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. 2024 May 29;22(1):210.
doi: 10.1186/s12916-024-03362-7.

Healthy lifestyle change and all-cause and cancer mortality in the European Prospective Investigation into Cancer and Nutrition cohort

Komodo Matta  1 , Vivian Viallon  1 , Edoardo Botteri  2 , Giulia Peveri  3   4 , Christina Dahm  5 , Anne Østergaard Nannsen  5 , Anja Olsen  5   6 , Anne Tjønneland  6   7 , Alexis Elbaz  8 , Fanny Artaud  8 , Chloé Marques  8 , Rudolf Kaaks  9 , Verena Katzke  9 , Matthias B Schulze  10   11 , Erand Llanaj  10   12 , Giovanna Masala  13 , Valeria Pala  14 , Salvatore Panico  15 , Rosario Tumino  16 , Fulvio Ricceri  17 , Jeroen W G Derksen  18 , Therese Haugdahl Nøst  19   20 , Torkjel M Sandanger  20 , Kristin Benjaminsen Borch  20 , J Ramón Quirós  21 , Carlota Castro-Espin  1   22   23 , Maria-José Sánchez  24   25   26   27 , Amaia Aizpurua Atxega  28   29 , Lluís Cirera  26   30   31 , Marcela Guevara  26   32   33 , Jonas Manjer  34 , Sandar Tin Tin  35 , Alicia Heath  36 , Mathilde Touvier  37 , Marcel Goldberg  38 , Elisabete Weiderpass  1 , Marc J Gunter  1   36 , Heinz Freisling  1 , Elio Riboli  36 , Pietro Ferrari  39
Affiliations

Healthy lifestyle change and all-cause and cancer mortality in the European Prospective Investigation into Cancer and Nutrition cohort

Komodo Matta et al. BMC Med. .

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.

Keywords: Cancer; Change score; Composite score; Healthy lifestyle index; Longitudinal; Mortality; Prospective study.

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Conflict of interest statement

Marc J. Gunter is a member of the editorial board for BMC Medicine. The other authors declare no potential competing interests.

IARC disclaimer

Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer /World Health Organization.

WHO Disclaimer

The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the WHO, its representatives, or the countries they represent.

Figures

Fig. 1
Fig. 1
Flowchart of exclusion criteria for the study
Fig. 2
Fig. 2
Forest plot of all-cause and cancer mortality hazard ratios (and 95% confidence intervals and p-values) for HLI change as continuous (per one-unit HLI change) and categorical (improve, increasing HLI by more than one unit; stable, within a one-unit change; worsen, decreasing HLI by more than one unit), overall and for subgroups, by sex, baseline HLI, socioeconomic position (SEP), and baseline smoking status
Fig. 3
Fig. 3
Cubic spline of all-cause and cancer mortality hazard ratios (HR1 95% CI) by HLI change between follow-up and baseline assessments (complete case data). Histograms show the number of deaths
Fig. 4
Fig. 4
Forest plot of all-cause and cancer mortality hazard ratios (and 95% confidence intervals and p-values) for HLI change, leaving out one component at a time
See this image and copyright information in PMC

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