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dc.contributor.authorFreisling, Heinz
dc.contributor.authorViallon, Vivian
dc.contributor.authorLennon, Hannah
dc.contributor.authorBagnardi, Vincenzo
dc.contributor.authorRicci, Cristian
dc.contributor.authorButterworth, Adam S.
dc.contributor.authorSweeting, Michael
dc.contributor.authorMuller, David
dc.contributor.authorRomieu, Isabelle
dc.contributor.authorBazelle, Pauline
dc.contributor.authorKvaskoff, Marina
dc.contributor.authorArveux, Patrick
dc.contributor.authorSeveri, Gianluca
dc.contributor.authorBamia, Christina
dc.contributor.authorKühn, Tilman
dc.contributor.authorKaaks, Rudolf
dc.contributor.authorBergmann, Manuela
dc.contributor.authorBoeing, Heiner
dc.contributor.authorTjønneland, Anne
dc.contributor.authorOlsen, Anja
dc.contributor.authorOvervad, Kim
dc.contributor.authorDahm, Christina C.
dc.contributor.authorMenéndez, Virginia
dc.contributor.authorAgudo, Antonio
dc.contributor.authorSánchez, Maria-Jose
dc.contributor.authorAmiano, Pilar
dc.contributor.authorSantiuste, Carmen
dc.contributor.authorGurrea, Aurelio Barricarte
dc.contributor.authorTong, Tammy Y. N.
dc.contributor.authorSchmidt, Julie A.
dc.contributor.authorTzoulaki, Ioanna
dc.contributor.authorTsilidis, Konstantinos K.
dc.contributor.authorWard, Heather
dc.contributor.authorPalli, Domenico
dc.contributor.authorAgnoli, Claudia
dc.contributor.authorTumino, Rosario
dc.contributor.authorRicceri, Fulvio
dc.contributor.authorPanico, Salvatore
dc.contributor.authorPicavet, H. Susan J.
dc.contributor.authorBakker, Marije
dc.contributor.authorMonninkhof, Evelyn
dc.contributor.authorNilsson, Peter
dc.contributor.authorManjer, Jonas
dc.contributor.authorRolandsson, Olov
dc.contributor.authorThysell, Elin
dc.contributor.authorWeiderpass, Elisabete
dc.contributor.authorJenab, Mazda
dc.contributor.authorRiboli, Elio
dc.contributor.authorVineis, Paolo
dc.contributor.authorDanesh, John
dc.contributor.authorWareham, Nick J.
dc.contributor.authorGunter, Marc J.
dc.contributor.authorFerrari, Pietro
dc.description.abstractAbstract: 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.
dc.publisherBioMed Central
dc.rightsAttribution 4.0 International (CC BY 4.0)en
dc.subjectResearch Article
dc.subjectHealthy lifestyle
dc.subjectCancer and cardiometabolic multimorbidity
dc.subjectCardiovascular disease
dc.titleLifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study
prism.publicationNameBMC Medicine
pubs.funder-project-idDirection General de la Sante (FR) (GR-IARC-2003-09-12-01)

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Attribution 4.0 International (CC BY 4.0)
Except where otherwise noted, this item's licence is described as Attribution 4.0 International (CC BY 4.0)