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Gastroenterology. 2018 Dec;155(6):1805-1815.e5. doi: 10.1053/j.gastro.2018.08.044. Epub 2018 Sep 8.

Healthy Lifestyle Factors Associated With Lower Risk of Colorectal Cancer Irrespective of Genetic Risk.

Author information

1
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany. Electronic address: p.carr@dkfz.de.
2
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.
3
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
4
Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany.
5
Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany; Genetic Tumour Epidemiology Group, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg, Germany.
6
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany.

Abstract

BACKGROUND & AIMS:

The combined effects of healthy lifestyle factors on colorectal cancer (CRC) risk are unclear. We aimed to develop a healthy lifestyle score, to investigate the joint effects of modifiable lifestyle factors on reduction of CRC risk and determine whether associations differ with genetic risk.

METHODS:

We collected data from a large population-based case-control study in Germany and used multiple logistic regression analyses to examine associations between the healthy lifestyle score (derived from 5 modifiable lifestyle factors: smoking, alcohol consumption, diet, physical activity, and body fatness) and CRC risk. We created a genetic risk score, based on 53 risk variants, to investigate the association of the healthy lifestyle score and risk of CRC, stratified by genetic risk.

RESULTS:

We included 4092 patients with CRC and 3032 individuals without CRC (controls) in our analysis. In adjusted models, compared with participants with 0 or 1 healthy lifestyle factor, participants with 2 (odds ratio [OR] 0.85; 95% confidence interval [CI] 0.67-1.06), 3 (OR 0.62; 95% CI 0.50-0.77), 4 (OR 0.53; 95% CI 0.42-0.66), or 5 (OR 0.33; 95% CI 0.26-0.43) healthy lifestyle factors had increasingly lower risks of CRC (P trend <.0001). We found no differences among subgroups stratified by genetic risk score, history of colonoscopy, or family history of CRC. Overall, 45% of CRC cases (95% CI 34%-53%) could be attributed to nonadherence to all 5 healthy lifestyle behaviors.

CONCLUSIONS:

In a large population-based case-control study, we identified a combination of lifestyle factors that appears to reduce risk of CRC, regardless of the patient's genetic profile. These results reinforce the importance of primary prevention of CRC.

KEYWORDS:

Chemoprevention; Colon Cancer; DACHS; Food

PMID:
30201362
PMCID:
PMC6279591
[Available on 2019-12-01]
DOI:
10.1053/j.gastro.2018.08.044
[Indexed for MEDLINE]

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