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; Dossus, Laure; Dartois, Laureen; Kaaks, Rudolf; Li, Kuanrong; Tjonneland, Anne; Overvad, Kim; Quiros, Jose Ramon; Buckland, Genevieve; Sanchez, Maria Jose; Dorronsoro, Miren; Chirlaque, Maria-Dolores; Barricarte, Aurelio; Khaw, Kay-Tee; Wareham, Nicholas J.; Bradbury, Kathryn E.; Trichopoulou, Antonia; Lagiou, Pagona; Trichopoulos, Dimitrios; Palli, Domenico; Krogh, Vittorio; Tumino, Rosario; Naccarati, Alessio; Panico, Salvatore; Siersema, Peter D.; Peeters, Petra H. M.; Ljuslinder, Ingrid; Johansson, Ingegerd; Ericson, Ulrika; Ohlsson, Bodil; Weiderpass, Elisabete; Skeie, Guri; Borch, Kristin Benjaminsen; Rinaldi, Sabina; Romieu, Isabelle; Kong, Joyce; Gunter, Marc J.; Ward, Heather A.; Riboli, Elio; Boeing, Heiner

doi:10.1186/s12916-014-0168-4

Identifier to cite or link to this item: http://hdl.handle.net/20.500.13003/11099

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URI: http://hdl.handle.net/20.500.13003/11099

DOI: 10.1186/s12916-014-0168-4

ISSN: 1741-7015

WOS ID: 000344889900001

Scopus EID: 2-s2.0-84907952984

PMID: 25319089

Embase PUI: L600155703

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Publication date

2014-10-10

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research article

Citation

Aleksandrova K, Pischon T, Jenab M, Bueno-De-Mesquita HB, Fedirko V, Norat T, et al. Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study. BMC Med. 2014 Oct 10;12:168.

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.