%0 Journal Article
%A Aleksandrova, Krasimira
%A Pischon, Tobias
%A Jenab, Mazda
%A Bueno-de-Mesquita, H
%A Fedirko, Veronika
%A Norat, Teresa
%A Romaguera, Dora
%A Knüppel, Sven
%A Boutron-Ruault, Marie-Christine
%A Dossus, Laure
%A Dartois, Laureen
%A Kaaks, Rudolf
%A Li, Kuanrong
%A Tjønneland, Anne
%A Overvad, Kim
%A Quirós, José Ramón
%A Buckland, Genevieve
%A Sanchez-Perez, Maria-Jose
%A Dorronsoro, Miren
%A Chirlaque, Maria-Dolores
%A Barricarte, Aurelio
%A Khaw, Kay-Tee
%A Wareham, Nicholas J
%A Bradbury, Kathryn E
%A Trichopoulou, Antonia
%A Lagiou, Pagona
%A Trichopoulos, Dimitrios
%A Palli, Domenico
%A Krogh, Vittorio
%A Tumino, Rosario
%A Naccarati, Alessio
%A Panico, Salvatore
%A Siersema, Peter D
%A Peeters, Petra
%A Ljuslinder, Ingrid
%A Johansson, Ingegerd
%A Ericson, Ulrika
%A Ohlsson, Bodil
%A Weiderpass, Elisabete
%A Skeie, Guri
%A Borch, Kristin
%A Rinaldi, Sabina
%A Romieu, Isabelle
%A Kong, Joyce
%A Gunter, Marc J
%A Ward, Heather A
%A Riboli, Elio
%A Boeing, Heiner
%T Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study.
%D 2014
%U http://hdl.handle.net/10668/1988
%X BACKGROUNDExcess 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.METHODSIn 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.RESULTSAfter 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.CONCLUSIONSCombined 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.
%K Lifestyle factors
%K Combined impact
%K Population attributable risks
%K Colorectal cancer
%K European Prospective Investigation into Cancer and Nutrition (EPIC)
%K Neoplasias colorrectales
%K Consumo de alcohol
%K Dieta
%K Hábito de fumar
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