Healthy lifestyle and the risk of pancreatic cancer in the EPIC study

Sabine Naudin, Vivian Viallon, Dana Hashim, Heinz Freisling, Mazda Jenab, Elisabete Weiderpass, Flavie Perrier, Fiona McKenzie, H. Bas Bueno-de-Mesquita, Anja Olsen, Anne Tjønneland, Christina C. Dahm, Kim Overvad, Francesca R. Mancini, Vinciane Rebours, Marie Christine Boutron-Ruault, Verena Katzke, Rudolf Kaaks, Manuela Bergmann, Heiner BoeingEleni Peppa, Anna Karakatsani, Antonia Trichopoulou, Valeria Pala, Giovana Masala, Salvatore Panico, Rosario Tumino, Carlotta Sacerdote, Anne M. May, Carla H. van Gils, Charlotta Rylander, Kristin Benjaminsen Borch, María Dolores Chirlaque López, Maria Jose Sánchez, Eva Ardanaz, José Ramón Quirós, Pilar Amiano Exezarreta, Malin Sund, Isabel Drake, Sara Regnér, Ruth C. Travis, Nick Wareham, Dagfinn Aune, Elio Riboli, Marc J. Gunter, Eric J. Duell, Paul Brennan, Pietro Ferrari

Research output: Contribution to journalArticlepeer-review


Pancreatic cancer (PC) is a highly fatal cancer with currently limited opportunities for early detection and effective treatment. Modifiable factors may offer pathways for primary prevention. In this study, the association between the Healthy Lifestyle Index (HLI) and PC risk was examined. Within the European Prospective Investigation into Cancer and Nutrition cohort, 1113 incident PC (57% women) were diagnosed from 400,577 participants followed-up for 15 years (median). HLI scores combined smoking, alcohol intake, dietary exposure, physical activity and, in turn, overall and central adiposity using BMI (HLIBMI) and waist-to-hip ratio (WHR, HLIWHR), respectively. High values of HLI indicate adherence to healthy behaviors. Cox proportional hazard models with age as primary time variable were used to estimate PC hazard ratios (HR) and 95% confidence intervals (CI). Sensitivity analyses were performed by excluding, in turn, each factor from the HLI score. Population attributable fractions (PAF) were estimated assuming participants’ shift to healthier lifestyles. The HRs for a one-standard deviation increment of HLIBMI and HLIWHR were 0.84 (95% CI: 0.79, 0.89; ptrend = 4.3e−09) and 0.77 (0.72, 0.82; ptrend = 1.7e−15), respectively. Exclusions of smoking from HLIWHR resulted in HRs of 0.88 (0.82, 0.94; ptrend = 4.9e−04). The overall PAF estimate was 19% (95% CI: 11%, 26%), and 14% (6%, 21%) when smoking was removed from the score. Adherence to a healthy lifestyle was inversely associated with PC risk, beyond the beneficial role of smoking avoidance. Public health measures targeting compliance with healthy lifestyles may have an impact on PC incidence.

Original languageEnglish
Pages (from-to)975-986
Number of pages12
JournalEuropean Journal of Epidemiology
Issue number10
Early online date2019 Sept 28
Publication statusPublished - 2020 Oct

Subject classification (UKÄ)

  • Cancer and Oncology
  • Public Health, Global Health, Social Medicine and Epidemiology

Free keywords

  • EPIC
  • Healthy Lifestyle Index
  • Pancreatic cancer
  • Population attributable fraction
  • Prospective study


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