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At this point, most of us generally have a clue about the basics of staying in good health—eat well, exercise, don’t drink too much and don’t smoke. And plenty of research has been dedicated to exploring how failing on any of those fronts, or even more than one at a time, can be detrimental to overall health. Yet, for many people, those bad habits have a way of accumulating. And, according to a new study published this week in the Archives of Internal Medicine, their cumulative impact can be pretty grim. In an analysis of nearly 5,000 adults tracked for two decades, researchers found that stacking up these four bad habits can work together to prematurely age you by as much as 12 years.
Looked at independently, the risky behaviors included smoking, a sedentary lifestyle, little consumption of fruit and vegetables and regular drinking—an average of three drinks per day for men, or two for women. When compared to people who had the most healthy habits—those who never smoked, exercised at least two hours per week, ate plenty of fruits and veggies and didn’t drink at all, or drank more moderately, those with all four bad habits had an increased risk of death equivalent to being 12 years older.
In fact, the study authors say that compared with practicing none of these bad habits, the combined effect of all four behaviors tripled or even quadrupled the risk of death. As the Associated press points out:
Overall, 314 people studied had all four unhealthy behaviors. Among them, 91 died during the study, or 29 percent. Among the 387 healthiest people with none of the four habits, only 32 died, or about 8 percent.
Of course, while these findings are stark, the notion that individual unhealthy behaviors can join forces to have a cumulatively negative impact is not new. Responding to the findings, Dr. Walter Willett, the chair of the Department of Nutrition at the Harvard School of Public Health, pointed out similar findings in the large scale Nurses’ Health Study. Still, Willet said that the simple, common sense steps that people can take to improve their overall health bear repeating, and studies that hammer home these correlations are indeed worthwhile. Referring to the new findings published this week, he wrote in an email to TIME, the “conclusions are profoundly important and worth replicating: healthy lifestyle practices that are modest and simple—specifically, not smoking, getting regular physical activity, eating a good diet and avoiding excessive alcohol consumption—can profoundly affect our chances of living to an old age.”