TY - JOUR
T1 - Healthy lifestyle and the risk of pancreatic cancer in the EPIC study
AU - Naudin, Sabine
AU - Viallon, Vivian
AU - Hashim, Dana
AU - Freisling, Heinz
AU - Jenab, Mazda
AU - Weiderpass, Elisabete
AU - Perrier, Flavie
AU - McKenzie, Fiona
AU - Bueno-de-Mesquita, H. Bas
AU - Olsen, Anja
AU - Tjønneland, Anne
AU - Dahm, Christina C.
AU - Overvad, Kim
AU - Mancini, Francesca R.
AU - Rebours, Vinciane
AU - Boutron-Ruault, Marie Christine
AU - Katzke, Verena
AU - Kaaks, Rudolf
AU - Bergmann, Manuela
AU - Boeing, Heiner
AU - Peppa, Eleni
AU - Karakatsani, Anna
AU - Trichopoulou, Antonia
AU - Pala, Valeria
AU - Masala, Giovana
AU - Panico, Salvatore
AU - Tumino, Rosario
AU - Sacerdote, Carlotta
AU - May, Anne M.
AU - van Gils, Carla H.
AU - Rylander, Charlotta
AU - Borch, Kristin Benjaminsen
AU - Chirlaque López, María Dolores
AU - Sánchez, Maria Jose
AU - Ardanaz, Eva
AU - Quirós, José Ramón
AU - Amiano Exezarreta, Pilar
AU - Sund, Malin
AU - Drake, Isabel
AU - Regnér, Sara
AU - Travis, Ruth C.
AU - Wareham, Nick
AU - Aune, Dagfinn
AU - Riboli, Elio
AU - Gunter, Marc J.
AU - Duell, Eric J.
AU - Brennan, Paul
AU - Ferrari, Pietro
PY - 2020/10
Y1 - 2020/10
N2 - 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.
AB - 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.
KW - EPIC
KW - Healthy Lifestyle Index
KW - Pancreatic cancer
KW - Population attributable fraction
KW - Prospective study
UR - http://www.scopus.com/inward/record.url?scp=85074035335&partnerID=8YFLogxK
U2 - 10.1007/s10654-019-00559-6
DO - 10.1007/s10654-019-00559-6
M3 - Article
C2 - 31564045
AN - SCOPUS:85074035335
SN - 0393-2990
VL - 35
SP - 975
EP - 986
JO - European Journal of Epidemiology
JF - European Journal of Epidemiology
IS - 10
ER -
