Combined impact of healthy lifestyle factors on colorectal cancer: A large European cohort study

Krasimira Aleksandrova, Tobias Pischon, Mazda Jenab, H. B. Bueno-de-Mesquita, Veronika Fedirko, Teresa Norat, Dora Romaguera, Sven Knüppel, Marie Christine Boutron-Ruault, Laure Dossus, Laureen Dartois, Rudolf Kaaks, Kuanrong Li, Anne Tjønneland, Kim Overvad, José R. Quirós, Genevieve Buckland, María J. Sánchez, Miren Dorronsoro, Maria Dolores ChirlaqueAurelio Barricarte, Kay Tee Khaw, Nicholas J. Wareham, Kathryn E. Bradbury, Antonia Trichopoulou, Pagona Lagiou, Dimitrios Trichopoulos, Domenico Palli, Vittorio Krogh, Rosario Tumino, Alessio Naccarati, Salvatore Panico, Peter D. Siersema, Petra H M Peeters, Ingrid Ljuslinder, Ingegerd Johansson, Ulrika Ericson, Bodil Ohlsson, Elisabete Weiderpass, Guri Skeie, Kristin B. Borch, Sabina Rinaldi, Isabelle Romieu, Joyce Kong, Marc J. Gunter, Heather A. Ward, Elio Riboli, Heiner Boeing

Research output: Contribution to journalArticlepeer-review


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

Original languageEnglish
Article number168
JournalBMC Medicine
Issue number1
Publication statusPublished - Oct 10 2014


  • colorectal cancer
  • combined impact
  • European Prospective Investigation into Cancer and Nutrition (EPIC)
  • lifestyle factors
  • population attributable risks

ASJC Scopus subject areas

  • Medicine(all)


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