{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Nutritional Sciences Research Center, Iran University of Medical Sciences, Tehran, Iran",
        "Department of Nutrition, Iran University of Medical Sciences, Tehran, Iran",
        "Student Research Committee, Iran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Minoo HasanRashedi"
    },
    {
      "affiliations": [
        "Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Mostafa Norouzzadeh"
    },
    {
      "affiliations": [
        "Department of Sport Nutrition, Tehran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Zahra Gohari Dezfuli"
    },
    {
      "affiliations": [
        "Imam Ali Hospital, Shiraz University of Medical Sciences, Kazerun, Iran"
      ],
      "name": "Sanaz Jamshidi"
    },
    {
      "affiliations": [
        "Nutritional Sciences Research Center, Iran University of Medical Sciences, Tehran, Iran",
        "Department of Nutrition, Iran University of Medical Sciences, Tehran, Iran",
        "Student Research Committee, Iran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Fatemeh Mehdipoor"
    },
    {
      "affiliations": [
        "Nutritional Sciences Research Center, Iran University of Medical Sciences, Tehran, Iran",
        "Department of Nutrition, Iran University of Medical Sciences, Tehran, Iran",
        "Student Research Committee, Iran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Seyed Mojtaba Ghoreishy"
    },
    {
      "affiliations": [
        "Nutritional Sciences Research Center, Iran University of Medical Sciences, Tehran, Iran",
        "Department of Nutrition, Iran University of Medical Sciences, Tehran, Iran",
        "Student Research Committee, Iran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Farshad Teymoori"
    },
    {
      "affiliations": [
        "Nutritional Sciences Research Center, Iran University of Medical Sciences, Tehran, Iran",
        "Department of Nutrition, Iran University of Medical Sciences, Tehran, Iran",
        "Student Research Committee, Iran University of Medical Sciences, Tehran, Iran"
      ],
      "name": "Farzad Shidfar"
    },
    {
      "affiliations": [
        "School of Medicine, Iran University of Medical Science, Tehran, Iran"
      ],
      "name": "Ramin Eskandari"
    }
  ],
  "title": "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",
  "uid": "4ee4150d-fb26-5bef-9f46-06a5b6360675"
}