Explore each chapter to understand the effort, benefits and context.
This chapter includes two kinds of chronic risk: those with a large effect on overall mortality, and those supported by strong evidence. Entries run roughly from higher to lower value for the effort or money involved. Some explicitly cite randomized trials, which assign people to comparison groups at random and provide the most reliable results. Other figures come from observational studies that follow people without assigning their behavior. Their HRs, RRs and other relative-risk measures can mix together two problems: people differ to begin with, and some change their behavior because they are already ill. Those figures indicate direction and approximate size, not the reduction you are guaranteed by following the advice. Unless another country or currency is specified, prices here are rough Chinese-market estimates in renminbi.
People walking about 5,800 steps daily had roughly 40% lower mortality than those walking 3,500; at about 7,800 steps the difference was 45%. Benefits rise further before flattening. For people over 60, the plateau was around 6,000–8,000 steps.
Smokers live over ten years less on average than nonsmokers. Quitting before 40 removes roughly 90% of the excess mortality associated with continuing. The earlier you quit, the more years you regain.
The global estimate is around 600,000 deaths from secondhand smoke in a year, nearly 30% among children. Long-term exposure is associated with roughly 30% higher risks of hypertension, heart disease and stroke. Exposure at home appears more harmful than exposure elsewhere.
Most people do not succeed by endurance alone. Varenicline more than doubles the quit rate compared with placebo. Nicotine patches, gum and similar replacement products improve success by about 50%; combining a patch with gum improves it by another 20% or more.
Gradually reducing a few cigarettes each day feels appealing. But at six months in the cited trial, 22% of people assigned to stop all at once remained abstinent, versus 15.5% assigned to taper. Set a date and stop that day.
Medicine and regular follow-up provide different kinds of help, and work best together. People receiving both were almost twice as likely to quit as those given brief advice alone. Phone support counts: proactive follow-up calls can improve success by another 20%–30%.
Switching to nicotine e-cigarettes helped about 60% more people quit than nicotine replacement, with strong evidence for that result. E-cigarettes are not harmless, and long-term safety data remain unavailable. They offer no benefit to someone who does not already smoke.
People drinking two or more sugary servings daily had about 20% higher mortality than people drinking almost none; one or two servings was associated with over 10% higher mortality. Diet drinks did not show a mortality benefit: more than two glasses daily was associated with roughly 25% higher mortality.
Betel-quid chewers had about 20% higher mortality than non-chewers, and nearly 50% higher diabetes and metabolic-syndrome risks. Oral and esophageal cancer risks are additional concerns.
Among people with a previous stroke or hypertension after 60, replacing ordinary salt reduced deaths by about 12% and strokes by 14% over roughly five years.
Daily interdental cleaning was associated with about 10% lower mortality. Older people with no teeth had roughly 90% higher mortality odds; those with fewer than 20 teeth had about double the odds.
Lowering blood pressure by 10 mmHg reduces mortality by about 13% and stroke by 27%. Lowering LDL cholesterol by one unit with a statin reduces mortality by about 10%. People taking medicines consistently had 30%–45% lower mortality than frequent missed-dose users.
Habitually short sleepers had about 10% higher mortality. Irregular schedules were also associated with higher risk: more regular sleepers had 20%–nearly 50% lower mortality than the least regular. Regularity predicted mortality better than duration.
People doing 150–300 minutes of brisk walking weekly had about 30% lower mortality than inactive people. Even less activity was associated with a 20% reduction. At three to five times the minimum, the reduction peaked near 40%; more did not add benefit but did not show harm.
Regular tennis, badminton or table-tennis players had about half the mortality and 56% less cardiovascular mortality than nonplayers. Swimmers had 28% lower overall mortality. Running and football showed no clear difference in this dataset.
Among people who did no structured exercise, three daily bursts of vigorous activity lasting one or two minutes were associated with about 40% lower mortality and nearly half the cardiovascular mortality. Stair climbing and hurrying on foot count.
People doing 30–60 minutes of weekly strength training had 10%–20% lower mortality than those doing none. More did not show extra benefit. Combining strength work with aerobic activity had the best outcomes.
The most sedentary people had 2.6 times the mortality of the least sedentary, and longer uninterrupted sitting added a separate association. Around 60–75 minutes of moderate activity daily largely offset the excess mortality associated with sitting.
The highest processed-meat consumers had about 20% higher mortality than the lowest. An extra daily serving was also associated with roughly 20% higher mortality.
Beyond 100 g of pure alcohol weekly—roughly 2.5 L of beer—higher intake was associated with shorter life. At age 40, weekly intake of 100–200 g corresponded to about six months less life, 200–350 g to one or two years less, and over 350 g to four or five years less. Across overall health outcomes, the lowest-risk amount was zero.
Suddenly stopping after prolonged heavy daily drinking can cause withdrawal. Mild symptoms include shaking, sweating, palpitations and insomnia; seizures or delirium tremens are life-threatening emergencies. In a Norwegian cohort of over 30,000 people, those with delirium tremens had 8% annual mortality afterward. Tell a clinician exactly how much you drink before quitting.
A clinician spending a few minutes reviewing your intake, explaining risk and agreeing a goal led to an average reduction of 20 g of pure alcohol weekly after a year—about half a liter of beer. Longer discussions did not add benefit. For people unable to control drinking, two medicines studied abroad helped; roughly one additional person benefited for every 12 treated.
Regular nut eaters had around 20% lower mortality than people eating none. Even once weekly was associated with about 10% lower risk; a daily handful showed the largest difference.
Two additional weekly servings of processed or red meat were associated with about 3% higher mortality; equivalent servings of fish or poultry showed no increase. This is a relatively small effect, worth an easy swap rather than an elaborate effort.
An extra 90 g of whole grains daily—about three servings—was associated with 17% lower mortality. Benefits continued up to around 200 g/day.
Habitual tea drinkers had about 15% lower mortality. From age 50, they had an estimated 1.26 additional years of life and 1.41 additional years free of cardiovascular disease.
Three or four daily cups were associated with about 17% lower mortality than no coffee.
Each extra 200 g/day was associated with about 10% lower mortality. Five servings versus two was associated with 13% lower mortality; one analysis found no further decrease above five.
High consumers had about 20% higher mortality and 50% higher cardiovascular mortality than low consumers. Certainty was rated low, so the numbers deserve caution.
Coal or wood cooking was associated with about 10% higher mortality, and solid-fuel heating with about 14% higher mortality. People who had switched to electricity or gas had 13%–33% lower mortality than those still using solid fuels.
Very hot tea was associated with eight times the odds of esophageal cancer compared with warm tea; even “hot” tea carried about twice the odds. Drinking within two minutes of pouring carried about five times the odds of waiting at least four minutes.
Women who deliberately avoided the sun had life expectancy 0.6–2.1 years shorter than those with the most exposure. Nonsmokers who avoided sunlight had a similar life expectancy to smokers in the highest-exposure group.
Mortality was lowest at BMI 20–25. At 27.5–30 it was about 20% higher, at 30–35 about 45% higher, and at 35–40 nearly double. East Asian populations showed particular sensitivity: each additional 5 BMI units above 25 was associated with about 40% higher risk.
People eating chili more than four times weekly had about 23% lower mortality and about one-third lower cardiovascular mortality than those rarely eating it.
More than two daily dairy servings was associated with about 17% lower mortality than none.
Each additional half whole egg daily was associated with about 7% higher mortality. Modeled replacement with egg whites, fish, poultry or nuts was associated with lower mortality. There is no need to quit eggs; the source cautions against three or four daily.
Almost-daily bathers had about 28% lower cardiovascular-event risk and 46% lower cerebral-hemorrhage risk than people bathing no more than twice weekly.
Naps under an hour were not associated with higher mortality or chronic-disease risk and improved alertness. Naps over an hour were associated with about 30% higher coronary risk and 20% higher diabetes and obesity risk. Set an alarm for half an hour. If you cannot cope without one or two hours daily, investigate why.
People who did not recover after short sleep had about 15% higher mortality than regular sleepers; severe unrecovered sleep loss was associated with 42% higher mortality. Groups that caught up showed no statistically clear increase. Go to bed earlier the following night.
Night workers had about 13% more cardiovascular disease and 27% more cardiovascular deaths. Each additional five years of night work was associated with another 7% increase in disease. Consider the cumulative years when weighing a transfer. Cancer evidence is much weaker than common claims suggest.
Damp, moldy peanuts can contain aflatoxins, established carcinogens that mainly damage the liver. After Guangzhou tightened small-workshop regulation, abnormal liver tests in high-consumption communities fell by about 35%. In Guangxi, maternal use of homemade peanut oil was associated with about 90% higher low-birth-weight odds and 80% higher preterm-birth odds.
Replacing saturated fats such as lard and butter reduced cardiovascular events by about 17%, without a clear change in overall mortality. There is no evidence here that rotating soybean, corn and rapeseed oils changes outcomes. More flaxseed oil did not clearly reduce coronary disease.