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

Published version
Peer-reviewed

Type

Article

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Authors

Freisling, Heinz 
Viallon, Vivian 
Lennon, Hannah 
Bagnardi, Vincenzo 
Ricci, Cristian 

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.

Description

Keywords

Cancer, Cancer and cardiometabolic multimorbidity, Cardiovascular disease, Diabetes, Healthy lifestyle, Obesity, Prevention, Adult, Alcohol Drinking, Body Mass Index, Cardiovascular Diseases, Cohort Studies, Diabetes Mellitus, Type 2, Female, Humans, Incidence, Life Style, Male, Middle Aged, Multimorbidity, Neoplasms, Proportional Hazards Models, Prospective Studies, Risk Factors, Risk Reduction Behavior

Journal Title

BMC Med

Conference Name

Journal ISSN

1741-7015
1741-7015

Volume Title

18

Publisher

Springer Science and Business Media LLC
Sponsorship
Medical Research Council (MC_UU_12015/1)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
Medical Research Council (MR/N003284/1)
Medical Research Council (G0800270)
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
British Heart Foundation (RG/18/13/33946)
Medical Research Council (G1000143)
Medical Research Council (G0401527)
European Research Council (268834)