Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort studyReportar como inadecuado

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Journal Title:

BMC Medicine


Volume 12


BioMed Central | 2014-10-10

Type of Work:

Article | Final Publisher PDF

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.

Subjects: Health Sciences, Oncology - Health Sciences, Public Health - Health Sciences, Epidemiology - Research Funding: The coordination of the EPIC study is financially supported by the European Commission DG-SANCO and the International Agency for Research on Cancer.

The national cohorts are supported by Danish Cancer Society Denmark; Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale INSERM France; Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research Germany; Hellenic Health Foundation Greece; Italian Association for Research on Cancer AIRC, National Research Council, HuGeF Foundation, Compagnia di San Paolo, Sicily Regional Government, AIRE ONLUS Ragusa and AVIS Ragusa Italy; Dutch Ministry of Public Health, Welfare and Sports VWS, Netherlands Cancer Registry NKR, LK Research Funds, Dutch Prevention Funds, Dutch ZON Zorg Onderzoek Nederland, World Cancer Research Fund WCRF and Statistics Netherlands The Netherlands; ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health, Norwegian Research Council, Norwegian Cancer Society, University of Tromso Norway; Health Research Fund FIS, Regional Governments of Andalucía, Asturias, Basque Country, Murcia no. 6236 and Navarra, ISCIII RETIC RD06-0020 Spain; Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skåne and Västerbotten Sweden; Cancer Research UK, Medical Research Council United Kingdom.

Keywords: Science and Technology - Life Sciences and Biomedicine - Medicine, General and Internal - General and Internal Medicine - lifestyle factors - combined impact - population attributable risks - colorectal cancer - European Prospective Investigation into Cancer and Nutrition EPIC - PHYSICAL-ACTIVITY - RISK-FACTORS - MYOCARDIAL-INFARCTION - ATTRIBUTABLE RISK - RECTAL CANCERS - COLON-CANCER - NUTRITION - PREVENTION - PROPORTION - METAANALYSIS -

Autor: Krasimira Aleksandrova, Tobias Pischon, Mazda Jenab, H. Bas Bueno-de-Mesquita, Veronika Fedirko, Teresa Norat, Dora Romaguera, Sv



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