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

doi:10.14309/ajg.0000000000002065

. 2023 Apr 1;118(4):702-711.

doi: 10.14309/ajg.0000000000002065. Epub 2022 Oct 12.

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

Edoardo Botteri^{1

2}, Giulia Peveri^{3

4}, Paula Berstad¹, Vincenzo Bagnardi⁵, Sairah L F Chen⁶, Torkjel M Sandanger⁶, Geir Hoff^{1

7}, Christina C Dahm⁸, Christian S Antoniussen⁸, Anne Tjønneland⁹, Anne Kirstine Eriksen⁹, Guri Skeie⁶, Aurora Perez-Cornago¹⁰, José María Huerta^{11

12}, Paula Jakszyn¹³, Sophia Harlid¹⁴, Björn Sundström¹⁵, Aurelio Barricarte^{12

16

17}, Evelyn M Monninkhof¹⁸, Jeroen W G Derksen¹⁸, Matthias B Schulze^{19

20}, Bas Bueno-de-Mesquita²¹, Maria-Jose Sánchez^{12

22

23

24}, Amanda J Cross²⁵, Konstantinos K Tsilidis^{25

26}, Maria Santucci De Magistris²⁷, Rudolf Kaaks²⁸, Verena Katzke²⁸, Joseph A Rothwell²⁹, Nasser Laouali²⁹, Gianluca Severi^{29

30}, Pilar Amiano^{31

32

33}, Paolo Contiero³⁴, Carlotta Sacerdote³⁵, Marcel Goldberg³⁶, Mathilde Touvier^{37

38}, Heinz Freisling³⁹, Vivian Viallon³⁹, Elisabete Weiderpass³⁹, Elio Riboli²⁵, Marc J Gunter³⁹, Mazda Jenab³⁹, Pietro Ferrari³⁹

Affiliations

¹ Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
² Department of Research, Cancer Registry of Norway, Oslo, Norway.
³ Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
⁴ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
⁶ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁷ Department of Research, Telemark Hospital, Skien, Norway.
⁸ Department of Public Health, Aarhus University, Denmark.
⁹ Danish Cancer Society Research Center, Copenhagen, Denmark.
¹⁰ Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
¹¹ Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
¹² CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
¹³ Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
¹⁴ Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden.
¹⁵ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹⁶ Navarra Public Health Institute, Pamplona, Spain.
¹⁷ Navarra Institute for Health Research (IdiSNA) Pamplona, Spain.
¹⁸ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹⁹ Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
²⁰ Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
²¹ Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
²² Escuela Andaluza de Salud Pública (EASP), Granada, Spain.
²³ Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
²⁴ Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
²⁵ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
²⁶ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
²⁷ Azienda Ospedaliera Universitaria Federico II di Napoli, Napoli, Italy.
²⁸ Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
²⁹ Université Paris-Saclay, UVSQ, Inserm, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France.
³⁰ Department of Statistics, Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy.
³¹ Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain.
³² Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain.
³³ Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
³⁴ Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
³⁵ Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy.
³⁶ Population-based Epidemiologic Cohorts Unit, Inserrm UMS 11, Villejuif, France.
³⁷ Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France.
³⁸ Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France.
³⁹ International Agency for Research on Cancer, World Health Organization, Lyon, France.

PMID: 36227801
DOI: 10.14309/ajg.0000000000002065

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

Edoardo Botteri et al. Am J Gastroenterol. 2023.

. 2023 Apr 1;118(4):702-711.

doi: 10.14309/ajg.0000000000002065. Epub 2022 Oct 12.

Authors

Affiliations

¹ Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
² Department of Research, Cancer Registry of Norway, Oslo, Norway.
³ Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
⁴ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
⁶ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁷ Department of Research, Telemark Hospital, Skien, Norway.
⁸ Department of Public Health, Aarhus University, Denmark.
⁹ Danish Cancer Society Research Center, Copenhagen, Denmark.
¹⁰ Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
¹¹ Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
¹² CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
¹³ Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
¹⁴ Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden.
¹⁵ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹⁶ Navarra Public Health Institute, Pamplona, Spain.
¹⁷ Navarra Institute for Health Research (IdiSNA) Pamplona, Spain.
¹⁸ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
¹⁹ Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
²⁰ Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
²¹ Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
²² Escuela Andaluza de Salud Pública (EASP), Granada, Spain.
²³ Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
²⁴ Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
²⁵ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
²⁶ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
²⁷ Azienda Ospedaliera Universitaria Federico II di Napoli, Napoli, Italy.
²⁸ Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
²⁹ Université Paris-Saclay, UVSQ, Inserm, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France.
³⁰ Department of Statistics, Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy.
³¹ Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain.
³² Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain.
³³ Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
³⁴ Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
³⁵ Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy.
³⁶ Population-based Epidemiologic Cohorts Unit, Inserrm UMS 11, Villejuif, France.
³⁷ Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France.
³⁸ Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France.
³⁹ International Agency for Research on Cancer, World Health Organization, Lyon, France.

PMID: 36227801
DOI: 10.14309/ajg.0000000000002065

Abstract

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.

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Career and Race Are Associated With Cancer.
Jin T, Huang M. Jin T, et al. Am J Gastroenterol. 2023 Apr 1;118(4):758. doi: 10.14309/ajg.0000000000002133. Epub 2022 Dec 7. Am J Gastroenterol. 2023. PMID: 36989432 No abstract available.

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References

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clinicians 2021;71(3):209–49.
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[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clinicians 2021;71(3):209–49.

[2] Sung H, Ferlay J, Siegel RL, et al. Global cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clinicians 2021;71(3):209–49.

[3] Botteri E, Borroni E, Sloan EK, et al. Smoking and colorectal cancer risk, overall and by molecular subtypes: A meta-analysis. Am J Gastroenterol 2020;115(12):1940–9.

[4] Botteri E, Borroni E, Sloan EK, et al. Smoking and colorectal cancer risk, overall and by molecular subtypes: A meta-analysis. Am J Gastroenterol 2020;115(12):1940–9.

[5] World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018 ( www.dietandcancerreport.org ). Accessed May 15, 2022.

[6] World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018 ( www.dietandcancerreport.org ). Accessed May 15, 2022.

[7] Aleksandrova K, Pischon T, Jenab M, et al. Combined impact of healthy lifestyle factors on colorectal cancer: A large European cohort study. BMC Med 2014;12(1):168.

[8] Aleksandrova K, Pischon T, Jenab M, et al. Combined impact of healthy lifestyle factors on colorectal cancer: A large European cohort study. BMC Med 2014;12(1):168.

[9] Kirkegaard H, Johnsen NF, Christensen J, et al. Association of adherence to lifestyle recommendations and risk of colorectal cancer: A prospective Danish cohort study. BMJ 2010;341:c5504.

[10] Kirkegaard H, Johnsen NF, Christensen J, et al. Association of adherence to lifestyle recommendations and risk of colorectal cancer: A prospective Danish cohort study. BMJ 2010;341:c5504.

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

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

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