scholarly journals Association Between Combined Lifestyle Factors and Healthy Ageing in Chinese Adults: The Singapore Chinese Health Study

2021 ◽  
Author(s):  
Yan-Feng Zhou ◽  
Xing-Yue Song ◽  
Xiong-Fei Pan ◽  
Lei Feng ◽  
Nan Luo ◽  
...  
Keyword(s):  
Healthy Lifestyle ◽  
Population Attributable Risk ◽  
Lifestyle Factors ◽  
Healthy Eating Index ◽  
Healthy Ageing ◽  
Health Study ◽  
Moderate Activity ◽  
Chinese Adults ◽  
Singapore Chinese

Abstract Background The aim of the study was to examine the relations of individual lifestyle factors and its composite score with healthy ageing among Chinese adults. Method We included 14 159 participants aged 45–74 years at baseline from the Singapore Chinese Health Study, a population-based prospective cohort. A protective lifestyle score (0–5 scale) was calculated at baseline (1993–1998) and updated at the second follow-up visit (2006–2010) on the basis of optimal body mass index (18.5–22.9 kg/m2), healthy diet (upper 40% of the Alternative Healthy Eating Index score), being physically active (≥2 h/wk of moderate activity or ≥0.5 h/wk of strenuous activity), nonsmoking (never smoking), and low-to-moderate alcohol drinking (>0 to ≤14 drinks/wk for men and >0 to ≤7 drinks/wk for women). Healthy ageing was assessed at the third follow-up visit (2014–2016) and was defined as absence of specific chronic diseases, absence of cognitive impairment and limitations in instrumental activities of daily living, good mental and overall self-perceived health, good physical functioning, and no function-limiting pain. Results About 20.0% (2834) of the participants met the criteria of healthy ageing after a median follow-up of 20 years. Each 1-point increase in the protective lifestyle score computed at baseline and second follow-up visits was associated with higher likelihood of healthy ageing by 25% (95% CI: 20%–30%) and 24% (18%–29%), respectively. The population-attributable risk percent of adherence to 4–5 protective lifestyle factors was 34.3% (95% CI: 25.3%–42.3%) at baseline and 31.3% (23.0%–38.7%) at second follow-up visits for healthy ageing. In addition, positive increase in lifestyle scores from baseline to second follow-up visits was also significantly associated with a higher likelihood of healthy ageing with an odds ratio of 1.18 (95% CI: 1.12%–1.24%) for each increment in protective lifestyle score. Conclusions Our findings confirmed that adopting healthy lifestyle factors, even after midlife, was associated with healthy ageing at old age.

Abstract P367: Primordial Prevention of Coronary Heart Disease through Healthy Lifestyle in a Large Prospective Cohort of Young Women

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Andrea K Chomistek ◽  
Stephanie E Chiuve ◽  
A. H Eliassen ◽  
Kenneth J Mukamal ◽  
Eric B Rimm
Keyword(s):  
Healthy Lifestyle ◽  
Population Attributable Risk ◽  
Lifestyle Factors ◽  
Healthy Eating Index ◽  
Poor Adherence ◽  
Health Study ◽  
Cvd Risk ◽  
Primordial Prevention ◽  
Younger Women

Background: Although overall mortality rates from CHD in the U.S. have continued to decline in recent decades, the CHD mortality rate among women 35 to 54 years old has been increasing on average by 1.5% per year since 1997. This unfavorable trend may be explained, in part, by adverse lifestyle habits among younger adults. The purpose of this analysis was to estimate the burden of CHD among younger women that can be attributed to lack of adherence to a healthy lifestyle. Methods and Results: We conducted a prospective analysis among 93,161 women, 27-44 years of age at baseline, enrolled in the Nurses’ Health Study II cohort and followed from 1991 to 2009. Lifestyle factors were assessed repeatedly during follow-up by questionnaire. Healthy lifestyle was defined as not currently smoking, having a BMI of 18.5 [[Unable to Display Character: –]] 24.9 kg/m 2 , engaging in at least 2.5 hours/week of moderate to vigorous-intensity physical activity, having a diet in the top 40% of Alternative Healthy Eating Index-2010, and consuming 5 [[Unable to Display Character: –]] 30g/day of alcohol. To estimate the proportion of CHD that could be attributed to poor adherence to a healthy lifestyle, we calculated the population attributable risk percent. During follow-up, we documented 441 new cases of non-fatal MI and fatal CHD. After adjustment for other CVD risk factors, non-smoking, healthy BMI, exercise, and healthy diet were independently and significantly associated with lower CHD risk. Compared to women with 0 healthy lifestyle factors, the hazard ratio (HR) for CHD was 0.07 (95% CI, 0.03, 0.17) for women with all 5 healthy lifestyle factors (4% of the study population). Approximately 67% (95% CI 28%, 87%) of CHD cases in this population were attributable to poor adherence to a healthy lifestyle. Among non-smokers, 59% (95% CI 13%, 84%) of CHD cases were attributable to poor adherence to the other four healthy lifestyle factors. Conclusions: Primordial prevention through maintenance or adoption of a healthy lifestyle may lower incidence of CHD and potentially reverse the unfavorable trend in CHD mortality in younger women.

scholarly journals Impact of Combined Lifestyle Factors on All-Cause and Cause-Specific Mortality and Life Expectancy in Chinese: The Singapore Chinese Health Study

2019 ◽  
Vol 75 (11) ◽  
pp. 2193-2199
Author(s):  
Xiong-Fei Pan ◽  
Yanping Li ◽  
Oscar H Franco ◽  
Jian-Min Yuan ◽  
An Pan ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Cancer Mortality ◽  
Healthy Lifestyle ◽  
Lifestyle Factors ◽  
Health Study ◽  
Chinese Adults ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Singapore Chinese ◽  
Cvd Mortality

Abstract Background To examine the impact of combined lifestyle factors on premature mortality and life expectancy in Chinese adults. Methods A total of 44,052 Chinese adults aged 45–74 years free of cardiovascular disease (CVD), cancer, and diabetes were followed from recruitment (1993–1998) to the end of 2016 in the Singapore Chinese Health Study. A composite score (0–5 scale) was calculated based on five baseline healthy lifestyle factors including healthy diet, nonsmoking status, light to moderate alcohol drinking, being physically active and optimal body mass index. Mortality cases were identified through linkage with the nationwide death registry. Results Adopting five healthy versus none was associated with a lower risk of all-cause and cause-specific mortality, and the hazard ratio (95% confidence interval [CI]) was 0.38 (0.29, 0.51) for all-cause mortality, 0.26 (0.13, 0.52) for CVD mortality, and 0.59 (0.37, 0.92) for cancer mortality. Nonadherence to 4–5 healthy lifestyle factors accounted for 34.9% (95% CI = 29.2, 40.2) in population attributable fraction for all-cause mortality, 35.1% (23.7, 44.9) for CVD mortality, and 18.0% (6.5, 28.0) for cancer mortality. Conversely, adherence to 4–5 healthy lifestyle factors versus none could achieve a gain of 8.1 years in women and 6.6 years in men for the life expectancy at 50 years. Conclusions A healthier lifestyle is associated with a substantially reduced risk of mortality and a longer life expectancy in the Chinese population. Our findings highlight the necessity of coordinated actions targeting combined lifestyle factors in reducing the overall burden of diseases and premature deaths.

scholarly journals Dietary Intakes of Fatty Acids in Midlife and Risk of Cognitive Impairment in Late Life: The Singapore Chinese Health Study (P01-009-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Yiwen Jiang ◽  
Liting Sheng ◽  
Jian-Min Yuan ◽  
Woon-Puay Koh ◽  
An Pan
Keyword(s):  
Fatty Acids ◽  
Cognitive Impairment ◽  
Lower Risk ◽  
Health Study ◽  
Fat Intake ◽  
Dietary Intakes ◽  
Chinese Adults ◽  
Total Carbohydrate ◽  
Singapore Chinese

Abstract Objectives We aimed to examine the association between dietary intakes of fat and risk of cognitive impairment in Chinese adults, which has rarely been evaluated. Methods The Singapore Chinese Health Study is an ongoing cohort among Chinese adults living in Singapore. Dietary information was assessed by a validated food-frequency questionnaire at baseline (1993–1998) when the participants were aged 45–74 years old. Cognitive impairment was identified using modified Singapore version of Mini-Mental State Examination at the 3rd follow-up interviews (2014–2016). After a mean follow-up of 19.7 years, 16,948 surviving participants was included in the final analysis. Multivariable logistic regression models were used to calculate odds ratio (OR) and 95% confidence interval (CI) with adjustment for potential confounders. Results Cognitive impairment was presented in 2443 participants. Compared to total carbohydrate, dietary fat intake was inversely related to cognitive impairment (OR comparing extreme quartiles = 0.82; 95% CI 0.69–0.97; P-trend = 0.008). The OR (95% CI) comparing extreme quartiles of specific dietary fats was 1.08 (0.89–1.31) for saturated fatty acids (SFAs; P-trend = 0.50), 0.81 (0.65–1.00) for monounsaturated fatty acids (MUFAs; P-trend = 0.03), 0.83 (0.71–0.97) for polyunsaturated fatty acids (PUFAs; P-trend < 0.001), 0.92 (0.77–1.10) for n-3 PUFAs (P-trend = 0.49), and 0.83 (0.71–0.99) for n-6 PUFAs (P-trend = 0.01). Plant-based fat showed an inverse association with cognitive impairment (OR 0.84; 95% CI 0.72–0.98; P-trend = 0.02), whereas no significant association was found for animal fat (P-trend = 0.97). When compared to SFAs, inverse associations remained similar for MUFAs (P-trend = 0.03) and PUFAs (P-trend < 0.001). Conclusions In this large population-based cohort in Chinese adults, we found that substitution of total carbohydrate or SFAs with MUFAs and PUFAs, mainly n-6 PUFAs, was related to a lower risk of cognitive impairment. Furthermore, plant-based fat intake was associated with a lower risk. Our results indicate the importance of considering the quality of fat intake in preventing cognitive impairment. Funding Sources National Medical Research Council, Singapore; National Institutes of Health; National Key Research and Development Program of China. Supporting Tables, Images and/or Graphs

scholarly journals Healthy Lifestyle for Prevention of Premature Death Among Users and Nonusers of Common Preventive Medications: A Prospective Study in Two US Cohorts

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 85-85
Author(s):  
Kai Wang ◽  
Yanping Li ◽  
Gang Liu ◽  
Eric Rimm ◽  
Andrew Chan ◽  
...  
Keyword(s):  
Healthy Lifestyle ◽  
Premature Death ◽  
Healthy Eating Index ◽  
Lipid Lowering ◽  
Health Study ◽  
Cancer Society ◽  
Premature Deaths ◽  
All Cause Mortality ◽  
Population Attributable Risks

Abstract Objectives Adherence to healthy lifestyle and pharmacological therapies represent two major approaches to chronic disease prevention. It remains unknown whether individuals who regularly use preventive medications still benefit from adherence to healthy lifestyle as those not using the medications. We aimed to examine the associations of healthy lifestyle with all-cause and cause-specific mortality among regular users and nonusers of major preventive medications. Methods We prospectively assessed lifestyles and regular use of aspirin, antihypertensives, and lipid-lowering medications through biennial questionnaires among 79,043 women in the Nurses’ Health Study (1988–2014) and 39,544 men in the Health Professionals Follow-up Study (1986–2014). A healthy lifestyle score (ranging 0–5) was defined based on body mass index of ≥18.5 and &lt; 27.5 kg/m2, never smoking, moderate-to-vigorous intensity activity for ≥30 minutes/day, alternate healthy eating index in the upper 40%, and light-to-moderate alcohol intake. We calculated multivariable hazard ratios (HRs) and population-attributable risks (PARs) of death from any cause, cardiovascular disease (CVD), cancer, and other causes in relation to healthy lifestyle according to medication use. Results During a median of 26 years of follow-up, we documented 35,195 deaths. A similar association of healthy lifestyle score with lower all-cause mortality was observed among medication users (HR, 0.82 per one-unit increment; 95% CI, 0.81–0.82) and nonusers (HR, 0.81 per one-unit increment; 95% CI, 0.79–0.83) (P-interaction = 0.54). The fraction of premature deaths that may potentially be prevented by adherence to all the 5 healthy lifestyle factors among medication users and nonusers was 38% (95% CI, 32–42%) and 40% (95% CI, 29–50%) for all-cause mortality, 37% (95% CI, 27–46%) and 45% (95% CI, 18–66%) for CVD mortality, 38% (95% CI, 28–46%) and 33% (95% CI, 14–49%) for cancer mortality, 33% (95% CI, 25–41%) and 38% (95% CI, 20–54%) for other mortality, respectively. Conclusions Adherence to healthy lifestyle confers substantial benefit for prevention of premature death among both regular users and nonusers of preventive medications. Adherence to healthy lifestyle remains important even among individuals regularly using preventive medications. Funding Sources American Cancer Society and NIH.

scholarly journals A healthy lifestyle pattern and the risk of symptomatic gallstone disease: results from 2 prospective cohort studies

2020 ◽  
Vol 112 (3) ◽  
pp. 586-594
Author(s):  
Janine Wirth ◽  
Amit D Joshi ◽  
Mingyang Song ◽  
Dong Hoon Lee ◽  
Fred K Tabung ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Prospective Cohort ◽  
Healthy Lifestyle ◽  
Gallstone Disease ◽  
Lifestyle Factors ◽  
Healthy Eating Index ◽  
Considerable Proportion ◽  
Prospective Cohort Studies ◽  
Symptomatic Gallstone Disease

ABSTRACT Background Symptomatic gallstones cause high financial and disease burden for public health systems. The combined role of diet and other lifestyle factors has not been studied so far. Objectives We aimed to investigate the association between an a priori defined healthy lifestyle score (HLS, including healthy diet, moderate alcohol and regular coffee intakes, never smoking, physical activity, and normal weight) and the risk of symptomatic gallstone disease, and to estimate the proportion of cases potentially preventable by lifestyle modification. Methods We followed 60,768 women from the Nurses’ Health Study (NHS) and 40,744 men from the Health Professionals Follow-up Study (HPFS), both ongoing prospective cohort studies, from baseline (1986) until 2012. Symptomatic gallstone disease was self-reported and validated by review of medical records. The association between the HLS and the risk of symptomatic gallstone disease was investigated using Cox proportional hazards regression. Results During 1,156,079 and 769,287 person-years of follow-up, respectively, 6946 women and 2513 men reported symptomatic gallstone disease. Comparing 6 with 0 points of the HLS, the multivariable HR of symptomatic gallstone disease was 0.26 (95% CI: 0.15, 0.45) for women, and 0.17 (95% CI: 0.07, 0.43) for men. For individual lifestyle factors, multivariable and mutually adjusted partial population attributable risks (women and men) were 33% and 23% for BMI &lt;25 kg/m2, 10% and 18% for ≥2 cups of coffee per day, 13% and 7% for moderate alcohol intake, 8% and 11% for a high Alternate Healthy Eating Index 2010, 9% and 5% for being physically active, and 1% and 5% for never smoking. The full population attributable risk percentage for all factors combined was 62% and 74%, respectively. Conclusions Findings from these large prospective studies indicate that adopting a healthy lifestyle, especially maintaining a healthy weight, can help to prevent a considerable proportion of symptomatic gallstone diseases.

Abstract MP26: Sleep duration and risk of stroke mortality among Chinese adults in Singapore: the Singapore Chinese Health Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
An Pan ◽  
Jian-Min Yuan ◽  
Woon-Puay Koh
Keyword(s):  
Sleep Duration ◽  
Reference Group ◽  
Total Mortality ◽  
Health Study ◽  
Stroke Mortality ◽  
Chinese Adults ◽  
Short Sleep Duration ◽  
Increased Risk ◽  
Long Sleep ◽  
Singapore Chinese

Introduction: Short or long sleep hours are associated with adverse health outcomes, including diabetes, hypertension, coronary heart disease (CHD) and total mortality. However, the prospective relation between sleep duration and stroke risk is less studied, particularly in Asians. Thus, we assessed the hypothesis that short (≤5 hours) and long (≥9 hours) sleep durations were related to increased risk of stroke mortality among Chinese adults residing in Singapore. Methods: The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years during 1993 and 1998. Sleep duration was assessed at baseline and categorized to five groups: ≤5, 6, 7, 8 or ≥9 hours. Death information was identified via registry linkage up to December 31, 2011, with ICD-9 codes 430-438 for all stroke deaths, 430-432 for hemorrhagic, and 433-438 for ischaemic or non-specified stroke deaths. Cox proportional hazard models were used to calculate hazard ratios (HRs) with adjustment for socio-demographic, lifestyle and comorbidities. Results: We documented 1,381 total stroke deaths (322 hemorrhagic and 1,059 ischaemic or non-specified strokes) during 926,752 person-years of follow-up. Compared to the reference group of sleeping for 7 hours, the multivariate-adjusted HR (95% confidence interval) for total stroke mortality was 1.25 (1.05-1.50) for ≤5 hours, 1.01 (0.87-1.18) for 6 hours, 1.09 (0.95-1.26) for 8 hours, and 1.54 (1.28-1.85) for ≥9 hours. The increased risk was also observed for ischaemic or non-specified stroke deaths with short (1.37; 1.12-1.68) and long (1.68; 1.36-2.06) sleep durations, but not for hemorrhagic stroke deaths (0.92 [0.62-1.36] and 1.14 [0.76-1.72], respectively). We observed significant interaction with baseline hypertension (P-interaction=0.04): positive association was found for short (1.54; 1.16-2.03) and long (1.95; 1.48-2.57) sleep durations among individuals with baseline hypertension, but not among those without baseline hypertension (1.07 [0.85-1.36] and 1.27 [0.98-1.63], respectively). Furthermore, in participants without baseline CHD/stroke, short and long sleep durations were related to an increased risk (HR 1.30 [1.07-1.57] and 1.43 [1.16-1.76], respectively); while in CHD/stroke patients, only long sleep duration was associated with an increased risk (2.34; 1.53-3.57), but not the short sleep duration (0.96; 0.57-1.62). Conclusions: In this large cohort study of Chinese adults, both short and long sleep durations were significantly associated with increased risks of stroke mortality. The associations were significant and stronger in hypertensive participants, but not in those without hypertension. Further studies are needed to confirm the interaction with hypertension and explore the mechanisms linking sleep quantity and stroke mortality.

Abstract P196: Bidirectional Association Between Hypertension and Gout: The Singapore Chinese Health Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
An Pan ◽  
Gim Gee Teng ◽  
Jian-Min Yuan ◽  
Woon-Puay Koh
Keyword(s):  
Smoking Status ◽  
Final Analysis ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Increased Risk ◽  
Bidirectional Association ◽  
Singapore Chinese ◽  
Incident Cases

Introduction: Although it has been hypothesized that the hypertension-gout relation is bidirectional, few studies have addressed this hypothesis in a prospective setting, particularly in the Asian populations. Methods: We analyzed data from the Singapore Chinese Health Study (SCHS), a cohort of 63,257 Chinese aged 45-74 years at recruitment from 1993-98. The information about self reports of physician-diagnosed hypertension and gout was enquired at follow-ups I (1999-2004) and II (2006-2010). We included participants with complete data for both follow-ups and who were free of heart disease, stroke and cancer at follow-up I. For the analysis of hypertension and risk of incident gout, participants with prevalent gout were further excluded and the final analysis included 31,694 participants. For the analysis of gout and risk of incident hypertension, participants with prevalent hypertension were further excluded and the final analysis included 20,490 participants. Cox proportional hazards models were used to estimate multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) with adjustment for age, sex, years of interview, dialect group, education, smoking status, alcohol intake, physical activity, body mass index (BMI) and history of diabetes. Results: The mean age of the participants at baseline was 60.1 (SD 7.3) years, and the average follow-up year was 6.8 (SD 1.4) years. In the analysis of hypertension and risk of gout, 836 incident cases were identified. Compared to normotensive participants, hypertensive patients had a 93% increased risk of developing gout (RR 1.93; 95% CI 1.66-2.24). The association was slightly stronger in women (RR 2.09; 95% CI 1.69-2.58) compared to men (RR 1.72; 95% CI 1.39-2.14; P for interaction=0.056). The association was also stronger in normal weight adults (BMI <24 kg/m2; RR 2.25; 95% CI 1.82-2.77) compared to overweight/obese individuals (BMI ≥24 kg/m2; RR 1.66; 95% CI 1.34-2.04; P for interaction=0.03). In the parallel analysis of gout and risk of hypertension, 5491 participants reported to have newly diagnosed hypertension during the follow-up. Compared to participants without gout, those with gout had a 17% increased risk of developing hypertension (RR 1.17; 95% CI 1.01-1.35). The association was evident in men (RR 1.29; 95% CI 1.07-1.55) but not in women (RR 0.94; 95% CI 0.73-1.20; P for interaction=0.03). The association was present in normal weight adults (RR 1.34; 95% CI 1.09-1.64) but not among overweight/obese individuals (RR 0.99; 95% CI 0.80-1.23; P for interaction=0.03). Conclusions: Our results provide compelling evidence that the hypertension-gout association is bidirectional in Chinese population. The potential interactions of the bidirectional association with sex and obesity deserve further investigations.

Leukocyte telomere length, cancer incidence and all‐cause mortality among Chinese adults: Singapore Chinese Health Study

2020 ◽  
Vol 148 (2) ◽  
pp. 352-362
Author(s):  
Hamed Samavat ◽  
Hung N. Luu ◽  
Kenneth B. Beckman ◽  
Aizhen Jin ◽  
Renwei Wang ◽  
...  
Keyword(s):  
Telomere Length ◽  
Cancer Incidence ◽  
Health Study ◽  
Leukocyte Telomere Length ◽  
Chinese Adults ◽  
All Cause Mortality ◽  
Singapore Chinese

scholarly journals Associations between maternal healthy lifestyle score and offspring birth outcomes and childhood obesity: results from the Lifeways Cross-Generation Cohort Study

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Pilar Navarro ◽  
John Mehegan ◽  
Celine Murrin ◽  
Cecily Kelleher ◽  
Catherine Phillips
Keyword(s):  
Physical Activity ◽  
Childhood Obesity ◽  
Birth Outcomes ◽  
Head Circumference ◽  
Alcohol Intake ◽  
Healthy Lifestyle ◽  
Lifestyle Factors ◽  
Healthy Eating Index ◽  
Dietary Quality ◽  
Reduced Risk

AbstractMaternal adherence to healthy lifestyle behaviours during pregnancy has been associated with reduced risk of obesity in the offspring. Our objective is to examine the association between a composite healthy lifestyle score (HLS) derived from body mass index (BMI), dietary quality, physical activity, smoking and alcohol intake, in expectant mothers and adverse offspring birth outcomes and childhood obesity. The Lifeways Cross-Generation Study comprises 1082 mother-child pairs. We defined five healthy lifestyle factors during pregnancy including: high dietary quality (top 40% of the Healthy Eating Index (HEI)-2015), moderate to vigorous physical activity (MVPA), healthy pre-pregnancy BMI (18.5–24.9 Kg/m2), never smoker, and no/moderate alcohol intake. A composite HLS was calculated (scored 0–5). Birthweight, length and head circumference were abstracted from hospital records. Waist circumference and BMI was determined when the child was 5 and 9 years. Logistic regression analyses were used to test HLS and individual HLS component associations with offspring birth and childhood outcomes. Offspring birthweight, length and head circumference were positively associated with the number of maternal healthy lifestyle factors (p < 0.001), whereas child BMI and incidence of overweight/obesity at age 5 and 9 were negatively associated with the maternal HLS (p < 0.05). In multivariable models, a lower maternal HLS (0–2 healthy lifestyle factors) was associated with increased risk of low birthweight (LBW) (OR:1.17, 95% CI:1.01–2.69, p = 0.043) and lower likelihood of macrosomia (OR:0.73, 95% CI:0.24–0.99, p = 0.034), relative to those with 5 healthy lifestyle factors. Examination of the individual HLS components revealed that, poor maternal dietary quality, smoking and alcohol intake were associated with higher risk of LBW (OR:1.61, 95%CI:1.01–7.85, p = 0.043, OR: 2.54, 95%CI:1.26–5.12, p = 0.025 and OR:2.30, 95%CI:1.01–5.26, p = 0.031, respectively). Likelihood of macrosomia and combined overweight/obesity at age 5 and 9 years was greater among mothers with a pre-pregnancy BMI in the obese range (OR:2.18, 95%CI:1.23–3.85, p = 0.042, OR:2.19, 95%CI:1.01–5.08, p = 0.03 and OR:3.89, 95%CI:1.00–10.59, p = 0.04, respectively). Smoking during pregnancy was also linked to greater risk of childhood overweight/obesity (OR:1.91, 95%CI:1.01–3.61, p = 0.04 at age 5 and OR:2.14, 95%CI:1.01–4.11, p = 0.03 at age 9). Our findings suggest that maternal adherence to a healthy lifestyle during pregnancy, in particular having a good quality diet, not smoking and no/low alcohol intake in combination with a healthy pre-pregnancy BMI, is associated with reduced risk of adverse offspring birth outcomes and childhood obesity. These findings highlight the potential benefits of implementing maternal based multifactorial interventions to improve offspring birth outcomes and combat childhood adiposity.

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