Healthy lifestyle change and all-cause and cancer mortality in the European Prospective Investigation into Cancer and Nutrition cohort
(2024) In BMC Medicine 22(1).- Abstract
Background: Healthy lifestyles are inversely associated with the risk of noncommunicable diseases, which are leading causes of death. However, few studies have used longitudinal data to assess the impact of changing lifestyle behaviours on all-cause and cancer mortality. Methods: Within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, lifestyle profiles of 308,497 cancer-free adults (71% female) aged 35–70 years at recruitment across nine countries were assessed with baseline and follow-up questionnaires administered on average of 7 years apart. A healthy lifestyle index (HLI), assessed at two time points, combined information on smoking status, alcohol intake, body mass index, and physical activity, and... (More)
Background: Healthy lifestyles are inversely associated with the risk of noncommunicable diseases, which are leading causes of death. However, few studies have used longitudinal data to assess the impact of changing lifestyle behaviours on all-cause and cancer mortality. Methods: Within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, lifestyle profiles of 308,497 cancer-free adults (71% female) aged 35–70 years at recruitment across nine countries were assessed with baseline and follow-up questionnaires administered on average of 7 years apart. A healthy lifestyle index (HLI), assessed at two time points, combined information on smoking status, alcohol intake, body mass index, and physical activity, and ranged from 0 to 16 units. A change score was calculated as the difference between HLI at baseline and follow-up. Associations between HLI change and all-cause and cancer mortality were modelled with Cox regression, and the impact of changing HLI on accelerating mortality rate was estimated by rate advancement periods (RAP, in years). Results: After the follow-up questionnaire, participants were followed for an average of 9.9 years, with 21,696 deaths (8407 cancer deaths) documented. Compared to participants whose HLIs remained stable (within one unit), improving HLI by more than one unit was inversely associated with all-cause and cancer mortality (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.81, 0.88; and HR: 0.87; 95% CI: 0.82, 0.92; respectively), while worsening HLI by more than one unit was associated with an increase in mortality (all-cause mortality HR: 1.26; 95% CI: 1.20, 1.33; cancer mortality HR: 1.19; 95% CI: 1.09, 1.29). Participants who worsened HLI by more than one advanced their risk of death by 1.62 (1.44, 1.96) years, while participants who improved HLI by the same amount delayed their risk of death by 1.19 (0.65, 2.32) years, compared to those with stable HLI. Conclusions: Making healthier lifestyle changes during adulthood was inversely associated with all-cause and cancer mortality and delayed risk of death. Conversely, making unhealthier lifestyle changes was positively associated with mortality and an accelerated risk of death.
(Less)
- author
- organization
- publishing date
- 2024-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cancer, Change score, Composite score, Healthy lifestyle index, Longitudinal, Mortality, Prospective study
- in
- BMC Medicine
- volume
- 22
- issue
- 1
- article number
- 210
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85194900865
- pmid:38807179
- ISSN
- 1741-7015
- DOI
- 10.1186/s12916-024-03362-7
- language
- English
- LU publication?
- yes
- id
- d57953cf-eff4-43d5-bdd8-9fec1e8f4377
- date added to LUP
- 2024-07-01 13:28:15
- date last changed
- 2024-07-01 13:29:11
@article{d57953cf-eff4-43d5-bdd8-9fec1e8f4377,
abstract = {{<p>Background: Healthy lifestyles are inversely associated with the risk of noncommunicable diseases, which are leading causes of death. However, few studies have used longitudinal data to assess the impact of changing lifestyle behaviours on all-cause and cancer mortality. Methods: Within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, lifestyle profiles of 308,497 cancer-free adults (71% female) aged 35–70 years at recruitment across nine countries were assessed with baseline and follow-up questionnaires administered on average of 7 years apart. A healthy lifestyle index (HLI), assessed at two time points, combined information on smoking status, alcohol intake, body mass index, and physical activity, and ranged from 0 to 16 units. A change score was calculated as the difference between HLI at baseline and follow-up. Associations between HLI change and all-cause and cancer mortality were modelled with Cox regression, and the impact of changing HLI on accelerating mortality rate was estimated by rate advancement periods (RAP, in years). Results: After the follow-up questionnaire, participants were followed for an average of 9.9 years, with 21,696 deaths (8407 cancer deaths) documented. Compared to participants whose HLIs remained stable (within one unit), improving HLI by more than one unit was inversely associated with all-cause and cancer mortality (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.81, 0.88; and HR: 0.87; 95% CI: 0.82, 0.92; respectively), while worsening HLI by more than one unit was associated with an increase in mortality (all-cause mortality HR: 1.26; 95% CI: 1.20, 1.33; cancer mortality HR: 1.19; 95% CI: 1.09, 1.29). Participants who worsened HLI by more than one advanced their risk of death by 1.62 (1.44, 1.96) years, while participants who improved HLI by the same amount delayed their risk of death by 1.19 (0.65, 2.32) years, compared to those with stable HLI. Conclusions: Making healthier lifestyle changes during adulthood was inversely associated with all-cause and cancer mortality and delayed risk of death. Conversely, making unhealthier lifestyle changes was positively associated with mortality and an accelerated risk of death.</p>}},
author = {{Matta, Komodo and Viallon, Vivian and Botteri, Edoardo and Peveri, Giulia and Dahm, Christina and Nannsen, Anne Østergaard and Olsen, Anja and Tjønneland, Anne and Elbaz, Alexis and Artaud, Fanny and Marques, Chloé and Kaaks, Rudolf and Katzke, Verena and Schulze, Matthias B. and Llanaj, Erand and Masala, Giovanna and Pala, Valeria and Panico, Salvatore and Tumino, Rosario and Ricceri, Fulvio and Derksen, Jeroen W.G. and Nøst, Therese Haugdahl and Sandanger, Torkjel M. and Borch, Kristin Benjaminsen and Quirós, J. Ramón and Castro-Espin, Carlota and Sánchez, Maria José and Atxega, Amaia Aizpurua and Cirera, Lluís and Guevara, Marcela and Manjer, Jonas and Tin Tin, Sandar and Heath, Alicia and Touvier, Mathilde and Goldberg, Marcel and Weiderpass, Elisabete and Gunter, Marc J. and Freisling, Heinz and Riboli, Elio and Ferrari, Pietro}},
issn = {{1741-7015}},
keywords = {{Cancer; Change score; Composite score; Healthy lifestyle index; Longitudinal; Mortality; Prospective study}},
language = {{eng}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Medicine}},
title = {{Healthy lifestyle change and all-cause and cancer mortality in the European Prospective Investigation into Cancer and Nutrition cohort}},
url = {{http://dx.doi.org/10.1186/s12916-024-03362-7}},
doi = {{10.1186/s12916-024-03362-7}},
volume = {{22}},
year = {{2024}},
}