Study Objectives: To examine the association between modifiable lifestyle factors, and the risk of developing restless legs syndrome (RLS). Methods: This is a Prospective Cohort study of population including 12,812 men participating in Health Professionals Follow-up Study and 42,728 women participating in the Nurses' Health study II. The participants were free of RLS at baseline (2002 for the HPFS and 2005 for the NHS II) and free of diabetes and arthritis through follow-up. RLS was assessed via a set of questions recommended by International Restless Legs Syndrome Study group. The Information was collected on height, weight, level of physical activity, dietary intake, and smoking status via questionnaires. Results: During 4-6 years of follow-up, we identified 1,538 incident RLS cases. Participants with normal weight, and who were physically active, non-smoker, and had some alcohol consumption had a lower risk of developing RLS. When we combined the effects of these four factors together, we observed a dose response relationship between the increased number of healthy lifestyle factors and a low risk of RLS: after adjusting for potential confounders the pooled odds ratio was 0.67 (95% CI: 0.47-0.97) for 4 vs.0 healthy factors (p trend < 0.001). In contrast, we did not observe significant associations between caffeine consumption or diet quality as assessed by the Alternate Healthy Eating Index, and altered RLS risk in men and women.
I NTRO DUCTI O NRestless legs syndrome (RLS), a debilitating illness that has affected people over the centuries, 1 is characterized by unpleasant sensations and an irresistible urge to move the legs. 2-4 A prevalence of 5% to 15% has been reported in United States and Europe 5-7 with lower prevalence rates (< 5%) in Asian populations. 8 Epidemiologic studies have suggested an association between RLS and cardiovascular diseases, Parkinson disease, erectile dysfunction, poor sleep, and depressive symptoms. 9-11 The burden of RLS on quality of life 12 is comparable to that of other chronic illnesses such as diabetes, arthritis, hypertension, and acute myocardial infarction. 3 The etiology of RLS is not known; however, several pathophysiologic mechanisms have been reported. Age and genetics are important determinants of clinical expression for primary RLS, 13-15 whereas secondary RLS is present in a variety of conditions including iron deficiency, diabetes, renal failure, Parkinson disease, and pregnancy. Lifestyle factors such as lack of physical activity, obesity, cigarette smoking, alcohol intake, and consumption of coffee have also been postulated to have an effect on the risk or severity of RLS. 13 However, the evidence linking these factors to RLS is based on small studies (n = 41), 16 and the use of different methodologic and diagnostic criteria, and the lack of control for covariates, has resulted in conflicting results. We thus prospectively examined the associations between lifestyle factors (i.e., obesity, physical activity, overall diet quality, smoking, and alcohol intake)...