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Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study

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Item Type:Article
Title:Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study
Creators Name:Aleksandrova, K. and Pischon, T. and Jenab, M. and Bueno-de-Mesquita, H. and Fedirko, V. and Norat, T. and Romaguera, D. and Knüppel, S. and Boutron-Ruault, M.C. and Dossus, L. and Dartois, L. and Kaaks, R. and Li, K. and Tjønneland, A. and Overvad, K. and Quirós, J. and Buckland, G. and Sánchez, M. and Dorronsoro, M. and Chirlaque, M.D. and Barricarte, A. and Khaw, K.T. and Wareham, N.J. and Bradbury, K.E. and Trichopoulou, A. and Lagiou, P. and Trichopoulos, D. and Palli, D. and Krogh, V. and Tumino, R. and Naccarati, A. and Panico, S. and Siersema, P.D. and Peeters, P. and Ljuslinder, I. and Johansson, I. and Ericson, U. and Ohlsson, B. and Weiderpass, E. and Skeie, G. and Borch, K. and Rinaldi, S. and Romieu, I. and Kong, J. and Gunter, M.J. and Ward, H.A. and Riboli, E. and Boeing, H.
Abstract: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.
Keywords:Lifestyle Factors, Combined Impact, Population Attributable Risks, Colorectal Cancer, European Prospective Investigation into Cancer and Nutrition (EPIC)
Source:BMC Medicine
Publisher:BioMed Central
Page Range:168
Date:10 October 2014
Official Publication:https://doi.org/10.1186/s12916-014-0168-4
PubMed:View item in PubMed

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