World Health Organization. Healthy living: what is a healthy lifestyle? Copenhagen: WHO Regional Office for Europe; 1999.
World Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. Geneva: World Health Organization; 2017.
World Health Organization. WHO global report on trends in prevalence of tobacco smoking 2000–2025. 3rd ed. Geneva: World Health Organisation; 2019.
World Health Organization. 2021 Physical Activity Factsheets for the European Union Member States in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2021.
Eurostat. Database on health determinants 2021 [Available from: https://ec.europa.eu/eurostat/web/health/data/database?node_code=hlth_det.
Whitman IR, Agarwal V, Nah G, Dukes JW, Vittinghoff E, Dewland TA, et al. Alcohol abuse and cardiac disease. J Am Coll Cardiol. 2017;69(1):13–24. https://doi.org/10.1016/j.jacc.2016.10.048.
Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metabolism. 2019;92:98–107. https://doi.org/10.1016/j.metabol.2018.10.011.
Freisling H, Viallon V, Lennon H, Bagnardi V, Ricci C, Butterworth AS, et al. Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. BMC Med. 2020;18(1):5. https://doi.org/10.1186/s12916-019-1474-7.
Liu Y, Pleasants RA, Croft JB, Wheaton AG, Heidari K, Malarcher AM, et al. Smoking duration, respiratory symptoms, and COPD in adults aged ≥ 45 years with a smoking history. Int J Chron Obstruct Pulmon Dis. 2015;10:1409. https://doi.org/10.2147/COPD.S82259.
Kirsch Micheletti J, Bláfoss R, Sundstrup E, Bay H, Pastre CM, Andersen LL. Association between lifestyle and musculoskeletal pain: cross-sectional study among 10,000 adults from the general working population. BMC Musculoskelet Disord. 2019;20(1):609. https://doi.org/10.1186/s12891-019-3002-5.
Bowe AK, Owens M, Codd MB, Lawlor BA, Glynn RW. Physical activity and mental health in an Irish population. Ir J Med Sci. 2019;188(2):625–31. https://doi.org/10.1007/s11845-018-1863-5.
Richardson S, McNeill A, Brose LS. Smoking and quitting behaviours by mental health conditions in Great Britain (1993–2014). Addict Behav. 2019;90:14–9. https://doi.org/10.1016/j.addbeh.2018.10.011.
Levy MZ, Allsopp RC, Futcher AB, Greider CW, Harley CB. Telomere end-replication problem and cell aging. J Mol Biol. 1992;225(4):951–60. https://doi.org/10.1016/0022-2836(92)90096-3.
Shaughnessy DT, McAllister K, Worth L, Haugen AC, Meyer JN, Domann FE, et al. Mitochondria, energetics, epigenetics, and cellular responses to stress. Environ Health Perspect. 2014;122(12):1271–8. https://doi.org/10.1289/ehp.1408418.
Cui Y, Gao YT, Cai Q, Qu S, Cai H, Li HL, et al. Associations of leukocyte telomere length with body anthropometric indices and weight change in Chinese women. Obesity. 2013;21(12):2582–8. https://doi.org/10.1002/oby.20321.
Crous-Bou M, Fung TT, Prescott J, Julin B, Du M, Sun Q, et al. Mediterranean diet and telomere length in Nurses’ Health Study: population based cohort study. BMJ. 2014;349:g6674. https://doi.org/10.1136/bmj.g6674.
Janssen BG, Gyselaers W, Byun H-M, Roels HA, Cuypers A, Baccarelli AA, et al. Placental mitochondrial DNA and CYP1A1 gene methylation as molecular signatures for tobacco smoke exposure in pregnant women and the relevance for birth weight. J Transl Med. 2017;15(1):5. https://doi.org/10.1186/s12967-016-1113-4.
Navarro-Mateu F, Husky M, Cayuela-Fuentes P, Álvarez FJ, Roca-Vega A, Rubio-Aparicio M, et al. The association of telomere length with substance use disorders: a systematic review and meta-analysis of observational studies. Addiction. 2020;116(8):1954–72. https://doi.org/10.1111/add.15312.
Pyle A, Anugrha H, Kurzawa-Akanbi M, Yarnall A, Burn D, Hudson G. Reduced mitochondrial DNA copy number is a biomarker of Parkinson’s disease. Neurobiol Aging. 2016;38:216.e7-.e10. https://doi.org/10.1016/j.neurobiolaging.2015.10.033.
Ashar FN, Zhang Y, Longchamps RJ, Lane J, Moes A, Grove ML, et al. Association of mitochondrial DNA copy number with cardiovascular disease. JAMA Cardiol. 2017;2(11):1247–55. https://doi.org/10.1001/jamacardio.2017.3683.
Chen S, Lin J, Matsuguchi T, Blackburn E, Yeh F, Best LG, et al. Short leukocyte telomere length predicts incidence and progression of carotid atherosclerosis in American Indians: the Strong Heart Family Study. Aging. 2014;6(5):414–27. https://doi.org/10.18632/aging.100671.
Mons U, Müezzinler A, Schöttker B, Dieffenbach AK, Butterbach K, Schick M, et al. Leukocyte telomere length and all-cause, cardiovascular disease, and cancer mortality: results from individual-participant-data meta-analysis of 2 large prospective cohort studies. Am J Epidemiol. 2017;185(12):1317–26. https://doi.org/10.1093/aje/kww210.
Lindqvist D, Epel ES, Mellon SH, Penninx BW, Révész D, Verhoeven JE, et al. Psychiatric disorders and leukocyte telomere length: underlying mechanisms linking mental illness with cellular aging. Neurosci Biobehav Rev. 2015;55:333–64. https://doi.org/10.1016/j.neubiorev.2015.05.007.
Noble N, Paul C, Turon H, Oldmeadow C. Which modifiable health risk behaviours are related? A systematic review of the clustering of Smoking, Nutrition, Alcohol and Physical activity (‘SNAP’) health risk factors. Prev Med. 2015;81:16–41. https://doi.org/10.1016/j.ypmed.2015.07.003.
Poortinga W. The prevalence and clustering of four major lifestyle risk factors in an English adult population. Prev Med. 2007;44(2):124–8. https://doi.org/10.1016/j.ypmed.2006.10.006.
Demarest S, Van der Heyden J, Charafeddine R, Drieskens S, Gisle L, Tafforeau J. Methodological basics and evolution of the Belgian Health Interview Survey 1997–2008. Arch Public Health. 2013;71(1):24. https://doi.org/10.1186/0778-7367-71-24.
Goldberg DP. User’s guide to the General Health Questionnaire. Windsor: NFER-Nelson; 1988.
Ware JE Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33. https://doi.org/10.1097/00005650-199603000-00003.
Cantril H. Pattern of human concerns. New Brunswick: Rutgers University Press; 1965.
Kroenke K, Spitzer RL, Williams JB, Löwe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–59. https://doi.org/10.1016/j.genhosppsych.2010.03.006.
Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46(3):266–74. https://doi.org/10.1097/MLR.0b013e318160d093.
Gisle L, Drieskens S, Demarest S, Van der Heyden J. Enquête de santé 2018: Santé mentale. Bruxelles: Sciensano; 2018. (https://www.enquetesante.be. Available from. Numéro de rapport: D/2020/14.440/3).
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care. 1992;30(6):473–83.
Braunholtz S, Davidson S, Myant K, O’Connor R. Well? What do you think?: the Third National Scottish Survey of Public Attitudes to Mental Health, Mental Wellbeing and Mental Health Problems. Scotland: Scottish Government Edinburgh; 2007.
Van Lente E, Barry MM, Molcho M, Morgan K, Watson D, Harrington J, et al. Measuring population mental health and social well-being. Int J Public Health. 2012;57(2):421–30. https://doi.org/10.1007/s00038-011-0317-x.
de Bruin A, Picavet HSJ, Nossikov A. Health interview surveys: towards international harmonization of methods and instruments. Copenhagen: World Health Organization. Regional Office for Europe; 1996.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.
Superior Health Council. Dietary guidelines for the Belgian adult population. Report 9284. Brussels: Superior Health Council; 2019.
World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020.
World Health Organization. HEARTS Technical package for cardiovascular disease management in primary health care: healthy-lifestyle counselling. Geneva: World Health Organization; 2018.
World Health Organization. Country profiles on nutrition, physical activity and obesity in the 28 European Union Member States of the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2013.
Bhaskaran K, dos-Santos-Silva I, Leon DA, Douglas IJ, Smeeth L. Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK. Lancet Diabetes Endocrinol. 2018;6(12):944–53. https://doi.org/10.1016/S2213-8587(18)30288-2.
Benetou V, Kanellopoulou A, Kanavou E, Fotiou A, Stavrou M, Richardson C, et al. Diet-related behaviors and diet quality among school-aged adolescents living in Greece. Nutrients. 2020;12(12):3804. https://doi.org/10.3390/nu12123804.
Martens DS, Plusquin M, Gyselaers W, De Vivo I, Nawrot TS. Maternal pre-pregnancy body mass index and newborn telomere length. BMC Med. 2016;14(1):148. https://doi.org/10.1186/s12916-016-0689-0.
Janssen BG, Munters E, Pieters N, Smeets K, Cox B, Cuypers A, et al. Placental mitochondrial DNA content and particulate air pollution during in utero life. Environ Health Perspect. 2012;120(9):1346–52. https://doi.org/10.1289/ehp.1104458.
Jacka FN, O’Neil A, Opie R, Itsiopoulos C, Cotton S, Mohebbi M, et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med. 2017;15(1):23. https://doi.org/10.1186/s12916-017-0791-y.
Pavkovic B, Zaric M, Markovic M, Klacar M, Huljic A, Caricic A. Double screening for dual disorder, alcoholism and depression. Psychiatry Res. 2018;270:483–9. https://doi.org/10.1016/j.psychres.2018.10.013.
De Wit LM, Van Straten A, Van Herten M, Penninx BW, Cuijpers P. Depression and body mass index, a u-shaped association. BMC Public Health. 2009;9:14. https://doi.org/10.1186/1471-2458-9-14.
Meader N, King K, Moe-Byrne T, Wright K, Graham H, Petticrew M, et al. A systematic review on the clustering and co-occurrence of multiple risk behaviours. BMC Public Health. 2016;16:657. https://doi.org/10.1186/s12889-016-3373-6.
Saneei P, Esmaillzadeh A, Hassanzadeh Keshteli A, Reza Roohafza H, Afshar H, Feizi A, et al. Combined healthy lifestyle is inversely associated with psychological disorders among adults. PLoS ONE. 2016;11(1):e0146888. https://doi.org/10.1371/journal.pone.0146888.
Bonnet F, Irving K, Terra J-L, Nony P, Berthezène F, Moulin P. Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis. 2005;178(2):339–44. https://doi.org/10.1016/j.atherosclerosis.2004.08.035.
Loprinzi PD, Mahoney S. Concurrent occurrence of multiple positive lifestyle behaviors and depression among adults in the United States. J Affect Disord. 2014;165:126–30. https://doi.org/10.1016/j.jad.2014.04.073.
Yang H, Gao J, Wang T, Yang L, Liu Y, Shen Y, et al. Association between adverse mental health and an unhealthy lifestyle in rural-to-urban migrant workers in Shanghai. J Formos Med Assoc. 2017;116(2):90–8. https://doi.org/10.1016/j.jfma.2016.03.004.
Oftedal S, Kolt GS, Holliday EG, Stamatakis E, Vandelanotte C, Brown WJ, et al. Associations of health-behavior patterns, mental health and self-rated health. Prev Med. 2019;118:295–303. https://doi.org/10.1016/j.ypmed.2018.11.017.
Conry MC, Morgan K, Curry P, McGee H, Harrington J, Ward M, et al. The clustering of health behaviours in Ireland and their relationship with mental health, self-rated health and quality of life. BMC Public Health. 2011;11(1):692. https://doi.org/10.1186/1471-2458-11-692.
Buttery AK, Mensink GB, Busch MA. Healthy behaviours and mental health: findings from the German Health Update (GEDA). The European Journal of Public Health. 2015;25(2):219–25. https://doi.org/10.1093/eurpub/cku094.
Ahmed NJ, Husen AZ, Khoshnaw N, Getta HA, Hussein ZS, Yassin AK, et al. The effects of smoking on IgE, oxidative stress and haemoglobin concentration. Asian Pac J Cancer Prev. 2020;21(4):1069–72. https://doi.org/10.31557/APJCP.2020.21.4.1069.
Langley MR, Yoon H, Kim HN, Choi C-I, Simon W, Kleppe L, et al. High fat diet consumption results in mitochondrial dysfunction, oxidative stress, and oligodendrocyte loss in the central nervous system. Biochim Biophys Acta Mol Basis Dis. 2020;1866(3):165630. https://doi.org/10.1016/j.bbadis.2019.165630.
Tan HK, Yates E, Lilly K, Dhanda AD. Oxidative stress in alcohol-related liver disease. World J Hepatol. 2020;12(7):332–49. https://doi.org/10.4254/wjh.v12.i7.332.
Martens DS, Nawrot TS. Air pollution stress and the aging phenotype: the telomere connection. Curr Environ Health Rep. 2016;3(3):258–69. https://doi.org/10.1007/s40572-016-0098-8.
Martens DS, Van Der Stukken C, Derom C, Thiery E, Bijnens EM, Nawrot TS. Newborn telomere length predicts later life telomere length: tracking telomere length from birth to child- and adulthood. EBioMedicine. 2021;63:103164. https://doi.org/10.1016/j.ebiom.2020.103164.
Hang D, Nan H, Kværner AS, De Vivo I, Chan AT, Hu Z, et al. Longitudinal associations of lifetime adiposity with leukocyte telomere length and mitochondrial DNA copy number. Eur J Epidemiol. 2018;33(5):485–95. https://doi.org/10.1007/s10654-018-0382-z.
Gu Y, Honig LS, Schupf N, Lee JH, Luchsinger JA, Stern Y, et al. Mediterranean diet and leukocyte telomere length in a multi-ethnic elderly population. Age. 2015;37(2):24. https://doi.org/10.1007/s11357-015-9758-0.
Sellami M, Al-Muraikhy S, Al-Jaber H, Al-Amri H, Al-Mansoori L, Mazloum NA, et al. Age and sport intensity-dependent changes in cytokines and telomere length in elite athletes. Antioxidants. 2021;10(7):1035. https://doi.org/10.3390/antiox10071035.
Savela S, Saijonmaa O, Strandberg TE, Koistinen P, Strandberg AY, Tilvis RS, et al. Physical activity in midlife and telomere length measured in old age. Exp Gerontol. 2013;48(1):81–4. https://doi.org/10.1016/j.exger.2012.02.003.
Mirabello L, Huang WY, Wong JY, Chatterjee N, Reding D, David Crawford E, et al. The association between leukocyte telomere length and cigarette smoking, dietary and physical variables, and risk of prostate cancer. Aging Cell. 2009;8(4):405–13. https://doi.org/10.1111/j.1474-9726.2009.00485.x.
Sun Q, Shi L, Prescott J, Chiuve SE, Hu FB, De Vivo I, et al. Healthy lifestyle and leukocyte telomere length in US women. PLoS ONE. 2012;7(5):e38374. https://doi.org/10.1371/journal.pone.0038374.
Sindi S, Solomon A, Kåreholt I, Hovatta I, Antikainen R, Hänninen T, et al. Telomere length change in a multidomain lifestyle intervention to prevent cognitive decline: a randomized clinical trial. J Gerontol A. 2021;76(3):491–8. https://doi.org/10.1093/gerona/glaa279.
Paltoglou G, Raftopoulou C, Nicolaides NC, Genitsaridi SM, Karampatsou SI, Papadopoulou M, et al. A comprehensive, multidisciplinary, personalized, lifestyle intervention program is associated with increased leukocyte telomere length in children and adolescents with overweight and obesity. Nutrients. 2021;13(8):2682. https://doi.org/10.3390/nu13082682.
Chakravarty EF, Hubert HB, Krishnan E, Bruce BB, Lingala VB, Fries JF. Lifestyle risk factors predict disability and death in healthy aging adults. Am J Med. 2012;125(2):190–7. https://doi.org/10.1016/j.amjmed.2011.08.006.
Bosnes I, Nordahl HM, Stordal E, Bosnes O, Myklebust TÅ, Almkvist O. Lifestyle predictors of successful aging: a 20-year prospective HUNT study. PLoS ONE. 2019;14(7):e0219200. https://doi.org/10.1371/journal.pone.0219200.
Epel ES, Prather AA. Stress, telomeres, and psychopathology: toward a deeper understanding of a triad of early aging. Annu Rev Clin Psychol. 2018;14:371–97. https://doi.org/10.1146/annurev-clinpsy-032816-045054.
Verhoeven JE, Révész D, Epel ES, Lin J, Wolkowitz OM, Penninx BW. Major depressive disorder and accelerated cellular aging: results from a large psychiatric cohort study. Mol Psychiatry. 2014;19(8):895–901. https://doi.org/10.1038/mp.2013.151.
Han LK, Verhoeven JE, Tyrka AR, Penninx BW, Wolkowitz OM, Månsson KN, et al. Accelerating research on biological aging and mental health: current challenges and future directions. Psychoneuroendocrinology. 2019;106:293–311. https://doi.org/10.1016/j.psyneuen.2019.04.004.
Kim MY, Lee JW, Kang HC, Kim E, Lee DC. Leukocyte mitochondrial DNA (mtDNA) content is associated with depression in old women. Arch Gerontol Geriatr. 2011;53(2):e218–21. https://doi.org/10.1016/j.archger.2010.11.019.
Mengel-From J, Thinggaard M, Dalgard C, Kyvik KO, Christensen K, Christiansen L. Mitochondrial DNA copy number in peripheral blood cells declines with age and is associated with general health among elderly. Hum Genet. 2014;133(9):1149–59. https://doi.org/10.1007/s00439-014-1458-9.
Otsuka I, Izumi T, Boku S, Kimura A, Zhang Y, Mouri K, et al. Aberrant telomere length and mitochondrial DNA copy number in suicide completers. Sci Rep. 2017;7(1):3176.
Chung JK, Lee SY, Park M, Joo E-J, Kim SA. Investigation of mitochondrial DNA copy number in patients with major depressive disorder. Psychiatry Res. 2019;282:112616. https://doi.org/10.1016/j.psychres.2019.112616.
Takahashi PY, Jenkins GD, Welkie BP, McDonnell SK, Evans JM, Cerhan JR, et al. Association of mitochondrial DNA copy number with self-rated health status. Appl Clin Genet. 2018;11:121–7. https://doi.org/10.2147/TACG.S167640.
Vyas CM, Ogata S, Reynolds CF 3rd, Mischoulon D, Chang G, Cook NR, et al. Lifestyle and behavioral factors and mitochondrial DNA copy number in a diverse cohort of mid-life and older adults. PLoS ONE. 2020;15(8):e0237235. https://doi.org/10.1371/journal.pone.0237235.
Verhoeven JE, Révész D, van Oppen P, Epel ES, Wolkowitz OM, Penninx BW. Anxiety disorders and accelerated cellular ageing. Br J Psychiatry. 2015;206(5):371–8. https://doi.org/10.1192/bjp.bp.114.151027.
Pisanu C, Vitali E, Meloni A, Congiu D, Severino G, Ardau R, et al. Investigating the role of leukocyte telomere length in treatment-resistant depression and in response to electroconvulsive therapy. J Pers Med. 2021;11(11):1100. https://doi.org/10.3390/jpm11111100.
da Silva RS, de Moraes LS, da Rocha CAM, Ferreira-Fernandes H, Yoshioka FKN, Rey JA, et al. Telomere length and telomerase activity of leukocytes as biomarkers of selective serotonin reuptake inhibitor responses in patients with major depressive disorder. Psychiatr Genet. 2022;32(1):34–6. https://doi.org/10.1097/ypg.0000000000000305.
Aas M, Elvsåshagen T, Westlye LT, Kaufmann T, Athanasiu L, Djurovic S, et al. Telomere length is associated with childhood trauma in patients with severe mental disorders. Transl Psychiatry. 2019;9(1):97. https://doi.org/10.1038/s41398-019-0432-7.
Birkenæs V, Elvsåshagen T, Westlye LT, Høegh MC, Haram M, Werner MCF, et al. Telomeres are shorter and associated with number of suicide attempts in affective disorders. J Affect Disord. 2021;295:1032–9. https://doi.org/10.1016/j.jad.2021.08.135.
Phillips AC, Robertson T, Carroll D, Der G, Shiels PG, McGlynn L, et al. Do symptoms of depression predict telomere length? Evidence from the West of Scotland Twenty-07 Study. Psychosom Med. 2013;75(3):288–96. https://doi.org/10.1097/PSY.0b013e318289e6b5.
Incollingo Rodriguez AC, Polcari JJ, Nephew BC, Harris R, Zhang C, Murgatroyd C, et al. Acculturative stress, telomere length, and postpartum depression in Latinx mothers. J Psychiatr Res. 2022;147:301–6. https://doi.org/10.1016/j.jpsychires.2022.01.063.
Darrow SM, Verhoeven JE, Révész D, Lindqvist D, Penninx BW, Delucchi KL, et al. The association between psychiatric disorders and telomere length: a meta-analysis involving 14,827 persons. Psychosom Med. 2016;78(7):776–87. https://doi.org/10.1097/PSY.0000000000000356.
Simon NM, Walton ZE, Bui E, Prescott J, Hoge E, Keshaviah A, et al. Telomere length and telomerase in a well-characterized sample of individuals with major depressive disorder compared to controls. Psychoneuroendocrinology. 2015;58:9–22. https://doi.org/10.1016/j.psyneuen.2015.04.004.
Schaakxs R, Verhoeven JE, Voshaar RCO, Comijs HC, Penninx BW. Leukocyte telomere length and late-life depression. Am J Geriatr Psychiatry. 2015;23(4):423–32. https://doi.org/10.1016/j.jagp.2014.06.003.
de Baumont AC, Hoffmann MS, Bortoluzzi A, Fries GR, Lavandoski P, Grun LK, et al. Telomere length and epigenetic age acceleration in adolescents with anxiety disorders. Sci Rep. 2021;11(1):7716. https://doi.org/10.1038/s41598-021-87045-w.
Schutte NS, Malouff JM. The association between depression and leukocyte telomere length: a meta-analysis. Depress Anxiety. 2015;32(4):229–38. https://doi.org/10.1002/da.22351.
Drieskens S, Demarest S, Bel S, De Ridder K, Tafforeau J. Correction of self-reported BMI based on objective measurements: a Belgian experience. Archives of Public Health. 2018;76:10. https://doi.org/10.1186/s13690-018-0255-7.
Gorber SC, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res. 2009;11(1):12–24. https://doi.org/10.1093/ntr/ntn010.
Knez J, Winckelmans E, Plusquin M, Thijs L, Cauwenberghs N, Gu Y, et al. Correlates of peripheral blood mitochondrial DNA content in a general population. Am J Epidemiol. 2016;183(2):138–46. https://doi.org/10.1093/aje/kwv175.
