Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study
Creators: name: Freisling, Heinz
name: Viallon, Vivian
name: Lennon, Hannah
name: Bagnardi, Vincenzo
name: Ricci, Cristian
name: Butterworth, Adam S.
name: Sweeting, Michael
name: Muller, David
name: Romieu, Isabelle
name: Bazelle, Pauline
name: Kvaskoff, Marina
name: Arveux, Patrick
name: Severi, Gianluca
name: Bamia, Christina
name: Kühn, Tilman
name: Kaaks, Rudolf
name: Bergmann, Manuela
name: Boeing, Heiner
name: Tjønneland, Anne
name: Olsen, Anja
name: Overvad, Kim
name: Dahm, Christina C.
name: Menéndez, Virginia
name: Agudo, Antonio
name: Sánchez, Maria-Jose
name: Amiano, Pilar
name: Santiuste, Carmen
name: Gurrea, Aurelio Barricarte
name: Tong, Tammy Y. N.
name: Schmidt, Julie A.
name: Tzoulaki, Ioanna
name: Tsilidis, Konstantinos K.
name: Ward, Heather
name: Palli, Domenico
name: Agnoli, Claudia
name: Tumino, Rosario
name: Ricceri, Fulvio
name: Panico, Salvatore
name: Picavet, H. Susan J.
name: Bakker, Marije
name: Monninkhof, Evelyn
name: Nilsson, Peter
name: Manjer, Jonas
name: Rolandsson, Olov
name: Thysell, Elin
name: Weiderpass, Elisabete
name: Jenab, Mazda
name: Riboli, Elio
name: Vineis, Paolo
name: Danesh, John
name: Wareham, Nick J.
name: Gunter, Marc J.
name: Ferrari, Pietro
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Research Article
Healthy lifestyle
Obesity
Cancer and cardiometabolic multimorbidity
Cancer
Cardiovascular disease
Diabetes
Prevention

description: Abstract: Background: Although lifestyle factors have been studied in relation to individual non-communicable diseases (NCDs), their association with development of a subsequent NCD, defined as multimorbidity, has been scarcely investigated. The aim of this study was to investigate associations between five lifestyle factors and incident multimorbidity of cancer and cardiometabolic diseases. Methods: In this prospective cohort study, 291,778 participants (64% women) from seven European countries, mostly aged 43 to 58 years and free of cancer, cardiovascular disease (CVD), and type 2 diabetes (T2D) at recruitment, were included. Incident multimorbidity of cancer and cardiometabolic diseases was defined as developing subsequently two diseases including first cancer at any site, CVD, and T2D in an individual. Multi-state modelling based on Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (95% CI) of developing cancer, CVD, or T2D, and subsequent transitions to multimorbidity, in relation to body mass index (BMI), smoking status, alcohol intake, physical activity, adherence to the Mediterranean diet, and their combination as a healthy lifestyle index (HLI) score. Cumulative incidence functions (CIFs) were estimated to compute 10-year absolute risks for transitions from healthy to cancer at any site, CVD (both fatal and non-fatal), or T2D, and to subsequent multimorbidity after each of the three NCDs. Results: During a median follow-up of 11 years, 1910 men and 1334 women developed multimorbidity of cancer and cardiometabolic diseases. A higher HLI, reflecting healthy lifestyles, was strongly inversely associated with multimorbidity, with hazard ratios per 3-unit increment of 0.75 (95% CI, 0.71 to 0.81), 0.84 (0.79 to 0.90), and 0.82 (0.77 to 0.88) after cancer, CVD, and T2D, respectively. After T2D, the 10-year absolute risks of multimorbidity were 40% and 25% for men and women, respectively, with unhealthy lifestyle, and 30% and 18% for men and women with healthy lifestyles. Conclusion: Pre-diagnostic healthy lifestyle behaviours were strongly inversely associated with the risk of cancer and cardiometabolic diseases, and with the prognosis of these diseases by reducing risk of multimorbidity.