The association of the Healthy Lifestyle Index (HLI) and HLI trajectories with risk of all-cause and cause-specific mortality: a GRADE-assessed dose-response systematic review and meta-analysis.

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: HR 0.48 (52% risk reduction)

• Primary Outcome: All-cause mortality with higher HLI adherence

• Nnt Or Sensitivity: Trajectory analysis: 20% lower all-cause mortality risk with HLI improvement vs 14% higher risk with HLI decline

• Confidence Interval: 95% CI 0.46 to 0.53

Clinical Application

Lifestyle interventions are feasible and cost-effective in Australian healthcare settings Aligns with RACGP guidelines for lifestyle medicine, supports PBS-funded lifestyle intervention programs, and complements TGA-approved preventive health strategies Adult patients across primary care, cardiology, and oncology settings

Abstract

BACKGROUND: The Healthy Lifestyle Index (HLI) integrates key behaviours to assess their cumulative impact on health. While higher HLI adherence is linked to lower disease and mortality risk, its long-term trajectory association remains understudied. This study aims to examine the dose-response relationship and long-term association of HLI on mortality risks. DESIGN: Systematic review and dose-response meta-analysis using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. DATA SOURCES: PubMed, Scopus and Web of Science were searched until June 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included observational cohort studies that assessed the relationship of HLI or its trajectories with all-cause, cardiovascular disease (CVD)-cause or cancer-cause of mortality. RESULT: Analysis of 13.7 million participants demonstrated that higher adherence to the HLI is linked to lower risk of all-cause (HR: 0.48; 95% CI 0.46 to 0.53; GRADE: moderate), CVD-cause (HR: 0.49; 95% CI 0.44 to 0.51; GRADE: moderate) and cancer-cause mortality (HR: 0.55; 95% CI 0.49 to 0.61; GRADE: low). These associations were further confirmed in a dose-response manner. Moreover, compared with maintaining an unhealthy lifestyle, a decline in HLI adherence was associated with a 14% higher risk of all-cause and a 19% higher risk of cancer-related mortality. In contrast, an improvement in HLI adherence was linked to a 20% lower risk of all-cause and a 13% lower risk of cancer-related mortality. CONCLUSION: Adherence to HLI and its long-term patterns are associated with lower mortality risk. These findings emphasise the importance of lifestyle-based prevention and intervention strategies in reducing mortality. PROSPERO REGISTRATION NUMBER: CRD42024500538.

References

1. 1.HasanRashedi, M., Norouzzadeh, M., Gohari Dezfuli, Z., Jamshidi, S., Mehdipoor, F., Ghoreishy, S. M., Teymoori, F., Shidfar, F., & Eskandari, R. (2026). The association of the Healthy Lifestyle Index (HLI) and HLI trajectories with risk of all-cause and cause-specific mortality: a GRADE-assessed dose-response systematic review and meta-analysis. BMJ Open. https://doi.org/10.1136/bmjopen-2025-104953