On the use of the healthy lifestyle index to investigate specific disease outcomes

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  • Vivian Viallon
  • Heinz Freisling
  • Komodo Matta
  • Anne Østergaard Nannsen
  • Christina C. Dahm
  • Anne Kirstine Eriksen
  • Rudolf Kaaks
  • Verena A. Katzke
  • Matthias B. Schulze
  • Giovanna Masala
  • Giovanna Tagliabue
  • Vittorio Simeon
  • Rosario Tumino
  • Lorenzo Milani
  • Jeroen W.G. Derksen
  • Yvonne T. van der Schouw
  • Therese Haugdahl Nøst
  • Kristin Benjaminsen Borch
  • Torkjel M. Sandanger
  • J. Ramón Quirós
  • Miguel Rodriguez-Barranco
  • Catalina Bonet
  • Amaia Aizpurua-Atxega
  • Lluís Cirera
  • Marcela Guevara
  • Björn Sundström
  • Anna Winkvist
  • Alicia K. Heath
  • Marc J. Gunter
  • Elisabete Weiderpass
  • Mattias Johansson
  • Pietro Ferrari
The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell’s C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.
OriginalsprogEngelsk
Artikelnummer16330
TidsskriftScientific Reports
Vol/bind14
Udgave nummer1
Antal sider12
ISSN2045-2322
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
This study was partially supported by the grant LIBERTY (AAP SHS-E-SP 2020, PI: P Ferrari) from the French Institut National du Cancer (INCa). The coordination of EPIC is financially supported by International Agency for Research on Cancer (IARC) and by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle G\u00E9n\u00E9rale de l\u2019Education Nationale, Institut National de la Sant\u00E9 et de la Recherche M\u00E9di\u2010 cale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam\u2010Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro\u2010AIRC\u2010Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Health Research Fund (FIS) \u2010 Instituto de Salud Carlos III (ISCIII), Regional Govern\u2010 ments of Andaluc\u00EDa, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology \u2010 ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Ska\u030Ane and Va\u0308sterbotten (Sweden); Cancer Research UK (14,136 to EPIC\u2010Norfolk; C8221/A29017 to EPIC\u2010Oxford), Medical Research Council (1,000,143 to EPIC\u2010Norfolk; MR/M012190/1 to EPIC\u2010Oxford) (UK). IDIBELL acknowledges support from the Generalitat de Catalunya through the CERCA Program. The funders were not involved in designing the study; collecting, analysing, and interpreting results; or writing and submitting the manuscript for publication.

Funding Information:
The authors thank the EPIC participants and PIs for their cooperation in providing invaluable data. We also thank Bertrand Hemon, Corinne Casagrande and Carine Biessy (International Agency for Research on Cancer) for managing the EPIC data. The authors additional thank the government of Asturias (Spain) and all EPIC centers in the 9 European countries for their ongoing support to the EPIC Study. Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/World Health Organization.

Publisher Copyright:
© The Author(s) 2024.

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