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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., Pischon, T., Jenab, M., Bueno-de-Mesquita, H., Fedirko, V., Norat, T., Romaguera, D., Knüppel, S., Boutron-Ruault, M.C., Dossus, L., Dartois, L., Kaaks, R., Li, K., Tjønneland, A., Overvad, K., Quirós, J., Buckland, G., Sánchez, M., Dorronsoro, M., Chirlaque, M.D., Barricarte, A., Khaw, K.T., Wareham, N.J., Bradbury, K.E., Trichopoulou, A., Lagiou, P., Trichopoulos, D., Palli, D., Krogh, V., Tumino, R., Naccarati, A., Panico, S., Siersema, P.D., Peeters, P., Ljuslinder, I., Johansson, I., Ericson, U., Ohlsson, B., Weiderpass, E., Skeie, G., Borch, K., Rinaldi, S., Romieu, I., Kong, J., Gunter, M.J., Ward, H.A., 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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