BackgroundThere is overwhelming evidence that behavioural factors influence health, but their combined impact on the general population is less well documented. We aimed to quantify the potential combined impact of four health behaviours on mortality in men and women living in the general community.Methods and FindingsWe examined the prospective relationship between lifestyle and mortality in a prospective population study of 20,244 men and women aged 45–79 y with no known cardiovascular disease or cancer at baseline survey in 1993–1997, living in the general community in the United Kingdom, and followed up to 2006. Participants scored one point for each health behaviour: current non-smoking, not physically inactive, moderate alcohol intake (1–14 units a week) and plasma vitamin C >50 mmol/l indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from zero to four. After an average 11 y follow-up, the age-, sex-, body mass–, and social class–adjusted relative risks (95% confidence intervals) for all-cause mortality(1,987 deaths) for men and women who had three, two, one, and zero compared to four health behaviours were respectively, 1.39 (1.21–1.60), 1.95 (1.70–-2.25), 2.52 (2.13–3.00), and 4.04 (2.95–5.54) p < 0.001 trend. The relationships were consistent in subgroups stratified by sex, age, body mass index, and social class, and after excluding deaths within 2 y. The trends were strongest for cardiovascular causes. The mortality risk for those with four compared to zero health behaviours was equivalent to being 14 y younger in chronological age.ConclusionsFour health behaviours combined predict a 4-fold difference in total mortality in men and women, with an estimated impact equivalent to 14 y in chronological age.

Aim To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5‐year follow‐up. Method We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40–69 years from the ADDITION‐Cambridge trial. Participants were identified via stepwise screening between 2002 and 2006, and underwent assessment of weight change, physical activity (EPAQ2 questionnaire), diet (plasma vitamin C and self‐report), and alcohol consumption (self‐report) at baseline and 1 year after diagnosis. Remission was examined at 5 years after diabetes diagnosis via HbA1c level. We constructed log binomial regression models to quantify the association between change in behaviour and weight over both the first year after diagnosis and the subsequent 1–5 years, as well as remission at 5‐year follow‐up. Results Diabetes remission was achieved in 257 participants (30%) at 5‐year follow‐up. Compared with people who maintained the same weight, those who achieved ≥ 10% weight loss in the first year after diagnosis had a significantly higher likelihood of remission [risk ratio 1.77 (95% CI 1.32 to 2.38; p<0.01)]. In the subsequent 1–5 years, achieving ≥10% weight loss was also associated with remission [risk ratio 2.43 (95% CI 1.78 to 3.31); p<0.01]. Conclusion In a population‐based sample of adults with screen‐detected Type 2 diabetes, weight loss of ≥10% early in the disease trajectory was associated with a doubling of the likelihood of remission at 5 years. This was achieved without intensive lifestyle interventions or extreme calorie restrictions. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of Type 2 diabetes.

No abstract

Motivated by problems in percolation theory, we study the following 2-player positional game. Let Λ m×n be a rectangular grid-graph with m vertices in each row and n vertices in each column. Two players, Maker and Breaker, play in alternating turns. On each of her turns, Maker claims p (as-yet unclaimed) edges of the board Λ m×n , while on each of his turns Breaker claims q (as-yet unclaimed) edges of the board and destroys them. Maker wins the game if she manages to claim all the edges of a crossing path joining the left-hand side of the board to its right-hand side, otherwise Breaker wins. We call this game the (p, q)-crossing game on Λ m×n .Given m, n ∈ N, for which pairs (p, q) does Maker have a winning strategy for the (p, q)crossing game on Λ m×n ? The (1, 1)-case corresponds exactly to the popular game of Bridg-it, which is well understood due to it being a special case of the older Shannon switching game. In this paper, we study the general (p, q)-case. Our main result is to establish the following transition:• if p 2q, then Maker wins the game on arbitrarily long versions of the narrowest board possible, i.e. Maker has a winning strategy for the (2q, q)-crossing game on Λ m×(q+1) for any m ∈ N;• if p 2q − 1, then for every width n of the board, Breaker has a winning strategy for the (p, q)-crossing game on Λ m×n for all sufficiently large board-lengths m.Our winning strategies in both cases adapt more generally to other grids and crossing games.In addition we pose many new questions and problems.

Background The Dietary Approaches to Stop Hypertension (DASH) eating plan, developed by the National Institutes of Health in the USA, has been shown in both observational and experimental studies to reduce blood pressure, prevent chronic disease and reduce body weight. Despite its effectiveness it has not been promoted in the UK, although previous work has shown its cultural appropriateness and effectiveness in reducing blood pressure in a UK sample. In this study we characterised accordance with the DASH diet in a representative UK sample for the first time.Methods We analysed the four-day dietary intakes of 1491 adults (650 men, 841 women) included in years 1-3 of the rolling programme of the National Diet and Nutrition Survey (NDNS). We assessed DASH accordance using a score that has been shown to be strongly associated with disease incidence. To derive this accordance score we ranked NDNS participants by intake of eight foods and nutrients, adjusted for energy, and assigned between one and five points for each food/nutrient group based on their consumption quintile. These points were summed to create the final score with a range between eight (least accordant) to 40 (most accordant). We used surveyweighted linear regression to estimate mean age-adjusted accordance scores for men and women and estimated sex-adjusted scores for a range of age-groups. Age-and sex-adjusted accordance scores were estimated for three different indicators of individual-level socio-economic status: household income, occupational class and qualification level. Results The mean DASH accordance score for the population was 24.9 (standard deviation 5.6), and was significantly higher in women (mean 25.8, 95% CI 25.5-26.2) than men (mean 23.6, 95% CI 23.2-23.9). DASH accordance varied by age group, with those aged 19-34 years the least DASH accordant (mean 22.4, 95% CI 21.9-22.9) and those aged 55-64 the most (mean 26.6, 95% CI 25.9-27.2). DASH accordance was significantly higher in higher socio-economic status (SES) groups and lower in lower SES groups across all three measures of SES. The greatest difference between the highest and lowest categories was in occupational class (27.4 vs. 21.5 in the highest versus lowest groups, respectively) and the least in household income (26.5 vs. 23.1). Conclusion Accordance with the DASH diet varies by demographic and socio-economic characteristics in the UK population, revealing a social gradient in diet quality. Promoting the adoption of DASH diets could be part of a broader, population-based approach to prevent chronic disease but the observed gradient indicates that barriers may exist to the adoption of DASH diets.

No abstract