e-Article
Healthy lifestyle change and all-cause and cancer mortality in the European Prospective Investigation into Cancer and Nutrition cohort
Document Type
article
Author
Komodo Matta; Vivian Viallon; Edoardo Botteri; Giulia Peveri; Christina Dahm; Anne Østergaard Nannsen; Anja Olsen; Anne Tjønneland; Alexis Elbaz; Fanny Artaud; Chloé Marques; Rudolf Kaaks; Verena Katzke; Matthias B. Schulze; Erand Llanaj; Giovanna Masala; Valeria Pala; Salvatore Panico; Rosario Tumino; Fulvio Ricceri; Jeroen W. G. Derksen; Therese Haugdahl Nøst; Torkjel M. Sandanger; Kristin Benjaminsen Borch; J. Ramón Quirós; Carlota Castro-Espin; Maria-José Sánchez; Amaia Aizpurua Atxega; Lluís Cirera; Marcela Guevara; Jonas Manjer; Sandar Tin Tin; Alicia Heath; Mathilde Touvier; Marcel Goldberg; Elisabete Weiderpass; Marc J. Gunter; Heinz Freisling; Elio Riboli; Pietro Ferrari
Source
BMC Medicine, Vol 22, Iss 1, Pp 1-12 (2024)
Subject
Language
English
ISSN
1741-7015
Abstract
Abstract 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.