Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study

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  • Heinz Freisling, Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France. freislingh@iarc.fr., Frankrig
  • Vivian Viallon, Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France., Frankrig
  • Hannah Lennon, Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France., Frankrig
  • Vincenzo Bagnardi, Department of Statistics and Quantitative Methods, University of Milan Bicocca, Milan, Italy., Italien
  • Cristian Ricci, Centre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa., Sydafrika
  • Adam S Butterworth, Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., Storbritannien
  • Michael Sweeting, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., Storbritannien
  • David Muller, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK., Storbritannien
  • Isabelle Romieu, Nutritional Epidemiology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372, France., Frankrig
  • Pauline Bazelle, Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France., Frankrig
  • Marina Kvaskoff, Centre for Research in Epidemiology and Population Health (CESP), Inserm, Facultés de Médecine Universités Paris Sud, UVSQ, Université Paris Saclay, Gustave Roussy, Villejuif, France., Frankrig
  • Patrick Arveux, Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, Dijon, France., Frankrig
  • Gianluca Severi, Human Genetics Foundation,Torino, Molecular and Genetic Epidemiology Unit, Torino, Italy;, Italien
  • Christina Bamia, Hellenic Health Foundation, Athens, Greece., Grækenland
  • Tilman Kühn, German Cancer Research Center (DKFZ), Heidelberg, Tyskland
  • Rudolf Kaaks, German Cancer Research Center (DKFZ), Heidelberg, Tyskland
  • Manuela Bergmann, Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany, karina.meidtner@dife.de., Tyskland
  • Heiner Boeing, Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany, karina.meidtner@dife.de., Tyskland
  • Anne Tjønneland, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark., Danmark
  • Anja Olsen
  • Kim Overvad
  • Christina C Dahm
  • Virginia Menéndez, Public Health Directorate, Asturias, Spain., Spanien
  • Antonio Agudo, Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain., Spanien
  • Maria-Jose Sánchez, Andalusian School of Public Health and Instituto de Investigación Biosanitaria de Granada ibs, Servicio Andaluz de Salud/Universidad de Granada, Granada, Spain., Spanien
  • Pilar Amiano, Public Health Division of Gipuzkoa, Basque Government, Spain; Health Research Institute, Biodonostia, San Sebastián, Spain., Spanien
  • Carmen Santiuste, Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain., Spanien
  • Aurelio Barricarte Gurrea, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain., Spanien
  • Tammy Y N Tong, Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK., Storbritannien
  • Julie A Schmidt, Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK., Storbritannien
  • Ioanna Tzoulaki, Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, 45110, Greece., Grækenland
  • Konstantinos K Tsilidis, Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, 45110, Greece., Grækenland
  • Heather Ward, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK., Storbritannien
  • Domenico Palli, Cancer Risk Factors and Life-Style Epidemiology Unit. Institute for Cancer Research, Prevention and Clinical Network - ISPRO, 50141, Florence, Italy., Italien
  • Claudia Agnoli, 12 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Italien
  • Rosario Tumino, Civi M. Arezzo Hospital, ASP Ragusa, Italy., Italien
  • Fulvio Ricceri, Unit of Cancer Epidemiology, Citta' della Salute e della Scienza Hospital-University of Turin and Center for Cancer Prevention (CPO), Torino, ItalyHuman Genetics Foundation (HuGeF), Torino, Italy., Italien
  • Salvatore Panico, Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy., Italien
  • H Susan J Picavet, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands., Holland
  • Marije Bakker, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., Holland
  • Evelyn Monninkhof, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands., Holland
  • Peter Nilsson, Department of Public Health and Clinical Medicine, Nutritional research and Arcum-Arctic Research Centre, Umeå University, Umeå, Sweden., Sverige
  • Jonas Manjer, Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden, Sverige
  • Olov Rolandsson, Department of Public Health and Clinical Medicine, Section of Family Medicine, Umeå University, Umeå, Sweden., Sverige
  • Elin Thysell, Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden., Sverige
  • Elisabete Weiderpass, Director's Office, International Agency for Research on Cancer, Lyon, France., Frankrig
  • Mazda Jenab, Nutritional Epidemiology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372, France., Frankrig
  • Elio Riboli, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK., Storbritannien
  • Paolo Vineis, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK., Storbritannien
  • John Danesh, Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., Storbritannien
  • Nick J Wareham, MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK. jusheng.zheng@mrc-epid.cam.ac.uk., Storbritannien
  • Marc J Gunter, Nutritional Epidemiology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372, France.
  • ,
  • Pietro Ferrari, Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France., Frankrig

BACKGROUND: Although lifestyle factors have been studied in relation to individual non-communicable diseases (NCDs), their association with development of a subsequent NCD, defined as multimorbidity, has been scarcely investigated. The aim of this study was to investigate associations between five lifestyle factors and incident multimorbidity of cancer and cardiometabolic diseases.

METHODS: In this prospective cohort study, 291,778 participants (64% women) from seven European countries, mostly aged 43 to 58 years and free of cancer, cardiovascular disease (CVD), and type 2 diabetes (T2D) at recruitment, were included. Incident multimorbidity of cancer and cardiometabolic diseases was defined as developing subsequently two diseases including first cancer at any site, CVD, and T2D in an individual. Multi-state modelling based on Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (95% CI) of developing cancer, CVD, or T2D, and subsequent transitions to multimorbidity, in relation to body mass index (BMI), smoking status, alcohol intake, physical activity, adherence to the Mediterranean diet, and their combination as a healthy lifestyle index (HLI) score. Cumulative incidence functions (CIFs) were estimated to compute 10-year absolute risks for transitions from healthy to cancer at any site, CVD (both fatal and non-fatal), or T2D, and to subsequent multimorbidity after each of the three NCDs.

RESULTS: During a median follow-up of 11 years, 1910 men and 1334 women developed multimorbidity of cancer and cardiometabolic diseases. A higher HLI, reflecting healthy lifestyles, was strongly inversely associated with multimorbidity, with hazard ratios per 3-unit increment of 0.75 (95% CI, 0.71 to 0.81), 0.84 (0.79 to 0.90), and 0.82 (0.77 to 0.88) after cancer, CVD, and T2D, respectively. After T2D, the 10-year absolute risks of multimorbidity were 40% and 25% for men and women, respectively, with unhealthy lifestyle, and 30% and 18% for men and women with healthy lifestyles.

CONCLUSION: Pre-diagnostic healthy lifestyle behaviours were strongly inversely associated with the risk of cancer and cardiometabolic diseases, and with the prognosis of these diseases by reducing risk of multimorbidity.

OriginalsprogEngelsk
Artikelnummer5
TidsskriftBMC Medicine
Vol/bind18
Nummer1
Antal sider11
ISSN1741-7015
DOI
StatusUdgivet - 2020

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