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Int J Cancer. 2015 Aug 1;137(3):598-606. doi: 10.1002/ijc.29411. Epub 2015 Feb 13.

Healthy lifestyle index and risk of gastric adenocarcinoma in the EPIC cohort study.

Author information

1
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
2
Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
3
CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain.
4
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
5
Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
6
The School of Public Health, Imperial College London, London, United Kingdom.
7
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway.
8
Department of Research, Cancer Registry of Norway, Oslo, Norway.
9
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
10
Samfundet Folkhälsan, Helsinki, Finland.
11
Diabetes and Cardiovascular Disease, Genetic Epidemiology Department of Clinical Sciences, Malmö Lund University, Clinical Research Center 60:13, Malmö, Sweden.
12
Department of Clinical Sciences, Skåne University Hospital, Malmö, Sweden.
13
Division of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
14
International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France.
15
German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
16
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy.
17
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom.
18
Hellenic Health Foundation, Athens, Greece.
19
Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
20
Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece.
21
Department of Epidemiology, Harvard School of Public Health, Boston, MA.
22
Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France.
23
University of Paris-Sud, Villejuif, France.
24
IGR, Villejuif, France.
25
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
26
Dipartijmento Di Medicina Clinica E Di Chiruigia, Federico II University, Naples, Itlay.
27
Department for Biobank Research, Umeå University, Umeå, Sweden.
28
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
29
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
30
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
31
University of Cambridge CB2 2QQ and Nick Wareham, Professor and Director of MRC Epidemiology Unit, University of Cambridge, United Kingdom.
32
Navarre Public Health Institute, Pamplona, Spain.
33
Aarhus University, Department of Public Health, Section for Epidemiology, Aarhus, Denmark.
34
Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.
35
Public Health Direction and Biodonostia - Ciberesp, Basque Regional Health Department, San Sebatian, Spain.
36
Escuela Andaluza De Salud Pública, Instituto De Investigación Biosanitaria De Granada (Granada.Ibs), Granada, Spain.
37
Public Health Directorate, Oviedo, Spain.
38
HuGeF-Human Genetics Foundation, Molecular and Genetic Epidemiology Unit, Torino, Italy.
39
The Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy.
40
The German Institute of Human Nutrition, Potsdam-Rehbücke, Germany.

Abstract

Several modifiable lifestyle factors, including smoking, alcohol, certain dietary factors and weight are independently associated with gastric cancer (GC); however, their combined impact on GC risk is unknown. We constructed a healthy lifestyle index to investigate the joint influence of these behaviors on GC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The analysis included 461,550 participants (662 first incident GC cases) with a mean follow-up of 11.4 years. A healthy lifestyle index was constructed, assigning 1 point for each healthy behavior related to smoking status, alcohol consumption and diet quality (represented by the Mediterranean diet) for assessing overall GC and also body mass index for cardia GC and 0 points otherwise. Risk of GC was calculated using Cox proportional hazards regression models while adjusting for relevant confounders. The highest versus lowest score in the healthy lifestyle index was associated with a significant lower risk of GC, by 51% overall (HR 0.49 95% CI 0.35, 0.70), by 77% for cardia GC (HR 0.23 95% CI 0.08, 0.68) and by 47% for noncardia GC (HR 0.53 (95% CI 0.32, 0.87), p-trends<0.001. Population attributable risk calculations showed that 18.8% of all GC and 62.4% of cardia GC cases could have been prevented if participants in this population had followed the healthy lifestyle behaviors of this index. Adopting several healthy lifestyle behaviors including not smoking, limiting alcohol consumption, eating a healthy diet and maintaining a normal weight is associated with a large decreased risk of GC.

KEYWORDS:

EPIC; cohort; gastric cancer; healthy lifestyle score

PMID:
25557932
DOI:
10.1002/ijc.29411
[Indexed for MEDLINE]
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