Lifestyle and risk of follicular lymphoma: a systematic review and meta-analysis of observational studies
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REVIEW ARTICLE
Lifestyle and risk of follicular lymphoma: a systematic review and meta‑analysis of observational studies Michael K. Odutola1 · Eriobu Nnakelu2 · Graham G. Giles3,4,5 · Marina T. van Leeuwen1 · Claire M. Vajdic1 Received: 5 April 2020 / Accepted: 13 August 2020 © Springer Nature Switzerland AG 2020
Abstract Purpose To investigate the relationship between follicular lymphoma (FL) risk and common modifiable lifestyle factors, specifically smoking, alcohol, body mass index (BMI), and hair dye use. Methods We performed a systematic review and meta-analysis of observational studies published prior to 01 January 2020. We searched Ovid MEDLINE, Ovid EMBASE, and Web of Science and the reference lists of original studies and review articles. We used random-effects models to generate meta-estimates of relative risk (RR) with 95% confidence intervals (95% CI). Results Twenty-four cohort and ten case–control studies were eligible. Ten articles examined smoking, 11 alcohol, 13 BMI, and four hair dye use and risk of FL. The meta-estimate for current smoking was 1.11 (95% CI 0.92–1.35; I 2 = 51%) and there was no significant dose–response per 5-year increase in duration (p-trend = 0.087). Current alcohol intake was inversely associated with FL risk (meta-RR 0.87, 95% CI 0.81–0.94; I2 = 0%) and there was a significant dose–response per 5 drinks/ week increase in intake (p-trend = 0.008). There was no association with 5 kg/m2 increase in early adulthood BMI (meta-RR 1.05, 95% CI 0.91–1.20; I2 = 7%) or being overweight (meta-RR 0.99, 95% CI 0.92–1.07; I2 = 0%) or obese (meta-RR 1.08, 95% CI 0.99–1.17; I2 = 0%) as an adult. Hair dye use before 1980 was positively associated with FL risk (meta-RR 1.66, 95% CI 1.22–2.25; I2 = 55%) and no evidence of effect after 1980. Conclusion We found consistent evidence of an inverse association between current alcohol intake and FL risk, and a significant increased risk with hair dye use before 1980. The evidence for smoking is heterogeneous, but most studies did not support an association. Further research is required to understand the mechanisms underlying these associations and the potential for prevention strategies. Keywords Follicular lymphoma · Smoking · Alcohol · Adiposity · Hair dye · Meta-analysis
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10552-020-01342-9) contains supplementary material, which is available to authorized users. * Claire M. Vajdic [email protected] 1
Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
2
Institute of Human Virology Nigeria, Abuja, Nigeria
3
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
4
Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
5
Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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