Christina C. Dahm

Healthy lifestyle and the risk of lymphoma in the European Prospective Investigation into Cancer and Nutrition study

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review


  • Sabine Naudin, World Health Organization, Lyon, France
  • Marta Solans Margalef, CIBER Epidemiologia y Salud Publica (CIBERESP)., University of Girona, Spain
  • Fatemeh Saberi Hosnijeh, Utrecht University, Netherlands
  • Alexandra Nieters, Medical Center‐University of Freiburg, Germany
  • Cecilie Kyrø, Danish Cancer Society, Denmark
  • Anne Tjønneland, Danish Cancer Society, University of Copenhagen, Denmark
  • Christina C Dahm
  • Kim Overvad
  • Yahya Mahamat-Saleh, Universite Paris-Saclay, France
  • Caroline Besson, Universite Paris-Saclay, Hospital of Versailles, France
  • Marie-Christine Boutron-Ruault, Universite Paris-Saclay, Gustave Roussy, France
  • Tilman Kühn, German Cancer Research Center (DKFZ), Germany
  • Federico Canzian, German Cancer Research Center (DKFZ), Germany
  • Matthias B Schulze, German Institute of Human Nutrition, University of Potsdam, Germany
  • Eleni Peppa, Hellenic Health Foundation, Athens, Greece., Greece
  • Anna Karakatsani, Hellenic Health Foundation, Athens, National and Kapodistrian University of Athens, Greece
  • Antonia Trichopoulou, Hellenic Health Foundation, Athens, Greece., Greece
  • Sabina Sieri, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy., Italy
  • Giovana Masala, Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO., Italy
  • Salvatore Panico, University Federico II of Naples, Italy
  • Rosario Tumino, Cancer Registry and Histopathology Department, Azienda Sanitaria Provinciale (ASP) Ragusa, Italy., Italy
  • Fulvio Ricceri, Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy., University of Turin, Italy
  • Sairah Lai Fa Chen, UiT Norges Arktiske Universitet, Norway
  • Leila Luján Barroso, Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain., Spain
  • José María Huerta, Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain., Spanish Consortium for Research and Public Health (CIBERESP), Spain
  • Maria-Jose Sánchez, Spanish Consortium for Research and Public Health (CIBERESP), Andalusian School of Public Health, Granada, Spain., Instituto de Investigación Biosanitaria (ibs.GRANADA), Universidad de Granada, Spain
  • Eva Ardanaz, Spanish Consortium for Research and Public Health (CIBERESP), Navarra Public Health Institute, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain., Spain
  • Virginia Menéndez, Public Health Directorate, Asturias, Spain., Spain
  • Pilar Amiano Exezarreta, Spanish Consortium for Research and Public Health (CIBERESP), Public Health Division of Gipuzkoa, Spain
  • Florentin Spaeth, Umeå University, Sweden
  • Mats Jerkeman, Lund University, Sweden
  • Karin Jirstom, Lund University, Sweden
  • Julie A Schmidt, University of Oxford
  • ,
  • Dagfinn Aune, Imperial College London, Bjørknes University College, Oslo University Hospital, Norway
  • Elisabete Weiderpass, World Health Organization, Lyon, France
  • Elio Riboli, Imperial College London, United Kingdom
  • Roel Vermeulen, Utrecht University, Netherlands
  • Delphine Casabonne, CIBER Epidemiologia y Salud Publica (CIBERESP)., L'Hospitalet de Llobregat, Spain
  • Marc Gunter, Nutritional Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France.
  • ,
  • Paul Brennan, World Health Organization, Lyon, France
  • Pietro Ferrari, World Health Organization, Lyon, France

Limited evidence exists on the role of modifiable lifestyle factors on the risk of lymphoma. In this work, the associations between adherence to healthy lifestyles and risks of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) were evaluated in a large-scale European prospective cohort. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 2,999 incident lymphoma cases (132 HL and 2,746 NHL) were diagnosed among 453,808 participants after 15 years (median) of follow-up. The healthy lifestyle index (HLI) score combined information on smoking, alcohol intake, diet, physical activity and BMI, with large values of HLI expressing adherence to healthy behavior. Cox proportional hazards models were used to estimate lymphoma hazard ratios (HR) and 95% confidence interval (CI). Sensitivity analyses were conducted by excluding, in turn, each lifestyle factor from the HLI score. The HLI was inversely associated with HL, with HR for a 1-standard deviation (SD) increment in the score equal to 0.78 (95% CI: 0.66, 0.94). Sensitivity analyses showed that the association was mainly driven by smoking and marginally by diet. NHL risk was not associated with the HLI, with HRs for a 1-SD increment equal to 0.99 (0.95, 1.03), with no evidence for heterogeneity in the association across NHL subtypes. In the EPIC study, adherence to healthy lifestyles was not associated with overall lymphoma or NHL risk, while an inverse association was observed for HL, although this was largely attributable to smoking. These findings suggest a limited role of lifestyle factors in the etiology of lymphoma subtypes.

Original languageEnglish
JournalInternational Journal of Cancer
Pages (from-to)1649-1656
Number of pages8
Publication statusPublished - Sep 2020

    Research areas

  • EPIC, Hodgkin lymphoma, healthy lifestyle index, non-Hodgkin lymphoma, prospective study, REGRESSION, CIGARETTE-SMOKING, HODGKINS-LYMPHOMA, UPDATE

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