TY - JOUR
T1 - Healthy lifestyle change and all-cause and cancer mortality in the European Prospective Investigation into Cancer and Nutrition cohort
AU - Matta, Komodo
AU - Viallon, Vivian
AU - Botteri, Edoardo
AU - Peveri, Giulia
AU - Dahm, Christina
AU - Nannsen, Anne Østergaard
AU - Olsen, Anja
AU - Tjønneland, Anne
AU - Elbaz, Alexis
AU - Artaud, Fanny
AU - Marques, Chloé
AU - Kaaks, Rudolf
AU - Katzke, Verena
AU - Schulze, Matthias B.
AU - Llanaj, Erand
AU - Masala, Giovanna
AU - Pala, Valeria
AU - Panico, Salvatore
AU - Tumino, Rosario
AU - Ricceri, Fulvio
AU - Derksen, Jeroen W.G.
AU - Nøst, Therese Haugdahl
AU - Sandanger, Torkjel M.
AU - Borch, Kristin Benjaminsen
AU - Quirós, J. Ramón
AU - Castro-Espin, Carlota
AU - Sánchez, Maria José
AU - Atxega, Amaia Aizpurua
AU - Cirera, Lluís
AU - Guevara, Marcela
AU - Manjer, Jonas
AU - Tin Tin, Sandar
AU - Heath, Alicia
AU - Touvier, Mathilde
AU - Goldberg, Marcel
AU - Weiderpass, Elisabete
AU - Gunter, Marc J.
AU - Freisling, Heinz
AU - Riboli, Elio
AU - Ferrari, Pietro
N1 - Publisher Copyright:
© World Health Organization 2024.
PY - 2024/5/29
Y1 - 2024/5/29
N2 - Background: Healthy lifestyles are inversely associated with the risk of noncommunicable diseases, which are leading causes of death. However, few studies have used longitudinal data to assess the impact of changing lifestyle behaviours on all-cause and cancer mortality. Methods: Within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, lifestyle profiles of 308,497 cancer-free adults (71% female) aged 35–70 years at recruitment across nine countries were assessed with baseline and follow-up questionnaires administered on average of 7 years apart. A healthy lifestyle index (HLI), assessed at two time points, combined information on smoking status, alcohol intake, body mass index, and physical activity, and ranged from 0 to 16 units. A change score was calculated as the difference between HLI at baseline and follow-up. Associations between HLI change and all-cause and cancer mortality were modelled with Cox regression, and the impact of changing HLI on accelerating mortality rate was estimated by rate advancement periods (RAP, in years). Results: After the follow-up questionnaire, participants were followed for an average of 9.9 years, with 21,696 deaths (8407 cancer deaths) documented. Compared to participants whose HLIs remained stable (within one unit), improving HLI by more than one unit was inversely associated with all-cause and cancer mortality (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.81, 0.88; and HR: 0.87; 95% CI: 0.82, 0.92; respectively), while worsening HLI by more than one unit was associated with an increase in mortality (all-cause mortality HR: 1.26; 95% CI: 1.20, 1.33; cancer mortality HR: 1.19; 95% CI: 1.09, 1.29). Participants who worsened HLI by more than one advanced their risk of death by 1.62 (1.44, 1.96) years, while participants who improved HLI by the same amount delayed their risk of death by 1.19 (0.65, 2.32) years, compared to those with stable HLI. Conclusions: Making healthier lifestyle changes during adulthood was inversely associated with all-cause and cancer mortality and delayed risk of death. Conversely, making unhealthier lifestyle changes was positively associated with mortality and an accelerated risk of death.
AB - Background: Healthy lifestyles are inversely associated with the risk of noncommunicable diseases, which are leading causes of death. However, few studies have used longitudinal data to assess the impact of changing lifestyle behaviours on all-cause and cancer mortality. Methods: Within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, lifestyle profiles of 308,497 cancer-free adults (71% female) aged 35–70 years at recruitment across nine countries were assessed with baseline and follow-up questionnaires administered on average of 7 years apart. A healthy lifestyle index (HLI), assessed at two time points, combined information on smoking status, alcohol intake, body mass index, and physical activity, and ranged from 0 to 16 units. A change score was calculated as the difference between HLI at baseline and follow-up. Associations between HLI change and all-cause and cancer mortality were modelled with Cox regression, and the impact of changing HLI on accelerating mortality rate was estimated by rate advancement periods (RAP, in years). Results: After the follow-up questionnaire, participants were followed for an average of 9.9 years, with 21,696 deaths (8407 cancer deaths) documented. Compared to participants whose HLIs remained stable (within one unit), improving HLI by more than one unit was inversely associated with all-cause and cancer mortality (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.81, 0.88; and HR: 0.87; 95% CI: 0.82, 0.92; respectively), while worsening HLI by more than one unit was associated with an increase in mortality (all-cause mortality HR: 1.26; 95% CI: 1.20, 1.33; cancer mortality HR: 1.19; 95% CI: 1.09, 1.29). Participants who worsened HLI by more than one advanced their risk of death by 1.62 (1.44, 1.96) years, while participants who improved HLI by the same amount delayed their risk of death by 1.19 (0.65, 2.32) years, compared to those with stable HLI. Conclusions: Making healthier lifestyle changes during adulthood was inversely associated with all-cause and cancer mortality and delayed risk of death. Conversely, making unhealthier lifestyle changes was positively associated with mortality and an accelerated risk of death.
KW - Cancer
KW - Change score
KW - Composite score
KW - Healthy lifestyle index
KW - Longitudinal
KW - Mortality
KW - Prospective study
UR - http://www.scopus.com/inward/record.url?scp=85194900865&partnerID=8YFLogxK
U2 - 10.1186/s12916-024-03362-7
DO - 10.1186/s12916-024-03362-7
M3 - Article
C2 - 38807179
AN - SCOPUS:85194900865
SN - 1741-7015
VL - 22
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 210
ER -