Healthy lifestyle and the risk of pancreatic cancer in the EPIC study
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CANCER
Healthy lifestyle and the risk of pancreatic cancer in the EPIC study Sabine Naudin1 · Vivian Viallon1 · Dana Hashim2 · Heinz Freisling1 · Mazda Jenab3 · Elisabete Weiderpass4 · Flavie Perrier1 · Fiona McKenzie5 · H Bas Bueno‑de‑Mesquita6,7,8 · Anja Olsen9 · Anne Tjønneland9,10 · Christina C. Dahm11 · Kim Overvad11,12 · Francesca R. Mancini13,14 · Vinciane Rebours15,16 · Marie‑Christine Boutron‑Ruault13,14 · Verena Katzke17 · Rudolf Kaaks17 · Manuela Bergmann18 · Heiner Boeing18 · Eleni Peppa19 · Anna Karakatsani19,20 · Antonia Trichopoulou19,21 · Valeria Pala22 · Giovana Masala23 · Salvatore Panico24 · Rosario Tumino25 · Carlotta Sacerdote26 · Anne M. May27 · Carla H. van Gils27 · Charlotta Rylander28 · Kristin Benjaminsen Borch28 · María Dolores Chirlaque López29,30 · Maria‑Jose Sánchez30,31 · Eva Ardanaz30,32,33 · José Ramón Quirós34 · Pilar Amiano Exezarreta30,35 · Malin Sund36 · Isabel Drake37 · Sara Regnér37 · Ruth C. Travis38 · Nick Wareham39 · Dagfinn Aune8,40,41 · Elio Riboli8 · Marc J. Gunter3 · Eric J. Duell42 · Paul Brennan43 · Pietro Ferrari1 Received: 30 April 2019 / Accepted: 3 September 2019 © Springer Nature B.V. 2019
Abstract Pancreatic cancer (PC) is a highly fatal cancer with currently limited opportunities for early detection and effective treatment. Modifiable factors may offer pathways for primary prevention. In this study, the association between the Healthy Lifestyle Index (HLI) and PC risk was examined. Within the European Prospective Investigation into Cancer and Nutrition cohort, 1113 incident PC (57% women) were diagnosed from 400,577 participants followed-up for 15 years (median). HLI scores combined smoking, alcohol intake, dietary exposure, physical activity and, in turn, overall and central adiposity using BMI (HLIBMI) and waist-to-hip ratio (WHR, HLIWHR), respectively. High values of HLI indicate adherence to healthy behaviors. Cox proportional hazard models with age as primary time variable were used to estimate PC hazard ratios (HR) and 95% confidence intervals (CI). Sensitivity analyses were performed by excluding, in turn, each factor from the HLI score. Population attributable fractions (PAF) were estimated assuming participants’ shift to healthier lifestyles. The HRs for a onestandard deviation increment of H LIBMI and H LIWHR were 0.84 (95% CI: 0.79, 0.89; ptrend = 4.3e−09) and 0.77 (0.72, 0.82; ptrend = 1.7e−15), respectively. Exclusions of smoking from HLIWHR resulted in HRs of 0.88 (0.82, 0.94; ptrend = 4.9e−04). The overall PAF estimate was 19% (95% CI: 11%, 26%), and 14% (6%, 21%) when smoking was removed from the score. Adherence to a healthy lifestyle was inversely associated with PC risk, beyond the beneficial role of smoking avoidance. Public health measures targeting compliance with healthy lifestyles may have an impact on PC incidence. Keywords Pancreatic cancer · Healthy Lifestyle Index · Population attributable fraction · EPIC · Prospective study
Disclaimer Where authors are identified as personnel of the International Agency for Research
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