The global population of centenarians—individuals aged 100 and above—has seen a dramatic rise, growing from 151,000 in 2000 to 573,000 in 2021. This upward trend suggests that more people are achieving the elusive milestone of living to 100 years. Centenarians often embody successful aging, with many enjoying relatively fewer chronic diseases and maintaining independence well into their 90s. While genetics play a role in longevity, over 60% of successful aging is influenced by modifiable lifestyle factors.
To uncover the secrets to their longevity, we conducted an extensive review of the lifestyle and health habits of centenarians and near-centenarians (those aged 95–99) from around the world. Our findings, derived from 34 observational studies published since 2000, highlight four crucial factors contributing to extreme longevity.
1. A Balanced and Low-Salt Diet
Centenarians and near-centenarians typically adhere to a diverse and balanced diet. On average, their energy intake consists of 57% to 65% from carbohydrates, 12% to 32% from protein, and 27% to 31% from fat. Their diet is rich in staple foods like rice and wheat, fruits, vegetables, and protein sources such as poultry, fish, and legumes, with moderate consumption of red meat. This dietary pattern closely mirrors the Mediterranean diet, which is associated with lower risks of physical decline and mortality.
Notably, centenarians often prefer a low-salt diet. Although only one study in our review measured daily sodium intake—finding an average of 1.6 grams per day—this falls within the World Health Organization’s recommendation of less than 2 grams of sodium per day (equivalent to about 5 grams of salt). For example, the traditional Okinawan diet, consumed by many Japanese centenarians, contains an estimated 1.1 grams of sodium.
Our review indicates that individuals with a higher salt intake—a preference for salty foods or the habit of adding extra salt to meals—face a 3.6-fold increased risk of physical function impairment compared to those with lower salt consumption. These findings suggest that incorporating whole grains, root vegetables, beans, legumes, fruits, and vegetables into our diet, minimizing red meat, opting for lean poultry, fish, and plant-based protein, and carefully monitoring salt intake could be key to a longer life.
2. Lower Medication Use
Centenarians are not immune to chronic conditions, but they tend to develop them later in life compared to the general population. Over half of the centenarians in our review experienced common health issues such as hypertension, dementia, or cognitive impairment. Despite this, they took an average of 4.6 medications, often including blood pressure and heart disease medications. This is comparable to a large health register-based study in Spain, which found that centenarians took an average of 4.9 medications, whereas non-centenarians took 6.7 medications on average.
The fact that centenarians generally take fewer medications may reflect better overall health and fewer medical conditions. However, it’s important to note that medication use data is often self-reported and may not be entirely accurate, especially among those with cognitive impairment.
Polypharmacy—defined as taking five or more medications simultaneously—is common among older adults and is associated with increased risks of adverse events such as falls, cognitive impairment, and hospitalization due to harmful drug interactions. While the number or type of prescribed medications may not always be within a patient’s control, it is crucial for healthcare providers to prescribe medications only when necessary, fully inform patients of the benefits and risks, and regularly review treatment plans.
3. Prioritizing Good Sleep
Quality sleep is essential for maintaining a healthy immune system, regulating stress hormones, and supporting cardiometabolic functions like obesity prevention, blood pressure control, and diabetes management. Good sleep is linked to prolonged years of good health and a reduced risk of chronic diseases.
In our review, 68% of centenarians reported satisfaction with their sleep quality. For comparison, a 2020 survey of adults’ sleep satisfaction across 13 countries found satisfaction rates ranging from 29% to 67%.
The optimal sleep duration for adults is between seven and eight hours per night. Tips for achieving better sleep include maintaining a regular sleep routine, creating a restful environment, exercising regularly, and managing stress effectively.
4. Living in a Natural Environment
Over 75% of the centenarians and near-centenarians in our review lived in rural areas. This trend is also observed in “blue zones,” regions known for their high concentrations of centenarians, such as Okinawa in Japan, Sardinia in Italy, the Nicoya Peninsula in Costa Rica, and Ikaria in Greece.
The connection between nature and health is well-documented, with exposure to green spaces associated with lower stress levels, reduced depression, lower blood pressure, and a decreased risk of type 2 diabetes and heart disease. These factors potentially contribute to increased life expectancy.
Additional Factors for Longevity
Our review did not encompass all lifestyle factors associated with longevity. Other research indicates that avoiding smoking, limiting alcohol consumption, staying physically active, and maintaining strong social connections are also crucial for increasing the likelihood of living to 100.
While adopting these lifestyle habits doesn’t guarantee reaching 100 years, they certainly improve the chances of leading a long and healthy life. Becoming a centenarian is, in many ways, a lifelong endeavor, and the earlier one can adopt positive lifestyle changes, the better.
As more people strive to adopt healthier lifestyles to prevent and manage chronic conditions, healthcare professionals are increasingly recognizing the value of lifestyle medicine. The journey to a long life begins with small, daily choices that accumulate over time.
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