6 (P < 0.001), tumour necrosis factor alpha (P < 0.001) and white blood cell count (P < 0.001) concentrations.

Conclusions

These results suggest a cumulative protective effect of healthy lifestyle behaviours against systemic inflammation in middle-to-older aged adults which is independent of having a healthy body weight.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization. Preventing chronic diseases: a vital investment. Geneva: World Health Organization; 2005.

  2. Villegas R, Kearney PM, Perry IJ. The cumulative effect of core lifestyle behaviours on the prevalence of hypertension and dyslipidemia. BMC Public Health. 2008;8:210.

    Article  PubMed  PubMed Central  Google Scholar 

  3. O’Doherty MG, Cairns K, O’Neill V, Lamrock F, Jørgensen T, Brenner H, et al. Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES). Eur J Epidemiol. 2016;31:455–68.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yusuf S, Hawken S, Ôunpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.

    Article  PubMed  Google Scholar 

  5. Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. Prev Med. 2012;55:163–70.

    Article  PubMed  Google Scholar 

  6. Plassman BL, Williams JW, Burke JR, Holsinger T, Benjamin S. Systematic review: factors associated with risk for and possible prevention of cognitive decline in later life. Ann Intern Med. 2010;153:182–93.

    Article  PubMed  Google Scholar 

  7. Deary IJ, Corley J, Gow AJ, Harris SE, Houlihan LM, Marioni RE, et al. Age-associated cognitive decline. Br Med Bull. 2009;92:135–52.

    Article  PubMed  Google Scholar 

  8. Beaglehole R, Yach D. Globalisation and the prevention and control of non-communicable disease: the neglected chronic diseases of adults. Lancet. 2003;362:903–8.

    Article  CAS  PubMed  Google Scholar 

  9. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. Canadian Med Assoc J. 2006;174:801–9.

    Article  Google Scholar 

  10. Harrington JM, Fitzgerald AP, Kearney PM, McCarthy VJ, Madden J, Browne G, et al. DASH diet score and distribution of blood pressure in middle-aged men and women. Am J Hypertens. 2013;26:1311–20.

    Article  PubMed  Google Scholar 

  11. Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van Horn L, Lichtenstein AH, et al. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation. 2010;122:406–41.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lee WJ, Liang CK, Peng LN, Chiou ST, Chen LK. Protective factors against cognitive decline among community‐dwelling middle‐aged and older people in Taiwan: A 6‐year national population‐based study. Geriatr Gerontol Int. 2017;17:20–27.

    Article  PubMed  Google Scholar 

  13. Li Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH, et al. Impact of healthy lifestyle factors on life expectancies in the US population. Circulation. 2018;117:032047

    Google Scholar 

  14. Phillips CM, Perry IJ. Does Inflammation Determine Metabolic Health Status in Obese and Nonobese Adults? J Clin Endocrinol Metab. 2013;98:E1610–E1619.

    Article  CAS  PubMed  Google Scholar 

  15. Millar SR, Perry IJ, Phillips CM. HbA1c alone is a poor indicator of cardiometabolic risk in middle-aged subjects with pre-diabetes but is suitable for type 2 diabetes diagnosis: a cross-sectional study. PloS One. 2015;10:e0134154.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Phillips CM, Shivappa N, Hébert JR, Perry IJ. Dietary inflammatory index and mental health: a cross-sectional analysis of the relationship with depressive symptoms, anxiety and well-being in adults. Clin Nutr. 2018;37:1485–91.

    Article  PubMed  Google Scholar 

  17. Phillips C, Shivappa N, Hébert J, Perry I. Dietary inflammatory index and biomarkers of lipoprotein metabolism, inflammation and glucose homeostasis in adults. Nutrients. 2018;10:1033.

    Article  PubMed Central  Google Scholar 

  18. Howcroft TK, Campisi J, Louis GB, Smith MT, Wise B, Wyss-Coray T, et al. The role of inflammation in age-related disease. Aging. 2013;5:84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Hansson GK, Hermansson A. The immune system in atherosclerosis. Nat Immunol. 2011;12:204.

    Article  CAS  PubMed  Google Scholar 

  20. Donath MY, Shoelson SE. Type 2 diabetes as an inflammatory disease. Nat Rev Immunol. 2011;11:98.

    Article  CAS  PubMed  Google Scholar 

  21. Calder PC, Bosco N, Bourdet-Sicard R, Capuron L, Delzenne N, Doré J, et al. Health relevance of the modification of low grade inflammation in ageing (inflammageing) and the role of nutrition. Ageing Res Rev. 2017;40:95–119.

    Article  CAS  PubMed  Google Scholar 

  22. Casas R, Sacanella E, Estruch R. The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases. Endocr Metab Immune Disorders Drug Targ. 2014;14:245–54.

    Article  CAS  Google Scholar 

  23. Phillips CM, Harrington JM, Perry IJ. Relationship between dietary quality, determined by DASH score, and cardiometabolic health biomarkers: A cross-sectional analysis in adults. Clin Nutr. 2018;38:1620–8.

    Article  PubMed  Google Scholar 

  24. Jarvandi S, Davidson NO, Jeffe DB, Schootman M. Influence of lifestyle factors on inflammation in men and women with type 2 diabetes: results from the National Health and Nutrition Examination Survey, 1999–2004. Ann Behav Med. 2012;44:399–407.

    Article  PubMed  Google Scholar 

  25. Nivukoski U, Niemel M, Bloigu A, Bloigu R, Aalto M, Laatikainen T, et al. Impacts of unfavourable lifestyle factors on biomarkers of liver function, inflammation and lipid status. PloS one. 2019;14(6):e0218463.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sotos-Prieto M, Bhupathiraju S, Falcon L, Gao X, Tucker K, Mattei J. Association between a healthy lifestyle score and inflammatory markers among Puerto Rican adults. Nutr Metab Cardiovasc Dis. 2016;26:178–84.

    Article  CAS  PubMed  Google Scholar 

  27. Kearney PM, Harrington JM, Mc Carthy VJ, Fitzgerald AP, Perry IJ. Cohort Profile: The Cork and Kerry Diabetes and Heart Disease Study. Int J Epidemiol. 2013;42:1253–62.

    Article  PubMed  Google Scholar 

  28. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95.

    Article  Google Scholar 

  29. Riboli E, Elmståhl S, Saracci R, Gullberg B, Lindgärde F. The Malmö Food Study: validity of two dietary assessment methods for measuring nutrient intake. Int J Epidemiol. 1997;26:S161.

    Article  PubMed  Google Scholar 

  30. Bingham SA, Gill C, Welch A, Cassidy A, Runswick SA, Oakes S, et al. Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. Int J Epidemiol. 1997;26:S137. suppl_1

    Article  PubMed  Google Scholar 

  31. Harrington J. Validation of a food frequency questionnaire as a tool for assessing nutrient intake. Galway: NUI; 1997.

  32. Friel S, Nic Gabhainn S, Kelleher C. The national health and lifestyle surveys: Survey of Lifestyle, Attitude and Nutrition, (SLAN) & the Irish Health Behaviour in School-aged Children survey (HBSC). Dublin: Health Promotion Unit, Department of Health and Children; 1999.

  33. Kelleher C, Nic Gabhainn S, Friel S, Corrigan H, Nolan G, Sixsmith J, et al. The National Health and Lifestyle Surveys (II) Survey of Lifestyle, Attitudes and Nutrition (SLÁN) and the Irish Health Behaviour in School-Aged children survey (HBSC). Dublin: Department of Health and Children; 2003.

  34. Morgan K, McGee H, Watson D, Perry I, Barry MM, Shelley E, et al. SLÁN 2007: Survey of Lifestyle, Attitudes and Nutrition in Ireland. Main Report. Dublin: Department of Health and Children; 2008.

  35. Murrin C. Maternal factors during pregnancy contributing to early life risk of childhood obesity [PhD Thesis]. University College Dublin, 2010.

  36. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Int Med. 2008;168:713–20.

    Article  Google Scholar 

  37. Maher GM, Perry CP, Perry IJ, Harrington JM. Protective lifestyle behaviours and depression in middle-aged Irish men and women: a secondary analysis. Public Health Nutr. 2016;19:2999–3006.

    Article  PubMed  Google Scholar 

  38. Harrington J, Perry I, Lutomski J, Morgan K, McGee H, Shelley E, et al. SLÁN 2007: Survey of Lifestyle, Attitudes and Nutrition in Ireland. Dietary Habits of the Irish Population. Dublin: Department of Health and Children; 2008.

  39. Khaw K-T, Wareham N, Bingham S, Welch A, Luben R, Day N. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med. 2008;5:e12.

    Article  PubMed  PubMed Central  Google Scholar 

  40. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36:S67–S74.

    Article  Google Scholar 

  41. Clarke D, Romano JP, Wolf M. The Romano-Wolf Multiple Hypothesis Correction in Stata. 2019. https://www.iza.org/publications/dp/12845/the-romano-wolf-multiple-hypothesis-correction-in-stata.

  42. Navarro SL, Kantor ED, Song X, Milne GL, Lampe JW, Kratz M, et al. Factors associated with multiple biomarkers of systemic inflammation. Cancer Epidemiol Prev Biomarkers 2016. https://doi.org/10.1158/1055-9965.EPI-15-0956.

  43. Abramson JL, Vaccarino V. Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults. Arch Int Med. 2002;162:1286–92.

    Article  Google Scholar 

  44. Karch I, Olszowska M, Tomkiewicz L, Drapisz S, Łuszczak J, Podolec P. The effect of physical activity on serum levels of selected biomarkers of atherosclerosis. Kardiologia Polska. 2013;71:55–60.

    PubMed  Google Scholar 

  45. Phillips CM, Dillon CB, Perry IJ. Does replacing sedentary behaviour with light or moderate to vigorous physical activity modulate inflammatory status in adults? Int J Behav Nutr Phys Activity. 2017;14:138.

    Article  Google Scholar 

  46. Peterson R. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256:183–94.

    Article  Google Scholar 

  47. Galland L. Diet and inflammation. Nutr Clin Pract. 2010;25:634–40.

    Article  PubMed  Google Scholar 

  48. Millar SR, Harrington JM, Perry IJ, Phillips CM. Protective lifestyle behaviours and lipoprotein particle subclass profiles in a middle-to older-aged population. Atherosclerosis. 2020;314:18–26.

    Article  CAS  PubMed  Google Scholar 

  49. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. 2014;17:1689–96.

    Article  PubMed  Google Scholar 

  50. Poulsen MM, Fjeldborg K, Ornstrup MJ, Kjær TN, Nøhr MK, Pedersen SB. Resveratrol and inflammation: challenges in translating pre-clinical findings to improved patient outcomes. Biochim et Biophys Acta. 2015;1852:1124–36.

    Article  CAS  Google Scholar 

  51. Van Cleemput M, Heyerick A, Libert C, Swerts K, Philippé J, De Keukeleire D, et al. Hop bitter acids efficiently block inflammation independent of GRα, PPARα, or PPARγ. Mol Nutr Food Res. 2009;53:1143–55.

    Article  PubMed  Google Scholar 

  52. Yadav VR, Prasad S, Sung B, Aggarwal BB. The role of chalcones in suppression of NF-κB-mediated inflammation and cancer. Int Immunopharmacol. 2011;11:295–309.

    Article  CAS  PubMed  Google Scholar 

  53. Lau ES, Paniagua SM, Guseh JS, Bhambhani V, Zanni MV, Courchesne P, et al. Sex differences in circulating biomarkers of cardiovascular disease. J Am College Cardiol. 2019;74:1543–53.

    Article  CAS  Google Scholar 

  54. World Health Organization. Global health and aging. Geneva: World Health Organization; 2011.

  55. Hinchion R, Sheehan J, Perry I. Primary care research: patient registration. Ir Med J. 2002;95:249–249.

    PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by a research grant from the Irish Health Research Board (reference: HRC/2007/13) and Breakthrough Cancer Research (reference: BCR-2018-07 PH-UCC). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

Authors and Affiliations

  1. HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Western Gateway Building, College Rd, Cork, Ireland

    Seán R. Millar, Janas M. Harrington, Ivan J. Perry & Catherine M. Phillips

  2. School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland

    Catherine M. Phillips

Authors
  1. Seán R. Millar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janas M. Harrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ivan J. Perry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catherine M. Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SRM, IJP, and CMP were responsible for conceptualisation; SRM conducted the statistical analysis and wrote the manuscript; CMP, JMH, and IJP were responsible for project administration and funding acquisition; SRM and JMH contributed to the methodology, including data collection and data management. All authors contributed to the critical review and editing of the manuscript for important intellectual content and approved the final manuscript.

Corresponding author

Correspondence to Seán R. Millar.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Millar, S.R., Harrington, J.M., Perry, I.J. et al. Associations between a protective lifestyle behaviour score and biomarkers of chronic low-grade inflammation: a cross-sectional analysis in middle-to-older aged adults. Int J Obes 46, 476–485 (2022). https://doi.org/10.1038/s41366-021-01012-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-021-01012-z

  • Springer Nature Limited

This article is cited by

Search

Navigation