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

Naudin, Sabine ; Viallon, Vivian ; Hashim, Dana ; Freisling, Heinz ; Jenab, Mazda ; Weiderpass, Elisabete ; Perrier, Flavie ; McKenzie, Fiona ; Bueno-de-Mesquita, H. Bas and Olsen, Anja , et al. (2020) In European Journal of Epidemiology 35(10). p.975-986
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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
EPIC, Healthy Lifestyle Index, Pancreatic cancer, Population attributable fraction, Prospective study
in
European Journal of Epidemiology
volume
35
issue
10
pages
12 pages
publisher
Springer
external identifiers
  • pmid:31564045
  • scopus:85074035335
ISSN
0393-2990
DOI
10.1007/s10654-019-00559-6
language
English
LU publication?
yes
id
7f473c44-2c9b-4e11-8122-21d7e1a75c85
date added to LUP
2019-11-06 15:54:13
date last changed
2023-09-23 16:44:28
@article{7f473c44-2c9b-4e11-8122-21d7e1a75c85,
  abstract     = {{<p>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 (HLI<sub>BMI</sub>) and waist-to-hip ratio (WHR, HLI<sub>WHR</sub>), 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 HLI<sub>BMI</sub> and HLI<sub>WHR</sub> were 0.84 (95% CI: 0.79, 0.89; p<sub>trend</sub> = 4.3e−09) and 0.77 (0.72, 0.82; p<sub>trend</sub> = 1.7e−15), respectively. Exclusions of smoking from HLI<sub>WHR</sub> resulted in HRs of 0.88 (0.82, 0.94; p<sub>trend</sub> = 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.</p>}},
  author       = {{Naudin, Sabine and Viallon, Vivian and Hashim, Dana and Freisling, Heinz and Jenab, Mazda and Weiderpass, Elisabete and Perrier, Flavie and McKenzie, Fiona and Bueno-de-Mesquita, H. Bas and Olsen, Anja and Tjønneland, Anne and Dahm, Christina C. and Overvad, Kim and Mancini, Francesca R. and Rebours, Vinciane and Boutron-Ruault, Marie Christine and Katzke, Verena and Kaaks, Rudolf and Bergmann, Manuela and Boeing, Heiner and Peppa, Eleni and Karakatsani, Anna and Trichopoulou, Antonia and Pala, Valeria and Masala, Giovana and Panico, Salvatore and Tumino, Rosario and Sacerdote, Carlotta and May, Anne M. and van Gils, Carla H. and Rylander, Charlotta and Borch, Kristin Benjaminsen and Chirlaque López, María Dolores and Sánchez, Maria Jose and Ardanaz, Eva and Quirós, José Ramón and Amiano Exezarreta, Pilar and Sund, Malin and Drake, Isabel and Regnér, Sara and Travis, Ruth C. and Wareham, Nick and Aune, Dagfinn and Riboli, Elio and Gunter, Marc J. and Duell, Eric J. and Brennan, Paul and Ferrari, Pietro}},
  issn         = {{0393-2990}},
  keywords     = {{EPIC; Healthy Lifestyle Index; Pancreatic cancer; Population attributable fraction; Prospective study}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{975--986}},
  publisher    = {{Springer}},
  series       = {{European Journal of Epidemiology}},
  title        = {{Healthy lifestyle and the risk of pancreatic cancer in the EPIC study}},
  url          = {{http://dx.doi.org/10.1007/s10654-019-00559-6}},
  doi          = {{10.1007/s10654-019-00559-6}},
  volume       = {{35}},
  year         = {{2020}},
}