Your browser has javascript turned off or blocked. This will lead to some parts of our website to not work properly or at all. Turn on javascript for best performance.

The browser you are using is not supported by this website. All versions of Internet Explorer are no longer supported, either by us or Microsoft (read more here: https://www.microsoft.com/en-us/microsoft-365/windows/end-of-ie-support).

Please use a modern browser to fully experience our website, such as the newest versions of Edge, Chrome, Firefox or Safari etc.

Ulrika Ericson

Ulrika Ericson

Associate professor

Ulrika Ericson

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

Author

  • Krasimira Aleksandrova
  • Tobias Pischon
  • Mazda Jenab
  • H. Bas Bueno-de-Mesquita
  • Veronika Fedirko
  • Teresa Norat
  • Dora Romaguera
  • Sven Knueppel
  • Marie-Christine Boutron-Ruault
  • Laure Dossus
  • Laureen Dartois
  • Rudolf Kaaks
  • Kuanrong Li
  • Anne Tjonneland
  • Kim Overvad
  • Jose Ramon Quiros
  • Genevieve Buckland
  • Maria Jose Sanchez
  • Miren Dorronsoro
  • Maria-Dolores Chirlaque
  • Aurelio Barricarte
  • Kay-Tee Khaw
  • Nicholas J. Wareham
  • Kathryn E. Bradbury
  • Antonia Trichopoulou
  • Pagona Lagiou
  • Dimitrios Trichopoulos
  • Domenico Palli
  • Vittorio Krogh
  • Rosario Tumino
  • Alessio Naccarati
  • Salvatore Panico
  • Peter D. Siersema
  • Petra H. M. Peeters
  • Ingrid Ljuslinder
  • Ingegerd Johansson
  • Ulrika Ericson
  • Bodil Ohlsson
  • Elisabete Weiderpass
  • Guri Skeie
  • Kristin Benjaminsen Borch
  • Sabina Rinaldi
  • Isabelle Romieu
  • Joyce Kong
  • Marc J. Gunter
  • Heather A. Ward
  • Elio Riboli
  • Heiner Boeing

Summary, in English

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.

Department/s

  • Diabetes - Cardiovascular Disease
  • Internal Medicine - Epidemiology
  • EXODIAB: Excellence in Diabetes Research in Sweden
  • EpiHealth: Epidemiology for Health

Publishing year

2014

Language

English

Publication/Series

BMC Medicine

Volume

12

Document type

Journal article

Publisher

BioMed Central (BMC)

Topic

  • Cancer and Oncology
  • Endocrinology and Diabetes

Keywords

  • lifestyle factors
  • combined impact
  • population attributable risks
  • colorectal cancer
  • European Prospective Investigation into Cancer and
  • Nutrition (EPIC)

Status

Published

Research group

  • Diabetes - Cardiovascular Disease
  • Internal Medicine - Epidemiology

ISBN/ISSN/Other

  • ISSN: 1741-7015