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BioMed Central, BMC Medicine, 1(12), 2014

DOI: 10.1186/s12916-014-0168-4

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

Journal article published in 2014 by Krasimira Aleksandrova, Tobias Pischon ORCID, Mazda Jenab ORCID, H. Bas Bueno de Mesquita, H. Bas Bueno-De-Mesquita, Veronika Fedirko, Teresa Norat, Dora Romaguera, Sven Knüppel, Marie-Christine Boutron-Ruault, Laure Dossus, Laureen Dartois, Rudolf Kaaks, Kuanrong Li, Anne Tjønneland and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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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