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. 2014 Oct 10:12:168.
doi: 10.1186/s12916-014-0168-4.

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

Krasimira Aleksandrova  1 , Tobias Pischon  2 , Mazda Jenab  3 , H Bas Bueno-de-Mesquita  4   5   6 , Veronika Fedirko  7   8 , Teresa Norat  9 , Dora Romaguera  10   11   12 , Sven Knüppel  13 , Marie-Christine Boutron-Ruault  14   15   16 , Laure Dossus  17   18   19 , Laureen Dartois  20   21   22 , Rudolf Kaaks  23 , Kuanrong Li  24 , Anne Tjønneland  25 , Kim Overvad  26 , José Ramón Quirós  27 , Genevieve Buckland  28 , María José Sánchez  29   30 , Miren Dorronsoro  31 , Maria-Dolores Chirlaque  32   33 , Aurelio Barricarte  34 , Kay-Tee Khaw  35 , Nicholas J Wareham  36 , Kathryn E Bradbury  37 , Antonia Trichopoulou  38   39 , Pagona Lagiou  40   41 , Dimitrios Trichopoulos  42   43   44 , Domenico Palli  45 , Vittorio Krogh  46 , Rosario Tumino  47 , Alessio Naccarati  48 , Salvatore Panico  49 , Peter D Siersema  50 , Petra H M Peeters  51   52 , Ingrid Ljuslinder  53 , Ingegerd Johansson  54 , Ulrika Ericson  55 , Bodil Ohlsson  56 , Elisabete Weiderpass  57   58   59   60 , Guri Skeie  61 , Kristin Benjaminsen Borch  62 , Sabina Rinaldi  63 , Isabelle Romieu  64 , Joyce Kong  65 , Marc J Gunter  66 , Heather A Ward  67 , Elio Riboli  68 , Heiner Boeing  69
Affiliations

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

Krasimira Aleksandrova et al. BMC Med. .

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 VSports手机版. .

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 V体育安卓版. .

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 V体育ios版. 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. VSports最新版本.

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Figures

Figure 1
Figure 1
Multivariable-adjusted hazard ratios (95% confidence intervals) of colorectal cancer according to increasing number of healthy lifestyle factors. Healthy lifestyle index (range 0 to 5 points) is calculated by summing the binary lifestyle factor variables (0, 1) including overweight and obesity, physical activity, smoking, alcohol consumption and diet quality. Participants received 1 point if they had any of the following behaviours: healthy weight, physically active, non-smokers or former smokers, limited alcohol consumption or healthy diet quality. The hazard ratios are calculated after stratification by EPIC study centre and multivariable adjustment for age at study recruitment, sex and educational status (none, primary school, technical/professional school/not specified). P-value for the linear trend was calculated using the Wald test treating the index as a continuous variable. EPIC. European Prospective Investigation into Cancer and Nutrition.
Figure 2
Figure 2
Multivariable-adjusted hazard ratios of colorectal cancer according to combinations of healthy lifestyle factors. HRs are shown for persons with the respective combination of healthy lifestyle factors compared with persons with none or one of the lifestyle factors; The multivariable model is stratified by EPIC study centre and adjusted for age at study recruitment, sex and educational status (none, primary school, technical/professional school/ not specified). The presented prevalences (%) represent the frequency distribution of the respective combinations of healthy lifestyle factors among the total study population. Within the reference group of individuals with 0 or 1 healthy lifestyle factors, 0.8% had 0 factors, 1.1% had only healthy weight; 0.85% had only high physical activity, 1.6% had only non-smoking, 1.4% had only limited alcohol and 0.9% had only healthy diet. CI, confidence interval; EPIC, European Prospective Investigation into Cancer and Nutrition; HR, hazard ratio.
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