TY - JOUR

T1 - Healthy lifestyle and the risk of pancreatic cancer in the EPIC study

AU - Naudin, Sabine

AU - Viallon, Vivian

AU - Hashim, Dana

AU - Freisling, Heinz

AU - Jenab, Mazda

AU - Weiderpass, Elisabete

AU - Perrier, Flavie

AU - McKenzie, Fiona

AU - Bueno-de-Mesquita, H. Bas

AU - Olsen, Anja

AU - Tjønneland, Anne

AU - Dahm, Christina C.

AU - Overvad, Kim

AU - Mancini, Francesca R.

AU - Rebours, Vinciane

AU - Boutron-Ruault, Marie Christine

AU - Katzke, Verena

AU - Kaaks, Rudolf

AU - Bergmann, Manuela

AU - Boeing, Heiner

AU - Peppa, Eleni

AU - Karakatsani, Anna

AU - Trichopoulou, Antonia

AU - Pala, Valeria

AU - Masala, Giovana

AU - Panico, Salvatore

AU - Tumino, Rosario

AU - Sacerdote, Carlotta

AU - May, Anne M.

AU - van Gils, Carla H.

AU - Rylander, Charlotta

AU - Borch, Kristin Benjaminsen

AU - Chirlaque López, María Dolores

AU - Sánchez, Maria Jose

AU - Ardanaz, Eva

AU - Quirós, José Ramón

AU - Amiano Exezarreta, Pilar

AU - Sund, Malin

AU - Drake, Isabel

AU - Regnér, Sara

AU - Travis, Ruth C.

AU - Wareham, Nick

AU - Aune, Dagfinn

AU - Riboli, Elio

AU - Gunter, Marc J.

AU - Duell, Eric J.

AU - Brennan, Paul

AU - Ferrari, Pietro

PY - 2020

Y1 - 2020

N2 - Pancreatic cancer (PC) is a highly fatal cancer with currently limited opportunities for early detection and effective treatment. Modifiable factors may offer pathways for primary prevention. In this study, the association between the Healthy Lifestyle Index (HLI) and PC risk was examined. Within the European Prospective Investigation into Cancer and Nutrition cohort, 1113 incident PC (57% women) were diagnosed from 400,577 participants followed-up for 15 years (median). HLI scores combined smoking, alcohol intake, dietary exposure, physical activity and, in turn, overall and central adiposity using BMI (HLIBMI) and waist-to-hip ratio (WHR, HLIWHR), respectively. High values of HLI indicate adherence to healthy behaviors. Cox proportional hazard models with age as primary time variable were used to estimate PC hazard ratios (HR) and 95% confidence intervals (CI). Sensitivity analyses were performed by excluding, in turn, each factor from the HLI score. Population attributable fractions (PAF) were estimated assuming participants’ shift to healthier lifestyles. The HRs for a one-standard deviation increment of HLIBMI and HLIWHR were 0.84 (95% CI: 0.79, 0.89; ptrend = 4.3e−09) and 0.77 (0.72, 0.82; ptrend = 1.7e−15), respectively. Exclusions of smoking from HLIWHR resulted in HRs of 0.88 (0.82, 0.94; ptrend = 4.9e−04). The overall PAF estimate was 19% (95% CI: 11%, 26%), and 14% (6%, 21%) when smoking was removed from the score. Adherence to a healthy lifestyle was inversely associated with PC risk, beyond the beneficial role of smoking avoidance. Public health measures targeting compliance with healthy lifestyles may have an impact on PC incidence.

AB - Pancreatic cancer (PC) is a highly fatal cancer with currently limited opportunities for early detection and effective treatment. Modifiable factors may offer pathways for primary prevention. In this study, the association between the Healthy Lifestyle Index (HLI) and PC risk was examined. Within the European Prospective Investigation into Cancer and Nutrition cohort, 1113 incident PC (57% women) were diagnosed from 400,577 participants followed-up for 15 years (median). HLI scores combined smoking, alcohol intake, dietary exposure, physical activity and, in turn, overall and central adiposity using BMI (HLIBMI) and waist-to-hip ratio (WHR, HLIWHR), respectively. High values of HLI indicate adherence to healthy behaviors. Cox proportional hazard models with age as primary time variable were used to estimate PC hazard ratios (HR) and 95% confidence intervals (CI). Sensitivity analyses were performed by excluding, in turn, each factor from the HLI score. Population attributable fractions (PAF) were estimated assuming participants’ shift to healthier lifestyles. The HRs for a one-standard deviation increment of HLIBMI and HLIWHR were 0.84 (95% CI: 0.79, 0.89; ptrend = 4.3e−09) and 0.77 (0.72, 0.82; ptrend = 1.7e−15), respectively. Exclusions of smoking from HLIWHR resulted in HRs of 0.88 (0.82, 0.94; ptrend = 4.9e−04). The overall PAF estimate was 19% (95% CI: 11%, 26%), and 14% (6%, 21%) when smoking was removed from the score. Adherence to a healthy lifestyle was inversely associated with PC risk, beyond the beneficial role of smoking avoidance. Public health measures targeting compliance with healthy lifestyles may have an impact on PC incidence.

KW - EPIC

KW - Healthy Lifestyle Index

KW - Pancreatic cancer

KW - Population attributable fraction

KW - Prospective study

U2 - 10.1007/s10654-019-00559-6

DO - 10.1007/s10654-019-00559-6

M3 - Journal article

C2 - 31564045

AN - SCOPUS:85074035335

VL - 35

SP - 975

EP - 986

JO - European Journal of Epidemiology

JF - European Journal of Epidemiology

SN - 0393-2990

ER -