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

Research output: Contribution to journalArticle

Abstract

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.

Details

Authors
  • 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 Boeing
  • Eleni 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
  • Ruth C. Travis
  • Nick Wareham
  • Dagfinn Aune
  • Elio Riboli
  • Marc J. Gunter
  • Eric J. Duell
  • Paul Brennan
  • Pietro Ferrari
Organisations
External organisations
  • International Agency for Research on Cancer, World Health Organization
  • Icahn School of Medicine at Mount Sinai
  • National Institute for Public Health and the Environment (RIVM)
  • University Medical Center Utrecht
  • Imperial College London
  • Danish Cancer Society Research Center
  • University of Copenhagen
  • Aarhus University
  • Aalborg University
  • Institut Gustave Roussy
  • Beaujon Hospital
  • Paris Diderot University
  • German Cancer Research Centre
  • German Institute of Human Nutrition
  • 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
  • Citta' della Salute e della Scienza Hospital-University of Turin
  • UiT The Arctic University of Norway, Tromsø
  • University of Murcia
  • University of Granada
  • Health Research Institute of Navarra (IDISNA)
  • CIBER Epidemiology and Public Health (CIBERESP)
  • Navarre Public Health Institute
  • Public Health Directorate
  • Umeå University
  • University of Oxford
  • University of Cambridge
  • Bjørknes University College
  • Oslo university hospital
  • Catalan Institute of Oncology
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

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

Keywords

  • EPIC, Healthy Lifestyle Index, Pancreatic cancer, Population attributable fraction, Prospective study
Original languageEnglish
JournalEuropean Journal of Epidemiology
Publication statusE-pub ahead of print - 2019 Sep 28
Publication categoryResearch
Peer-reviewedYes