Healthy lifestyle and the risk of lymphoma in the European Prospective Investigation into Cancer and Nutrition study

Research output: Contribution to journalArticle


Limited evidence exists on the role of modifiable lifestyle factors on the risk of lymphoma. In this work, the associations between adherence to healthy lifestyles and risks of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) were evaluated in a large-scale European prospective cohort. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 2,999 incident lymphoma cases (132 HL and 2,746 NHL) were diagnosed among 453,808 participants after 15 years (median) of follow-up. The healthy lifestyle index (HLI) score combined information on smoking, alcohol intake, diet, physical activity and BMI, with large values of HLI expressing adherence to healthy behavior. Cox proportional hazards models were used to estimate lymphoma hazard ratios (HR) and 95% confidence interval (CI). Sensitivity analyses were conducted by excluding, in turn, each lifestyle factor from the HLI score. The HLI was inversely associated with HL, with HR for a 1-standard deviation (SD) increment in the score equal to 0.78 (95% CI: 0.66, 0.94). Sensitivity analyses showed that the association was mainly driven by smoking and marginally by diet. NHL risk was not associated with the HLI, with HRs for a 1-SD increment equal to 0.99 (0.95, 1.03), with no evidence for heterogeneity in the association across NHL subtypes. In the EPIC study, adherence to healthy lifestyles was not associated with overall lymphoma or NHL risk, while an inverse association was observed for HL, although this was largely attributable to smoking. These findings suggest a limited role of lifestyle factors in the etiology of lymphoma subtypes.


  • Sabine Naudin
  • Marta Solans Margalef
  • Fatemeh Saberi Hosnijeh
  • Alexandra Nieters
  • Cecilie Kyrø
  • Anne Tjønneland
  • Christina C. Dahm
  • Kim Overvad
  • Yahya Mahamat-Saleh
  • Caroline Besson
  • Marie Christine Boutron-Ruault
  • Tilman Kühn
  • Federico Canzian
  • Matthias B. Schulze
  • Eleni Peppa
  • Anna Karakatsani
  • Antonia Trichopoulou
  • Sabina Sieri
  • Giovana Masala
  • Salvatore Panico
  • Rosario Tumino
  • Fulvio Ricceri
  • Sairah L.F. Chen
  • Leila L. Barroso
  • José M. Huerta
  • Maria Jose Sánchez
  • Eva Ardanaz
  • Virginia Menéndez
  • Pilar Amiano Exezarreta
  • Florentin Spaeth
  • Julie A. Schmidt
  • Dagfinn Aune
  • Elisabete Weiderpass
  • Elio Riboli
  • Roel Vermeulen
  • Delphine Casabonne
  • Marc Gunter
  • Paul Brennan
  • Pietro Ferrari
External organisations
  • International Agency for Research on Cancer, World Health Organization
  • University of Girona
  • Utrecht University
  • Albert-Ludwigs University Freiburg
  • Danish Cancer Society Research Center
  • Aarhus University
  • Aalborg University Hospital
  • Centre for Research in Epidemiology and Population Health (CESP)
  • Centre Hospitalier de Versailles
  • German Cancer Research Centre
  • German Institute of Human Nutrition
  • University of Potsdam
  • Hellenic Health Foundation, Athens
  • National and Kapodistrian University of Athens
  • Istituto Nazionale dei Tumori
  • Institute for Cancer Research, Prevention and Clinical Network (ISPRO)
  • University of Naples Federico II
  • Civic and M.P Arezzo Hospital
  • UiT The Arctic University of Norway, Tromsø
  • Catalan Institute of Oncology
  • Murcia Regional Health Council
  • Andalusian School Of Public Health (EASP)
  • University of Granada
  • Health Research Institute of Navarra (IDISNA)
  • Public Health Directorate
  • Biodonostia Health Research Institute
  • Umeå University
  • University of Oxford
  • Imperial College London
  • Bjørknes University College
  • Oslo university hospital
  • Bellvitge University Hospital-IDIBELL
  • University of Paris-Saclay
  • University of Turin
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Nutrition and Dietetics
  • Cancer and Oncology


  • EPIC, healthy lifestyle index, Hodgkin lymphoma, non-Hodgkin lymphoma, prospective study
Original languageEnglish
Pages (from-to)1649-1656
Number of pages8
JournalInternational Journal of Cancer
Issue number6
Early online date2020 Mar 30
Publication statusPublished - 2020 Sep 15
Publication categoryResearch