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

BMC Medicine

Heiner Boeing^3,30  Elio Riboli^3,31  Heather A Ward^3,31  Marc J Gunter^3,31  Joyce Kong^1,19  Isabelle Romieu^1,19  Sabina Rinaldi^1,19  Kristin Benjaminsen Borch^2,26  Guri Skeie^2,26  Elisabete Weiderpass^1,14  Bodil Ohlsson⁷  Ulrika Ericson^2,20  Ingegerd Johansson⁶  Ingrid Ljuslinder^2,29  Petra HM Peeters^3,31  Peter D Siersema^1,18  Salvatore Panico^1,16  Alessio Naccarati^2,27  Rosario Tumino^3,32  Vittorio Krogh^1,15  Domenico Palli⁹  Dimitrios Trichopoulos^3,34  Pagona Lagiou^2,25  Antonia Trichopoulou^2,24  Kathryn E Bradbury³  Nicholas J Wareham^1,13  Kay-Tee Khaw^1,11  Aurelio Barricarte^2,21  Maria-Dolores Chirlaque^1,10  Miren Dorronsoro⁴  María José Sánchez²  Genevieve Buckland^3,33  José Ramón Quirós⁵  Kim Overvad⁸  Anne Tjønneland^1,17  Kuanrong Li^2,28  Rudolf Kaaks^2,28  Laureen Dartois^1,12  Laure Dossus^1,12  Marie-Christine Boutron-Ruault^1,12  Sven Knüppel^3,30  Dora Romaguera^2,22  Teresa Norat^3,31  Veronika Fedirko^2,23  H Bas Bueno-de-Mesquita^3,31  Mazda Jenab^1,19  Tobias Pischon¹  Krasimira Aleksandrova^3,30 

[1] Molecular Epidemiology Group, Max Delbrueck Center for Molecular Medicine (MDC), Berlin-Buch, Germany;CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK;Epidemiology and Health Information, Public Health Division of Gipuzkoa, Basque Regional Health Department, San Sebastian, Spain;Public Health Directorate, Asturias, Spain;Department of Odontology, Umeå University, Umeå, Sweden;Department of Clinical Sciences, Division of Internal Medicine, Skåne University Hospital Malmö, Lund University, Malmö, Sweden;Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark;Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy;Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain;Clinical Gerontology Unit, Addenbrooke’s Hospital, University of Cambridge School of Clinical Medicine, Cambridge, UK;IGR, Villejuif, F-94805, France;MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK;Samfundet Folkhälsan, Helsinki, Finland;Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;Department of clinical and experimental medicine-Federico II University, Naples, Italy;Diet, Genes and Environment Danish Cancer Society Research Center, Copenhagen, Denmark;Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, the Netherlands;International Agency for Research on Cancer (IARC-WHO), Lyon, France;Diabetes and Cardiovascular Disease, Genetic Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden;Navarre Public Health Institute, Pamplona, Spain;CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Santiago de Compostela, Spain;Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA, USA;Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece;Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece;Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromsø, Norway;HuGeF - Human Genetics Foundation – Torino, Molecular and Genetic Epidemiology Unit, Turin, Italy;Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany;Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden;Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany;Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK;Cancer Registry and Histopathology Unit, “M.P.Arezzo” Hospital, Ragusa, Italy;Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain;Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

关键词: European Prospective Investigation into Cancer and Nutrition (EPIC);    colorectal cancer;    population attributable risks;    combined impact;    lifestyle factors;   

Others  :  1123234
DOI  :  10.1186/s12916-014-0168-4

 received in 2014-06-27, accepted in 2014-08-29,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Aleksandrova et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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