Changes in Lifestyle and Risk of Colorectal Cancer in the European Prospective Investigation Into Cancer and Nutrition

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  • Edoardo Botteri, Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
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  • Giulia Peveri, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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  • Paula Berstad, Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
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  • Vincenzo Bagnardi, University of Milan - Bicocca
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  • Sairah L F Chen, UiT The Arctic University of Norway
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  • Torkjel M Sandanger, UiT The Arctic University of Norway
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  • Geir Hoff, Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
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  • Christina C Dahm
  • Christian S Antoniussen
  • Anne Tjønneland, Kræftens Bekæmpelse
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  • Anne Kirstine Eriksen, Kræftens Bekæmpelse
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  • Guri Skeie, UiT The Arctic University of Norway
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  • Aurora Perez-Cornago, University of Oxford
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  • José María Huerta, Department of Epidemiology Research & Department of Infectious Disease Epidemiology and Prevention
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  • Paula Jakszyn, Catalan Institute of Oncology - ICO
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  • Sophia Harlid, Lund University, Malmö, Sweden; Umeå University, Umeå, Sweden.
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  • Björn Sundström, Lund University, Malmö, Sweden; Umeå University, Umeå, Sweden.
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  • Aurelio Barricarte, 23 CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
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  • Evelyn M Monninkhof, Univ Med Ctr Utrecht, Utrecht University, St. Antonius Hospital Utrecht, Utrecht University Medical Center, St Antonius Hosp, Div Heart & Lungs, ILD Ctr Excellence
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  • Jeroen W G Derksen, Univ Med Ctr Utrecht, Utrecht University, St. Antonius Hospital Utrecht, Utrecht University Medical Center, St Antonius Hosp, Div Heart & Lungs, ILD Ctr Excellence
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  • Matthias B Schulze, German Institute of Human Nutrition Potsdam-Rehbruecke
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  • Bas Bueno-de-Mesquita, National Institute for Public Health and the Environment (RIVM), Bilthoven
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  • Maria-Jose Sánchez, 23 CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
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  • Amanda J Cross, Imperial College London
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  • Konstantinos K Tsilidis, Imperial College London
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  • Maria Santucci De Magistris, Azienda Ospedaliera Universitaria Federico II di Napoli
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  • Rudolf Kaaks, German Cancer Research Center
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  • Verena Katzke, German Cancer Research Center
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  • Joseph A Rothwell, Univ Paris Saclay, Universite Paris Saclay, Universite Paris Sud - Paris 11, Universite Paris Saclay (ComUE), Centre National de la Recherche Scientifique (CNRS), Ecole Normale Superieure Paris-Saclay, CNRS, ENS Paris Saclay, Lab Aime Cotton,Univ Paris Sud
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  • Nasser Laouali, Univ Paris Saclay, Universite Paris Saclay, Universite Paris Sud - Paris 11, Universite Paris Saclay (ComUE), Centre National de la Recherche Scientifique (CNRS), Ecole Normale Superieure Paris-Saclay, CNRS, ENS Paris Saclay, Lab Aime Cotton,Univ Paris Sud
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  • Gianluca Severi, Univ Paris Saclay, Universite Paris Saclay, Universite Paris Sud - Paris 11, Universite Paris Saclay (ComUE), Centre National de la Recherche Scientifique (CNRS), Ecole Normale Superieure Paris-Saclay, CNRS, ENS Paris Saclay, Lab Aime Cotton,Univ Paris Sud
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  • Pilar Amiano, Ministry of Health of the Basque Government
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  • Paolo Contiero, Cardiovascular Epidemiology Unit, Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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  • Carlotta Sacerdote, Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Turin, Italy.
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  • Marcel Goldberg, Population-based Epidemiologic Cohorts Unit
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  • Mathilde Touvier, Univ Paris 13, Universite Sorbonne Paris Cite-USPC (ComUE), University of Paris Nord - Paris XIII, Sorbonne Paris Cite, UFR Sante Med & Biol Humaine
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  • Heinz Freisling, World Health Organization
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  • Vivian Viallon, World Health Organization
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  • Elisabete Weiderpass, World Health Organization
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  • Elio Riboli, Imperial College London
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  • Mazda Jenab, World Health Organization
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  • Pietro Ferrari, World Health Organization

INTRODUCTION: We investigated the impact of changes in lifestyle habits on colorectal cancer (CRC) risk in a multicountry European cohort.

METHODS: We used baseline and follow-up questionnaire data from the European Prospective Investigation into Cancer cohort to assess changes in lifestyle habits and their associations with CRC development. We calculated a healthy lifestyle index (HLI) score based on smoking status, alcohol consumption, body mass index, and physical activity collected at the 2 time points. HLI ranged from 0 (most unfavorable) to 16 (most favorable). We estimated the association between HLI changes and CRC risk using Cox regression models and reported hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS: Among 295,865 participants, 2,799 CRC cases were observed over a median of 7.8 years. The median time between questionnaires was 5.7 years. Each unit increase in HLI from the baseline to the follow-up assessment was associated with a statistically significant 3% lower CRC risk. Among participants in the top tertile at baseline (HLI > 11), those in the bottom tertile at follow-up (HLI ≤ 9) had a higher CRC risk (HR 1.34; 95% CI 1.02-1.75) than those remaining in the top tertile. Among individuals in the bottom tertile at baseline, those in the top tertile at follow-up had a lower risk (HR 0.77; 95% CI 0.59-1.00) than those remaining in the bottom tertile.

DISCUSSION: Improving adherence to a healthy lifestyle was inversely associated with CRC risk, while worsening adherence was positively associated with CRC risk. These results justify and support recommendations for healthy lifestyle changes and healthy lifestyle maintenance for CRC prevention.

OriginalsprogEngelsk
TidsskriftThe American Journal of Gastroenterology
ISSN0002-9270
DOI
StatusE-pub ahead of print - 2 dec. 2022

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Copyright © 2022 by The American College of Gastroenterology.

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