TY - JOUR
T1 - Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study
AU - Aleksandrova, Krasimira
AU - Pischon, Tobias
AU - Jenab, Mazda
AU - Bueno-de-Mesquita, H. Bas
AU - Fedirko, Veronika
AU - Norat, Teresa
AU - Romaguera, Dora
AU - Knueppel, Sven
AU - Boutron-Ruault, Marie-Christine
AU - Dossus, Laure
AU - Dartois, Laureen
AU - Kaaks, Rudolf
AU - Li, Kuanrong
AU - Tjonneland, Anne
AU - Overvad, Kim
AU - Quiros, Jose Ramon
AU - Buckland, Genevieve
AU - Sanchez, Maria Jose
AU - Dorronsoro, Miren
AU - Chirlaque, Maria-Dolores
AU - Barricarte, Aurelio
AU - Khaw, Kay-Tee
AU - Wareham, Nicholas J.
AU - Bradbury, Kathryn E.
AU - Trichopoulou, Antonia
AU - Lagiou, Pagona
AU - Trichopoulos, Dimitrios
AU - Palli, Domenico
AU - Krogh, Vittorio
AU - Tumino, Rosario
AU - Naccarati, Alessio
AU - Panico, Salvatore
AU - Siersema, Peter D.
AU - Peeters, Petra H. M.
AU - Ljuslinder, Ingrid
AU - Johansson, Ingegerd
AU - Ericson, Ulrika
AU - Ohlsson, Bodil
AU - Weiderpass, Elisabete
AU - Skeie, Guri
AU - Borch, Kristin Benjaminsen
AU - Rinaldi, Sabina
AU - Romieu, Isabelle
AU - Kong, Joyce
AU - Gunter, Marc J.
AU - Ward, Heather A.
AU - Riboli, Elio
AU - Boeing, Heiner
PY - 2014
Y1 - 2014
N2 - Background: Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods: In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated. Results: After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index. Conclusions: Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.
AB - Background: Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods: In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated. Results: After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index. Conclusions: Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.
KW - lifestyle factors
KW - combined impact
KW - population attributable risks
KW - colorectal cancer
KW - European Prospective Investigation into Cancer and
KW - Nutrition (EPIC)
U2 - 10.1186/s12916-014-0168-4
DO - 10.1186/s12916-014-0168-4
M3 - Article
C2 - 25319089
SN - 1741-7015
VL - 12
JO - BMC Medicine
JF - BMC Medicine
M1 - 168
ER -
