Table 4.

Sensitivity analysis with time lag for diet and regular exercise for hazard ratios (95%CIs) for incident SLE risk among women in Nurses’ Health Study (1986–2016) and Nurses’ Health Study II (1991–2017) in relation to the traditional Healthy Lifestyle Index Score¹ defined as drinking alcohol in moderation (>=5g/day), maintaining a healthy body weight (body mass index <25 kg/m2), never or past smoking (quit more than 4 years ago), healthy diet (highest 40th percentile of the Alternative Healthy Eating Index (AHEI)), and regular exercise (at least 19 metabolic equivalents (MET) hours per week

	Overall SLE (n=178)			dsDNA Positive SLE (n=89)			dsDNA Negative SLE (n=89)
Number of Healthy Behaviors	Cases/ person-years	MV HR (95%CI)2	p-trend	Cases/ person-years	MV HR (95%CI)2	p-trend	Cases/ person-years	MV HR (95%CI)2	p-trend
0–1	56/ 988626	1.00 (ref)	0.002	28/ 988374	1.00 (ref)	0.008	28/ 988345	1.00 (ref)	0.068
2	57/ 1365758	0.72 (0.50–1.04)		30/ 1365452	0.77 (0.46–1.29)		27/ 1365449	0.68 (0.40–1.16)
3	47/ 1112595	0.72 (0.49–1.07)		23/ 1112347	0.70 (0.40–1.24)		24/ 1112296	0.74 (0.43–1.30)
4–5	18/ 773959	0.40 (0.23–0.69)		8/ 773830	0.34 (0.15–0.74)		10/ 773838	0.47 (0.23–0.99)
Per unit increase in behavior	178/ 4240937	0.78 (0.67–0.91)		89/ 4240003	0.75 (0.60–0.93)		89/ 4239927	0.82 (0.66–1.01)

Abbreviations: CI, confidence interval; HR, hazard ratio; MV, multivariable; PY, person-years; ref, reference.

¹Healthy lifestyle index score (HLIS) as a summed score from 0–1 (one or no healthy behaviors) to 4–5 (4 or more healthy behaviors) or continuous score (per 1 unit of behavior change)

²Multivariable (MV)-adjusted hazard ratios (HR) from time-varying Cox proportional hazards models, adjusted for age (months), questionnaire cycle, cohort, non-white race, census-tract median household income (quartiles), ever oral contraceptive use, age at menarche <=10, menopausal status (pre-menopausal vs. post-menopausal never/ever used post-menopausal hormones)