Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study

被引：164

作者：

Freisling, Heinz ^{[1
]}

Viallon, Vivian ^{[1
]}

Lennon, Hannah ^{[1
]}

Bagnardi, Vincenzo ^{[2
]}

Ricci, Cristian ^{[3
]}

Butterworth, Adam S. ^{[4
]}

Sweeting, Michael ^{[5
]}

Muller, David ^{[6
]}

Romieu, Isabelle ^{[7
]}

Bazelle, Pauline ^{[1
]}

Kvaskoff, Marina ^{[8
]}

Arveux, Patrick ^{[8
,9
]}

Severi, Gianluca ^{[8
,10
]}

Bamia, Christina ^{[11
,12
]}

Kuehn, Tilman ^{[13
]}

Kaaks, Rudolf ^{[13
]}

Bergmann, Manuela ^{[14
]}

Boeing, Heiner ^{[14
]}

Tjonneland, Anne ^{[15
]}

Olsen, Anja ^{[15
]}

Overvad, Kim ^{[16
]}

Dahm, Christina C. ^{[16
]}

Menendez, Virginia ^{[17
]}

Agudo, Antonio ^{[18
]}

Sanchez, Maria-Jose ^{[19
,20
,21
]}

Amiano, Pilar ^{[19
,22
]}

Santiuste, Carmen ^{[23
]}

Gurrea, Aurelio Barricarte ^{[19
]}

Tong, Tammy Y. N. ^{[24
]}

Schmidt, Julie A. ^{[24
]}

Tzoulaki, Ioanna ^{[6
,25
,26
]}

Tsilidis, Konstantinos K. ^{[6
,26
]}

Ward, Heather ^{[6
]}

Palli, Domenico ^{[27
]}

Agnoli, Claudia ^{[28
]}

Tumino, Rosario ^{[29
]}

Ricceri, Fulvio ^{[30
]}

Panico, Salvatore ^{[31
]}

Picavet, H. Susan J. ^{[32
]}

Bakker, Marije ^{[33
]}

Monninkhof, Evelyn ^{[33
]}

Nilsson, Peter ^{[34
,35
]}

Manjer, Jonas ^{[36
]}

Rolandsson, Olov ^{[37
]}

Thysell, Elin ^{[38
]}

Weiderpass, Elisabete ^{[39
]}

Jenab, Mazda ^{[7
]}

Riboli, Elio ^{[6
]}

Vineis, Paolo ^{[6
]}

Danesh, John ^{[4
]}

机构：

[1] Int Agcy Res Canc, Nutr Methodol & Biostat Grp, 150 Cours Albert Thomas, F-69372 Lyon 08, France

[2] Univ Milano Bicocca, Dept Stat & Quantitat Methods, Milan, Italy

[3] North West Univ, CEN, Potchefstroom, South Africa

[4] Univ Cambridge, Dept Publ Hlth & Primary Care, British Heart Fdn, Med Res Council,Cardiovasc Epidemiol Unit, Cambridge, England

[5] Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge, England

[6] Imperial Coll London, Sch Public Hlth, Dept Epidemiol & Biostat, London, England

[7] Int Agcy Res Canc, Nutr Epidemiol Grp, Lyon, France

[8] Univ Paris Saclay, Univ Paris Sud, UVSQ,Fac Med, Ctr Res Epidemiol & Populat Hlth CESP,Inserm, Villejuif, France

[9] Georges Francois Leclerc Comprehens Canc Care Ctr, Breast & Gynaecol Canc Registry Cote Or, Dijon, France

[10] Human Genet Fdn, Mol & Genet Epidemiol Unit, Turin, Italy

[11] Natl & Kapodistrian Univ Athens, WHO Collaborating Ctr Nutr & Hlth, Dept Hyg Epidemiol & Med Stat, Sch Med, Athens, Greece

[12] Hellen Hlth Fdn, Athens, Greece

[13] German Canc Res Ctr, Heidelberg, Germany

[14] German Inst Human Nutr Potsdam Rehbrucke, Dept Epidemiol, Nuthetal, Germany

[15] Danish Canc Soc Res Ctr, Copenhagen, Denmark

[16] Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark

[17] Publ Hlth Directorate, Asturias, Spain

[18] Bellvitge Inst Biomed Res IDIBELL, Catalan Inst Oncol, Canc Epidemiol Res Program, Unit Nutr & Canc, Barcelona, Spain

[19] CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain

[20] Univ Granada, Andalusian Sch Publ Hlth, Granada, Spain

[21] Univ Granada, Inst Invest Biosanitaria Granada Ibs, Serv Andaluz Salud, Granada, Spain

[22] BioDonostia Res Inst, Publ Hlth Div Gipuzkoa, San Sebastian, Spain

[23] Murcia Reg Hlth Council, Dept Epidemiol, IMIB Arrixaca, Murcia, Spain

[24] Univ Oxford, Nuffield Dept Populat Hlth, Canc Epidemiol Unit, Oxford, England

[25] Imperial Coll London, MRC PHE Ctr Environm & Hlth, Sch Publ Hlth, London, England

[26] Univ Ioannina, Sch Med, Dept Hyg & Epidemiol, Ioannina, Greece

[27] Inst Canc Res Prevent & Clin Network ISPRO, Canc Risk Factors & Life Style Epidemiol Unit, Florence, Italy

[28] Fdn IRCCS Ist Nazl Tumori, Epidemiol & Prevent Unit, Milan, Italy

[29] ASP Ragusa, Civi M Arezzo Hosp, Ragusa, Italy

[30] Citta Salute & Sci Torino Hosp, Turin, Italy

[31] Univ Naples Federico II, Dept Clin & Expt Med, Naples, Italy

[32] Natl Inst Publ Hlth & Environm, Ctr Nutr Prevent & Hlth Serv, Bilthoven, Netherlands

[33] Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[34] Umea Univ, Publ Hlth & Clin Med, Nutr Res, Umea, Sweden

[35] Umea Univ, Arctic Res Ctr, Umea, Sweden

[36] Lund Univ, Skane Univ Hosp Malmo, Dept Surg, Malmo, Sweden

[37] Umea Univ, Dept Publ Hlth & Clin Med, Sect Family Med, Umea, Sweden

[38] Umea Univ, Dept Med Biosci, Pathol, Umea, Sweden

[39] Int Agcy Res Canc, Directors Off, Lyon, France

[40] Univ Cambridge, Inst Metab Sci, Sch Clin Med, MRC Epidemiol Unit, Cambridge Biomed Campus, Cambridge, England

来源：

BMC MEDICINE | 2020年 / 18卷 / 01期

基金：

瑞典研究理事会; 英国医学研究理事会; 欧洲研究理事会;

关键词：

Healthy lifestyle; Obesity; Cancer and cardiometabolic multimorbidity; Cancer; Cardiovascular disease; Diabetes; Prevention; CARDIOVASCULAR-DISEASE; COMPETING RISKS; OBESITY; MIDDLE; HEART; DIET;

D O I：

10.1186/s12916-019-1474-7

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Although lifestyle factors have been studied in relation to individual non-communicable diseases (NCDs), their association with development of a subsequent NCD, defined as multimorbidity, has been scarcely investigated. The aim of this study was to investigate associations between five lifestyle factors and incident multimorbidity of cancer and cardiometabolic diseases. Methods In this prospective cohort study, 291,778 participants (64% women) from seven European countries, mostly aged 43 to 58 years and free of cancer, cardiovascular disease (CVD), and type 2 diabetes (T2D) at recruitment, were included. Incident multimorbidity of cancer and cardiometabolic diseases was defined as developing subsequently two diseases including first cancer at any site, CVD, and T2D in an individual. Multi-state modelling based on Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (95% CI) of developing cancer, CVD, or T2D, and subsequent transitions to multimorbidity, in relation to body mass index (BMI), smoking status, alcohol intake, physical activity, adherence to the Mediterranean diet, and their combination as a healthy lifestyle index (HLI) score. Cumulative incidence functions (CIFs) were estimated to compute 10-year absolute risks for transitions from healthy to cancer at any site, CVD (both fatal and non-fatal), or T2D, and to subsequent multimorbidity after each of the three NCDs. Results During a median follow-up of 11 years, 1910 men and 1334 women developed multimorbidity of cancer and cardiometabolic diseases. A higher HLI, reflecting healthy lifestyles, was strongly inversely associated with multimorbidity, with hazard ratios per 3-unit increment of 0.75 (95% CI, 0.71 to 0.81), 0.84 (0.79 to 0.90), and 0.82 (0.77 to 0.88) after cancer, CVD, and T2D, respectively. After T2D, the 10-year absolute risks of multimorbidity were 40% and 25% for men and women, respectively, with unhealthy lifestyle, and 30% and 18% for men and women with healthy lifestyles. Conclusion Pre-diagnostic healthy lifestyle behaviours were strongly inversely associated with the risk of cancer and cardiometabolic diseases, and with the prognosis of these diseases by reducing risk of multimorbidity.

引用

页数：11

共 50 条

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Michael Sweeting
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Marina Kvaskoff
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Christina Bamia
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