title: Healthy lifestyle index and risk of gastric adenocarcinoma in the EPIC cohort study.
abstract: Several modifiable lifestyle factors, including smoking, alcohol, certain dietary factors and weight are independently associated with gastric cancer (GC); however, their combined impact on GC risk is unknown. We constructed a healthy lifestyle index to investigate the joint influence of these behaviors on GC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The analysis included 461,550 participants (662 first incident GC cases) with a mean follow-up of 11.4 years. A healthy lifestyle index was constructed, assigning 1 point for each healthy behavior related to smoking status, alcohol consumption and diet quality (represented by the Mediterranean diet) for assessing overall GC and also body mass index for cardia GC and 0 points otherwise. Risk of GC was calculated using Cox proportional hazards regression models while adjusting for relevant confounders. The highest versus lowest score in the healthy lifestyle index was associated with a significant lower risk of GC, by 51% overall (HR 0.49 95% CI 0.35, 0.70), by 77% for cardia GC (HR 0.23 95% CI 0.08, 0.68) and by 47% for noncardia GC (HR 0.53 (95% CI 0.32, 0.87), p-trends<0.001. Population attributable risk calculations showed that 18.8% of all GC and 62.4% of cardia GC cases could have been prevented if participants in this population had followed the healthy lifestyle behaviors of this index. Adopting several healthy lifestyle behaviors including not smoking, limiting alcohol consumption, eating a healthy diet and maintaining a normal weight is associated with a large decreased risk of GC.
authors.affiliation: Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Buckland
authors.affiliation: Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Travier
authors.affiliation: Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.|CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Huerta
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.|The School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: H B As
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway.
authors.forename: G
authors.initials: G
authors.lastname: Skeie
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway.|Department of Research, Cancer Registry of Norway, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Samfundet Folkhälsan, Helsinki, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway.
authors.forename: D
authors.initials: D
authors.lastname: Engeset
authors.affiliation: Diabetes and Cardiovascular Disease, Genetic Epidemiology Department of Clinical Sciences, Malmö Lund University, Clinical Research Center 60:13, Malmö, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Ericson
authors.affiliation: Department of Clinical Sciences, Skåne University Hospital, Malmö, Sweden.|Division of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Ohlsson
authors.affiliation: Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Agudo
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France.
authors.forename: I
authors.initials: I
authors.lastname: Romieu
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France.
authors.forename: P
authors.initials: P
authors.lastname: Ferrari
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France.
authors.forename: H
authors.initials: H
authors.lastname: Freisling
authors.affiliation: Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Colorado-Yohar
authors.affiliation: German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Li
authors.affiliation: German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kaaks
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Pala
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom.
authors.forename: A J
authors.initials: AJ
authors.lastname: Cross
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom.
authors.forename: E
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.|Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece.|Department of Epidemiology, Harvard School of Public Health, Boston, MA.
authors.forename: P
authors.initials: P
authors.lastname: Lagiou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Bamia
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France.|University of Paris-Sud, Villejuif, France.|IGR, Villejuif, France.
authors.forename: M C
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France.|University of Paris-Sud, Villejuif, France.|IGR, Villejuif, France.
authors.forename: G
authors.initials: G
authors.lastname: Fagherazzi
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France.|University of Paris-Sud, Villejuif, France.|IGR, Villejuif, France.
authors.forename: L
authors.initials: L
authors.lastname: Dartois
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: May
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: P H
authors.initials: PH
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authors.affiliation: Dipartijmento Di Medicina Clinica E Di Chiruigia, Federico II University, Naples, Itlay.
authors.forename: S
authors.initials: S
authors.lastname: Panico
authors.affiliation: International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France.|Department for Biobank Research, Umeå University, Umeå, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Johansson
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Wallner
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
authors.forename: D
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authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
authors.forename: T J
authors.initials: TJ
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authors.affiliation: University of Cambridge CB2 2QQ and Nick Wareham, Professor and Director of MRC Epidemiology Unit, University of Cambridge, United Kingdom.
authors.forename: K T
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain.|Navarre Public Health Institute, Pamplona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: Aarhus University, Department of Public Health, Section for Epidemiology, Aarhus, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain.|Public Health Direction and Biodonostia - Ciberesp, Basque Regional Health Department, San Sebatian, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Dorronsoro
authors.affiliation: CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain.|Escuela Andaluza De Salud Pública, Instituto De Investigación Biosanitaria De Granada (Granada.Ibs), Granada, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: Public Health Directorate, Oviedo, Spain.
authors.forename: J R
authors.initials: JR
authors.lastname: Quirós
authors.affiliation: HuGeF-Human Genetics Foundation, Molecular and Genetic Epidemiology Unit, Torino, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Naccarati
authors.affiliation: The Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Tumino
authors.affiliation: The German Institute of Human Nutrition, Potsdam-Rehbücke, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Boeing
authors.affiliation: Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
authors.forename: C A
authors.initials: CA
authors.lastname: Gonzalez
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology*; D000328:Adult; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012306:Risk; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000209:etiology*
keywords: EPIC; cohort; gastric cancer; healthy lifestyle score