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Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study.

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.

SUBMITTER: Freisling H

PROVIDER: S-EPMC6953215 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study.

Freisling Heinz H Viallon Vivian V Lennon Hannah H Bagnardi Vincenzo V Ricci Cristian C Butterworth Adam S AS Sweeting Michael M Muller David D Romieu Isabelle I Bazelle Pauline P Kvaskoff Marina M Arveux Patrick P Severi Gianluca G Bamia Christina C Kühn Tilman T Kaaks Rudolf R Bergmann Manuela M Boeing Heiner H Tjønneland Anne A Olsen Anja A Overvad Kim K Dahm Christina C CC Menéndez Virginia V Agudo Antonio A Sánchez Maria-Jose MJ Amiano Pilar P Santiuste Carmen C Gurrea Aurelio Barricarte AB Tong Tammy Y N TYN Schmidt Julie A JA Tzoulaki Ioanna I Tsilidis Konstantinos K KK Ward Heather H Palli Domenico D Agnoli Claudia C Tumino Rosario R Ricceri Fulvio F Panico Salvatore S Picavet H Susan J HSJ Bakker Marije M Monninkhof Evelyn E Nilsson Peter P Manjer Jonas J Rolandsson Olov O Thysell Elin E Weiderpass Elisabete E Jenab Mazda M Riboli Elio E Vineis Paolo P Danesh John J Wareham Nick J NJ Gunter Marc J MJ Ferrari Pietro P

BMC medicine 20200110 1

<h4>Background</h4>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.<h4>Methods</h4>In this prospective cohort study, 291,778 participants (64% women) from seven European countr ...[more]

PMID: 31918762

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Project description:OBJECTIVES:The evolution of multimorbidity describes the continuum from a healthy status to the development of a single disease and further progression to multimorbidity with additional diseases. We investigated the evolution of cardiometabolic multimorbidity and risk for mortality in a Chinese population. DESIGN:Longitudinal cohort study using data from the CHinese Electronic health Records Research in Yinzhou (CHERRY) study, with 5.43 million person-years follow-up (median 5.16 years). PARTICIPANTS:Data for 1 038 704 adults (total 22 750 deaths) were analysed. EXPOSURE:Cardiometabolic multimorbidity was defined as ever being diagnosed with two or more of three diseases: hypertension, diabetes and cardiovascular disease (CVD). PRIMARY AND SECONDARY OUTCOME MEASURES:Age-adjusted and sex-adjusted HRs were calculated for all-cause mortality. RESULTS:The cardiometabolic disease status of 105 209 (10.1%) individuals changed during the follow-up. The prevalence of cardiometabolic multimorbidity increased from 2.41% (95% CI: 2.38% to 2.44%) to 5.94% (95% CI: 5.90% to 5.99%). Baseline multimorbidity status showed the HR (95% CI) was 1.37 (1.33 to 1.42) in those with one disease, 1.71 (1.64 to 1.79) in those with two diseases and 2.22 (2.00 to 2.46) in those with three diseases. The highest HRs were observed for CVD only (3.31, 95% CI: 3.05 to 3.59) or diabetes and CVD (3.12, 95% CI: 2.37 to 4.11). Those with hypertension only had the lowest HR (1.26, 95% CI: 1.22 to 1.30). Longitudinal data showed the HRs (95% CI) in patients with one, two and three diseases were 1.36 (1.32 to 1.41), 2.03 (1.96 to 2.10) and 2.16 (2.05 to 2.29), respectively. CONCLUSIONS:The prevalence of cardiometabolic multimorbidity in a general Chinese population increased more than doubled over 5 years, indicating rapid evolution of cardiometabolic multimorbidity. A history of CVD dominates the risk for mortality. A complementary strategy for primary and secondary prevention of cardiometabolic diseases is needed in China.

Project description:BackgroundMultimorbidity is increasingly common and is associated with adverse health outcomes, highlighting the need to broaden the single-disease framework that dominates medical research. We examined the role of midlife clinical characteristics, socioeconomic position, and behavioural factors in the development of cardiometabolic multimorbidity (at least 2 of diabetes, coronary heart disease, and stroke), along with how these factors modify risk of mortality.Methods and findingsData on 8,270 men and women were drawn from the Whitehall II cohort study, with mean follow-up of 23.7 years (1985 to 2017). Three sets of risk factors were assessed at age 50 years, each on a 5-point scale: clinical profile (hypertension, hypercholesterolemia, overweight/obesity, family history of cardiometabolic disease), occupational position, and behavioural factors (smoking, alcohol consumption, diet, physical activity). The outcomes examined were cardiometabolic disease (diabetes, coronary heart disease, stroke), cardiometabolic multimorbidity, and mortality. We used multi-state models to examine the role of risk factors in 5 components of the cardiometabolic disease trajectory: from healthy state to first cardiometabolic disease, from first cardiometabolic disease to cardiometabolic multimorbidity, from healthy state to death, from first cardiometabolic disease to death, and from cardiometabolic multimorbidity to death. A total of 2,501 participants developed 1 of the 3 cardiometabolic diseases, 511 developed cardiometabolic multimorbidity, and 1,406 died. When behavioural and clinical risk factors were considered individually, only smoking was associated with all five transitions. In a model containing all 3 risk factor scales, midlife clinical profile was the strongest predictor of first cardiometabolic disease (hazard ratio for the least versus most favourable profile: 3.74; 95% CI: 3.14-4.45) among disease-free participants. Among participants with 1 cardiometabolic disease, adverse midlife socioeconomic (1.54; 95% CI: 1.10-2.15) and behavioural factors (2.00; 95% CI: 1.40-2.85), but not clinical characteristics, were associated with progression to cardiometabolic multimorbidity. Only midlife behavioural factors predicted mortality among participants with cardiometabolic disease (2.12; 95% CI: 1.41-3.18) or cardiometabolic multimorbidity (3.47; 95% CI: 1.81-6.66). A limitation is that the study was not large enough to estimate transitions between each disease and subsequent outcomes and between all possible pairs of diseases.ConclusionsThe importance of specific midlife factors in disease progression, from disease-free state to single disease, multimorbidity, and death, varies depending on the disease stage. While clinical risk factors at age 50 determine the risk of incident cardiometabolic disease in a disease-free population, midlife socioeconomic and behavioural factors are stronger predictors of progression to multimorbidity and mortality in people with cardiometabolic disease.

Project description:BackgroundThe prevalence of cardiometabolic multimorbidity (CMM), which significantly increases the risk of mortality, is increasing globally. However, the role of healthy lifestyle in the secondary prevention of CMM is unclear.MethodsIn total, 290,795 participants with CMM, which was defined as coexistence of at least two of hypertension (HTN), diabetes mellitus (DM), coronary heart disease (CHD), and stroke (ST), and those without these four diseases at baseline were derived from UK Biobank. The associations between specific CMM patterns and mortality, and that between healthy lifestyle (including physical activity, smoking, alcohol consumption, and vegetable and fruit consumption) and mortality in patients with specific CMM patterns were calculated using the flexible parametric Royston-Parmar proportion-hazard model. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated.ResultsDuring a median 12.3-year follow up period, 15,537 (5.3%) deaths occurred. Compared with participants without cardiometabolic diseases, the HRs for all-cause mortality were 1.54 [95% confidence interval (CI): 1.30, 1.82] in participants with HTN + DM, 1.84 (95% CI: 1.59, 2.12) in those with HTN + CHD, 1.89 (95% CI: 1.46, 2.45) in those with HTN + ST, and 2.89 (95% CI: 2.28, 3.67) in those with HTN + DM + CHD. At the age of 45 years, non-current smoking was associated with an increase in life expectancy by 3.72, 6.95, 6.75, and 4.86 years for participants with HTN + DM, HTN + CHD, HTN + ST, and HTN + DM + CHD, respectively. A corresponding increase by 2.03, 1.95, 2.99, and 1.88 years, respectively, was observed in participants with regular physical activity. Non-/moderate alcohol consumption and adequate fruit/vegetable consumption were not significantly associated with life expectancy in patients with specific CMM patterns.ConclusionCardiometabolic multimorbidity was associated with an increased risk of mortality. Regular physical activity and non-current smoking can increase life expectancy in patients with specific CMM patterns.

Project description:Background:Female adolescents are considered a risk group for cardiometabolic disease due to their lifestyle (LS). Objective:To evaluate the association between LS classes and body composition groups with cardiometabolic disease risk factors and pro- and anti-inflammatory biomarkers in female adolescents. Methods:This cross-sectional study was carried out with female adolescents aged 14 to 19 years, from Viçosa-MG, Brazil. Latent class analysis assessed LS classes. Kinanthropometric measurements were taken together with the body fat percentage (BF%), being analyzed by the Dual Energy X-ray Absorptiometry (DEXA) equipment. Blood pressure and biochemical parameters were analyzed in the Health Division of the Federal University of Viçosa. The pro- and anti-inflammatory biomarkers were analyzed using Luminex technology. Associations with biomarkers were estimated by multiple linear regression. Results:405 female adolescents were evaluated. The majority, 82.57%, 72.90%, and 65.31%, were classified as inactive by the number of steps, with high screen and cell phone time, respectively. Furthermore, 41.55% did meet the minimum of 60 minutes of moderate-to-vigorous physical activity (MVPA) and 54.69% had high values of BF% (DEXA). The "Sedentary & Inactive LS" class together with the high levels of weight and BF% were associated with increased levels of blood pressure, lipid profile, and uric acid. It was also found that "Inactive & Sedentary LS", high BF%, insulin resistance, and ultra-sensitive C-reactive protein were associated with the concentrations of proinflammatory biomarkers of tumor necrosis factor-?, interleukin-6, and leptin. Conclusion:We concluded that female adolescents with overweight/obese and high BF% presented higher values of anthropometric indicators, levels of blood pressure, concentration of uric acid and hs-CRP, and lower concentration of HDL. Inactive and Sedentary lifestyle of these girls, along with excess body fat, insulin resistance, and higher concentrations of hs-CRP were associated with the higher concentration proinflammatory markers.

Project description:BACKGROUND & AIMS:Colorectal cancer located at different anatomical subsites may have distinct etiologies and risk factors. Previous studies that have examined this hypothesis have yielded inconsistent results, possibly because most studies have been of insufficient size to identify heterogeneous associations with precision. METHODS:In the European Prospective Investigation into Cancer and Nutrition study, we used multivariable joint Cox proportional hazards models, which accounted for tumors at different anatomical sites (proximal colon, distal colon, and rectum) as competing risks, to examine the relationships between 14 established/suspected lifestyle, anthropometric, and reproductive/menstrual risk factors with colorectal cancer risk. Heterogeneity across sites was tested using Wald tests. RESULTS:After a median of 14.9 years of follow-up of 521,330 men and women, 6291 colorectal cancer cases occurred. Physical activity was related inversely to proximal colon and distal colon cancer, but not to rectal cancer (P heterogeneity = .03). Height was associated positively with proximal and distal colon cancer only, but not rectal cancer (P heterogeneity = .0001). For men, but not women, heterogeneous relationships were observed for body mass index (P heterogeneity = .008) and waist circumference (P heterogeneity = .03), with weaker positive associations found for rectal cancer, compared with proximal and distal colon cancer. Current smoking was associated with a greater risk of rectal and proximal colon cancer, but not distal colon cancer (P heterogeneity = .05). No heterogeneity by anatomical site was found for alcohol consumption, diabetes, nonsteroidal anti-inflammatory drug use, and reproductive/menstrual factors. CONCLUSIONS:The relationships between physical activity, anthropometry, and smoking with colorectal cancer risk differed by subsite, supporting the hypothesis that tumors in different anatomical regions may have distinct etiologies.

Dataset Information

Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study.

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Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study.

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