TY  - JOUR
A1  - Botteri, Edoardo
A1  - Peveri, Giulia
A1  - Berstad, Paula
A1  - Bagnardi, Vincenzo
A1  - Chen, Sairah L. F.
A1  - Sandanger, Torkjel M.
A1  - Hoff, Geir
A1  - Dahm, Christina C.
A1  - Antoniussen, Christian S.
A1  - Tjonneland, Anne
A1  - Eriksen, Anne Kirstine
A1  - Skeie, Guri
A1  - Perez-Cornago, Aurora
A1  - Huerta, Jose Maria
A1  - Jakszyn, Paula
A1  - Harlid, Sophia
A1  - Sundstroem, Bjoern
A1  - Barricarte, Aurelio
A1  - Monninkhof, Evelyn M.
A1  - Derksen, Jeroen W. G.
A1  - Schulze, Matthias Bernd
A1  - Bueno-de-Mesquita, Bas
A1  - Sanchez, Maria-Jose
A1  - Cross, Amanda J.
A1  - Tsilidis, Konstantinos K.
A1  - De Magistris, Maria Santucci
A1  - Kaaks, Rudolf
A1  - Katzke, Verena
A1  - Rothwell, Joseph A.
A1  - Laouali, Nasser
A1  - Severi, Gianluca
A1  - Amiano, Pilar
A1  - Contiero, Paolo
A1  - Sacerdote, Carlotta
A1  - Goldberg, Marcel
A1  - Touvier, Mathilde
A1  - Freisling, Heinz
A1  - Viallon, Vivian
A1  - Weiderpass, Elisabete
A1  - Riboli, Elio
A1  - Gunter, Marc J.
A1  - Jenab, Mazda
A1  - Ferrari, Pietro
T1  - Changes in lifestyle and risk of colorectal cancer in the European prospective investigation into cancer and nutrition
JF  - The American journal of gastroenterology : AJG
N2  - INTRODUCTION:
We investigated the impact of changes in lifestyle habits on colorectal cancer (CRC) risk in a multicountry European cohort.

METHODS:
We used baseline and follow-up questionnaire data from the European Prospective Investigation into Cancer cohort to assess changes in lifestyle habits and their associations with CRC development. We calculated a healthy lifestyle index (HLI) score based on smoking status, alcohol consumption, body mass index, and physical activity collected at the 2 time points. HLI ranged from 0 (most unfavorable) to 16 (most favorable). We estimated the association between HLI changes and CRC risk using Cox regression models and reported hazard ratios (HR) with 95% confidence intervals (CI). 

RESULTS:
Among 295,865 participants, 2,799 CRC cases were observed over a median of 7.8 years. The median time between questionnaires was 5.7 years. Each unit increase in HLI from the baseline to the follow-up assessment was associated with a statistically significant 3% lower CRC risk. Among participants in the top tertile at baseline (HLI > 11), those in the bottom tertile at follow-up (HLI <= 9) had a higher CRC risk (HR 1.34; 95% CI 1.02-1.75) than those remaining in the top tertile. Among individuals in the bottom tertile at baseline, those in the top tertile at follow-up had a lower risk (HR 0.77; 95% CI 0.59-1.00) than those remaining in the bottom tertile.

DISCUSSION:
Improving adherence to a healthy lifestyle was inversely associated with CRC risk, while worsening adherence was positively associated with CRC risk. These results justify and support recommendations for healthy lifestyle changes and healthy lifestyle maintenance for CRC prevention.
Y1  - 2022
U6  - https://doi.org/10.14309/ajg.0000000000002065
SN  - 0002-9270
SN  - 1572-0241
VL  - 118
IS  - 4
SP  - 702
EP  - 711
PB  - Lippincott Williams & Wilkins
CY  - Philadelphia
ER  -