Smoking cessation and effective obesity management together with improvements in exercise and diet could cut premature deaths in female patients by 55 per cent, according to a US cohort study.

Researchers compared mortality data with information on weight, diet, smoking status, alcohol consumption and exercise levels collected from 77,782 women who took part in the Nurses' Health Study between 1980 and 2004.

The women were aged 34 to 59 years and were free of cardiovascular disease (CVD) and cancer when they were recruited. During follow up, 8,882 women died. Cancer accounted for 4,527 deaths and CVD for 1,790.

Smoking was associated with a 66 per cent increased mortality risk. Being overweight, lack of exercise and a poor diet were also associated with greater mortality. However, women with all four lifestyle risk factors had the highest mortality.

The researchers found that 55 per cent of deaths from any cause, 44 per cent of deaths from cancer and 72 per cent of deaths from CVD were attributable to a combination of lifestyle factors. They recommend intensifying efforts to promote healthy lifestyle choices.

Dr David Haslam, clinical director of the National Obesity Forum, agreed that lifestyle interventions were one of the things that general practice should focus on. 'Lifestyle interventions such as weight management programmes can be incentivised for very quick health gains.'

Professor of prescribing and medicines management at Reading University, Molly Courtenay, also backed greater lifestyle interventions in the QOF. She added: 'Nurses would be ideal for delivering these sorts of messages.'

BMJ 2008; 337: 1,440

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