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00925njm 22002777a 4500 dc Aleksandrova, Krasimira author Pischon, Tobias author Jenab, Mazda author Bueno-de-Mesquita, H. Bas author Fedirko, Veronika author Norat, Teresa author Romaguera, Dora author Knueppel, Sven author Boutron-Ruault, Marie-Christine author Dossus, Laure author Dartois, Laureen author Kaaks, Rudolf author Li, Kuanrong author Tjonneland, Anne author Overvad, Kim author Quiros, Jose Ramon author Buckland, Genevieve author Sanchez, Maria Jose author Dorronsoro, Miren author Chirlaque, María-Dolores author Barricarte, Aurelio author Khaw, Kay-Tee author Wareham, Nicholas J. author Bradbury, Kathryn E. author Trichopoulou, Antonia author Lagiou, Pagona author Trichopoulos, Dimitrios author Palli, Domenico author Krogh, Vittorio author Tumino, Rosario author Naccarati, Alessio author Panico, Salvatore author Siersema, Peter D. author Peeters, Petra H. M. author Ljuslinder, Ingrid author Johansson, Ingegerd author Ericson, Ulrika author Ohlsson, Bodil author Weiderpass, Elisabete author Skeie, Guri author Borch, Kristin Benjaminsen author Rinaldi, Sabina author Romieu, Isabelle author Kong, Joyce author Gunter, Marc J. author Ward, Heather A. author Riboli, Elio author Boeing, Heiner author 2014-10-10 Background: Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods: In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated. Results: After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index. Conclusions: Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention. Aleksandrova K, Pischon T, Jenab M, Bueno-De-Mesquita HB, Fedirko V, Norat T, et al. Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study. BMC Med. 2014 Oct 10;12:168. 10.1186/s12916-014-0168-4 1741-7015 BMC Medicine http://hdl.handle.net/20.500.13003/11099 25319089 L600155703 2-s2.0-84907952984 http://hdl.handle.net/20.500.12105/20016 344889900001 Lifestyle factors Combined impact Population attributable risks Colorectal cancer European Prospective Investigation into Cancer and Nutrition (EPIC) Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study