@article{Aleksandrova:2014:10.1186/s12916-014-0168-4,
author = {Aleksandrova, K and Pischon, T and Jenab, M and Bueno-de-Mesquita, HB and Fedirko, V and Norat, T and Romaguera, D and Knueppel, S and Boutron-Ruault, M-C and Dossus, L and Dartois, L and Kaaks, R and Li, K and Tjonneland, A and Overvad, K and Quiros, JR and Buckland, G and Sanchez, MJ and Dorronsoro, M and Chirlaque, M-D and Barricarte, A and Khaw, K-T and Wareham, NJ and Bradbury, KE and Trichopoulou, A and Lagiou, P and Trichopoulos, D and Palli, D and Krogh, V and Tumino, R and Naccarati, A and Panico, S and Siersema, PD and Peeters, PHM and Ljuslinder, I and Johansson, I and Ericson, U and Ohlsson, B and Weiderpass, E and Skeie, G and Borch, KB and Rinaldi, S and Romieu, I and Kong, J and Gunter, MJ and Ward, HA and Riboli, E and Boeing, H},
doi = {10.1186/s12916-014-0168-4},
journal = {BMC Medicine},
title = {Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study},
url = {http://dx.doi.org/10.1186/s12916-014-0168-4},
volume = {12},
year = {2014}
}

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TY  - JOUR
AB  - Background: Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors areindividually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of thisstudy 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 theassociation of this index with CRC incidence using data collected within the European Prospective Investigation intoCancer 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 lifestyleinformation at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC caseswere identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazardsregression 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: 0.70to 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; Pfor 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) wereattributable 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 populationscharacterized by western lifestyles. Prevention str
AU  - Aleksandrova,K
AU  - Pischon,T
AU  - Jenab,M
AU  - Bueno-de-Mesquita,HB
AU  - Fedirko,V
AU  - Norat,T
AU  - Romaguera,D
AU  - Knueppel,S
AU  - Boutron-Ruault,M-C
AU  - Dossus,L
AU  - Dartois,L
AU  - Kaaks,R
AU  - Li,K
AU  - Tjonneland,A
AU  - Overvad,K
AU  - Quiros,JR
AU  - Buckland,G
AU  - Sanchez,MJ
AU  - Dorronsoro,M
AU  - Chirlaque,M-D
AU  - Barricarte,A
AU  - Khaw,K-T
AU  - Wareham,NJ
AU  - Bradbury,KE
AU  - Trichopoulou,A
AU  - Lagiou,P
AU  - Trichopoulos,D
AU  - Palli,D
AU  - Krogh,V
AU  - Tumino,R
AU  - Naccarati,A
AU  - Panico,S
AU  - Siersema,PD
AU  - Peeters,PHM
AU  - Ljuslinder,I
AU  - Johansson,I
AU  - Ericson,U
AU  - Ohlsson,B
AU  - Weiderpass,E
AU  - Skeie,G
AU  - Borch,KB
AU  - Rinaldi,S
AU  - Romieu,I
AU  - Kong,J
AU  - Gunter,MJ
AU  - Ward,HA
AU  - Riboli,E
AU  - Boeing,H
DO  - 10.1186/s12916-014-0168-4
PY  - 2014///
SN  - 1741-7015
TI  - Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study
T2  - BMC Medicine
UR  - http://dx.doi.org/10.1186/s12916-014-0168-4
UR  - http://hdl.handle.net/10044/1/28179
VL  - 12
ER  - 

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