Advanced

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

Aleksandrova, Krasimira; Pischon, Tobias; Jenab, Mazda; Bueno-de-Mesquita, H. Bas; Fedirko, Veronika; Norat, Teresa; Romaguera, Dora; Knueppel, Sven; Boutron-Ruault, Marie-Christine and Dossus, Laure, et al. (2014) In BMC Medicine 12.
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... (More)
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. (Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
lifestyle factors, combined impact, population attributable risks, colorectal cancer, European Prospective Investigation into Cancer and, Nutrition (EPIC)
in
BMC Medicine
volume
12
publisher
BioMed Central
external identifiers
  • wos:000344889900001
  • scopus:84907952984
ISSN
1741-7015
DOI
10.1186/s12916-014-0168-4
language
English
LU publication?
yes
id
0c08389f-570d-49c3-ad58-a9d1994ff254 (old id 4868355)
date added to LUP
2015-01-07 11:22:08
date last changed
2017-11-05 04:11:48
@article{0c08389f-570d-49c3-ad58-a9d1994ff254,
  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 &lt;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 &lt;0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend &lt;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.},
  articleno    = {168},
  author       = {Aleksandrova, Krasimira and Pischon, Tobias and Jenab, Mazda and Bueno-de-Mesquita, H. Bas and Fedirko, Veronika and Norat, Teresa and Romaguera, Dora and Knueppel, Sven and Boutron-Ruault, Marie-Christine and Dossus, Laure and Dartois, Laureen and Kaaks, Rudolf and Li, Kuanrong and Tjonneland, Anne and Overvad, Kim and Quiros, Jose Ramon and Buckland, Genevieve and Sanchez, Maria Jose and Dorronsoro, Miren and Chirlaque, Maria-Dolores and Barricarte, Aurelio and Khaw, Kay-Tee and Wareham, Nicholas J. and Bradbury, Kathryn E. and Trichopoulou, Antonia and Lagiou, Pagona and Trichopoulos, Dimitrios and Palli, Domenico and Krogh, Vittorio and Tumino, Rosario and Naccarati, Alessio and Panico, Salvatore and Siersema, Peter D. and Peeters, Petra H. M. and Ljuslinder, Ingrid and Johansson, Ingegerd and Ericson, Ulrika and Ohlsson, Bodil and Weiderpass, Elisabete and Skeie, Guri and Borch, Kristin Benjaminsen and Rinaldi, Sabina and Romieu, Isabelle and Kong, Joyce and Gunter, Marc J. and Ward, Heather A. and Riboli, Elio and Boeing, Heiner},
  issn         = {1741-7015},
  keyword      = {lifestyle factors,combined impact,population attributable risks,colorectal cancer,European Prospective Investigation into Cancer and,Nutrition (EPIC)},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {BMC Medicine},
  title        = {Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study},
  url          = {http://dx.doi.org/10.1186/s12916-014-0168-4},
  volume       = {12},
  year         = {2014},
}