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Healthy lifestyle and the risk of lymphoma in the European Prospective Investigation into Cancer and Nutrition study

Naudin, Sabine ; Solans Margalef, Marta ; Saberi Hosnijeh, Fatemeh ; Nieters, Alexandra ; Kyrø, Cecilie ; Tjønneland, Anne ; Dahm, Christina C. ; Overvad, Kim ; Mahamat-Saleh, Yahya and Besson, Caroline , et al. (2020) In International Journal of Cancer 147(6). p.1649-1656
Abstract

Limited evidence exists on the role of modifiable lifestyle factors on the risk of lymphoma. In this work, the associations between adherence to healthy lifestyles and risks of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) were evaluated in a large-scale European prospective cohort. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 2,999 incident lymphoma cases (132 HL and 2,746 NHL) were diagnosed among 453,808 participants after 15 years (median) of follow-up. The healthy lifestyle index (HLI) score combined information on smoking, alcohol intake, diet, physical activity and BMI, with large values of HLI expressing adherence to healthy behavior. Cox proportional hazards models were used to estimate... (More)

Limited evidence exists on the role of modifiable lifestyle factors on the risk of lymphoma. In this work, the associations between adherence to healthy lifestyles and risks of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) were evaluated in a large-scale European prospective cohort. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 2,999 incident lymphoma cases (132 HL and 2,746 NHL) were diagnosed among 453,808 participants after 15 years (median) of follow-up. The healthy lifestyle index (HLI) score combined information on smoking, alcohol intake, diet, physical activity and BMI, with large values of HLI expressing adherence to healthy behavior. Cox proportional hazards models were used to estimate lymphoma hazard ratios (HR) and 95% confidence interval (CI). Sensitivity analyses were conducted by excluding, in turn, each lifestyle factor from the HLI score. The HLI was inversely associated with HL, with HR for a 1-standard deviation (SD) increment in the score equal to 0.78 (95% CI: 0.66, 0.94). Sensitivity analyses showed that the association was mainly driven by smoking and marginally by diet. NHL risk was not associated with the HLI, with HRs for a 1-SD increment equal to 0.99 (0.95, 1.03), with no evidence for heterogeneity in the association across NHL subtypes. In the EPIC study, adherence to healthy lifestyles was not associated with overall lymphoma or NHL risk, while an inverse association was observed for HL, although this was largely attributable to smoking. These findings suggest a limited role of lifestyle factors in the etiology of lymphoma subtypes.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
EPIC, healthy lifestyle index, Hodgkin lymphoma, non-Hodgkin lymphoma, prospective study
in
International Journal of Cancer
volume
147
issue
6
pages
8 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:32176325
  • scopus:85082751003
ISSN
0020-7136
DOI
10.1002/ijc.32977
language
English
LU publication?
yes
id
91bb1aa0-a6ea-4879-86ba-df33a97eae49
date added to LUP
2020-04-28 16:03:23
date last changed
2024-08-21 20:34:23
@article{91bb1aa0-a6ea-4879-86ba-df33a97eae49,
  abstract     = {{<p>Limited evidence exists on the role of modifiable lifestyle factors on the risk of lymphoma. In this work, the associations between adherence to healthy lifestyles and risks of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) were evaluated in a large-scale European prospective cohort. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 2,999 incident lymphoma cases (132 HL and 2,746 NHL) were diagnosed among 453,808 participants after 15 years (median) of follow-up. The healthy lifestyle index (HLI) score combined information on smoking, alcohol intake, diet, physical activity and BMI, with large values of HLI expressing adherence to healthy behavior. Cox proportional hazards models were used to estimate lymphoma hazard ratios (HR) and 95% confidence interval (CI). Sensitivity analyses were conducted by excluding, in turn, each lifestyle factor from the HLI score. The HLI was inversely associated with HL, with HR for a 1-standard deviation (SD) increment in the score equal to 0.78 (95% CI: 0.66, 0.94). Sensitivity analyses showed that the association was mainly driven by smoking and marginally by diet. NHL risk was not associated with the HLI, with HRs for a 1-SD increment equal to 0.99 (0.95, 1.03), with no evidence for heterogeneity in the association across NHL subtypes. In the EPIC study, adherence to healthy lifestyles was not associated with overall lymphoma or NHL risk, while an inverse association was observed for HL, although this was largely attributable to smoking. These findings suggest a limited role of lifestyle factors in the etiology of lymphoma subtypes.</p>}},
  author       = {{Naudin, Sabine and Solans Margalef, Marta and Saberi Hosnijeh, Fatemeh and Nieters, Alexandra and Kyrø, Cecilie and Tjønneland, Anne and Dahm, Christina C. and Overvad, Kim and Mahamat-Saleh, Yahya and Besson, Caroline and Boutron-Ruault, Marie Christine and Kühn, Tilman and Canzian, Federico and Schulze, Matthias B. and Peppa, Eleni and Karakatsani, Anna and Trichopoulou, Antonia and Sieri, Sabina and Masala, Giovana and Panico, Salvatore and Tumino, Rosario and Ricceri, Fulvio and Chen, Sairah L.F. and Barroso, Leila L. and Huerta, José M. and Sánchez, Maria Jose and Ardanaz, Eva and Menéndez, Virginia and Amiano Exezarreta, Pilar and Spaeth, Florentin and Jerkeman, Mats and Jirstrom, Karin and Schmidt, Julie A. and Aune, Dagfinn and Weiderpass, Elisabete and Riboli, Elio and Vermeulen, Roel and Casabonne, Delphine and Gunter, Marc and Brennan, Paul and Ferrari, Pietro}},
  issn         = {{0020-7136}},
  keywords     = {{EPIC; healthy lifestyle index; Hodgkin lymphoma; non-Hodgkin lymphoma; prospective study}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{6}},
  pages        = {{1649--1656}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{International Journal of Cancer}},
  title        = {{Healthy lifestyle and the risk of lymphoma in the European Prospective Investigation into Cancer and Nutrition study}},
  url          = {{http://dx.doi.org/10.1002/ijc.32977}},
  doi          = {{10.1002/ijc.32977}},
  volume       = {{147}},
  year         = {{2020}},
}