Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study
Open accessAbstract
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.
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Adherence to the MedDiet reduced the risk of developing CVD and T2D among cancer patients (HR 0.89, 95% CI 0.81-0.97).
“Adherence to the MedDiet reduced the risk of developing CVD and T2D among cancer patients, with a HR of 0.89 (95% CI, 0.81 to 0.97).”
From Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases (2020) · cites this paper as [162]
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References 39 · Cited by 376
- Authors
- Freisling, H., Viallon, V., Lennon, H., Bagnardi, V., Ricci, C., Butterworth, A. S., Sweeting, M., Muller, D., Romieu, I., Bazelle, P., Kvaskoff, M., Arveux, P., Severi, G., Bamia, C., Kühn, T., Kaaks, R., Bergmann, M., Boeing, H., Tjønneland, A., Olsen, A., Overvad, K., Dahm, C. C., Menéndez, V., Agudo, A., Sánchez, M.-J., Amiano, P., Santiuste, C., Gurrea, A. B., Tong, T. Y. N., Schmidt, J. A., Tzoulaki, I., Tsilidis, K. K., Ward, H., Palli, D., Agnoli, C., Tumino, R., Ricceri, F., Panico, S., Picavet, H. S. J., Bakker, M., Monninkhof, E., Nilsson, P., Manjer, J., Rolandsson, O., Thysell, E., Weiderpass, E., Jenab, M., Riboli, E., Vineis, P., Danesh, J., Wareham, N. J., Gunter, M. J., & Ferrari, P.
- Affiliations
- Centre international de recherche sur le cancer (FR)
- University of Milano-Bicocca (IT)
- North-West University (ZA)
- University of Cambridge (GB)
- Imperial College London (GB)
- Inserm (FR)
- National and Kapodistrian University of Athens (GR)
- German Cancer Research Center (DE)
- German Institute of Human Nutrition (DE)
- Danish Cancer Society (DK)
- Aarhus University (DK)
- Gobierno del Principado de Asturias (ES)
- Institut d'Investigació Biomédica de Bellvitge (ES)
- Biogipuzkoa Health Research Institute (ES)
- Instituto Murciano de Investigación Biosanitaria (ES)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- University of Oxford (GB)
- University of Ioannina (GR)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- Federico II University Hospital (IT)
- National Institute for Public Health and the Environment (NL)
- Utrecht University (NL)
- Arctic Research Centre (SE)
- Lund University (SE)
- Umeå University (SE)
- Corresponding author
- Freisling, Heinz
- ORCID
- Freisling, Heinz
- Viallon, Vivian
- Lennon, Hannah
- Bagnardi, Vincenzo
- Ricci, Cristian
- Butterworth, Adam S.
- Sweeting, Michael
- Muller, David
- Romieu, Isabelle
- Kvaskoff, Marina
- Arveux, Patrick
- Severi, Gianluca
- Bamia, Christina
- Kaaks, Rudolf
- Boeing, Heiner
- Tjønneland, Anne
- Olsen, Anja
- Overvad, Kim
- Dahm, Christina C.
- Amiano, Pilar
- Santiuste, Carmen
- Tong, Tammy Y. N.
- Schmidt, Julie A.
- Tzoulaki, Ioanna
- Tsilidis, Konstantinos K.
- Ward, Heather
- Palli, Domenico
- Agnoli, Claudia
- Tumino, Rosario
- Ricceri, Fulvio
- Panico, Salvatore
- Picavet, H. Susan J.
- Bakker, Marije
- Monninkhof, Evelyn
- Manjer, Jonas
- Rolandsson, Olov
- Weiderpass, Elisabete
- Jenab, Mazda
- Vineis, Paolo
- Danesh, John
- Gunter, Marc J.
- Ferrari, Pietro
- Venue
- BMC Medicine
- Published
- 2020-01-10
- Volume
- 18
- Issue
- 1
- Pages
- 5-5
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC6953215
- OpenAlex
- W2999284773
- Cited by
- 376
- References
- 39
- Citations by year
- 2026: 51 · 2025: 82 · 2024: 70 · 2023: 64 · 2022: 61 · 2021: 37 · 2020: 11
- FWCI
- 15.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, cc-by)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- HAL (submittedVersion, cc-by)
- BOA (University of Milano-Bicocca) (submittedVersion, other-oa)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Lund University Publications (Lund University) (submittedVersion)
- Boloka Institutional Repository (North-west University) (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion, other-oa)
- Apollo (cc-by)
- Funders
- Direction General de la Sante (GR-IARC-2003-09-12-01)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- cancer, cardiometabolic disease, lifestyle factors, healthy lifestyle index, Mediterranean diet, body mass index, smoking, alcohol consumption, physical activity, cardiovascular disease, type 2 diabetes, non-communicable diseases, absolute risk, sex differences, European adults, cancer prevention
- MeSH terms
- Multimorbidity, Adult, Alcohol Drinking, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Humans, Life Style, Male, Middle Aged, Neoplasms, Prospective Studies, Risk Factors, Cohort Studies, Body Mass Index, Incidence, Proportional Hazards Models, Risk Reduction Behavior
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