Evidence map›Paper›PMID 31918762›Full record

ArticleBMC medicine2020

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

Heinz Freisling, Vivian Viallon, Hannah Lennon, Vincenzo Bagnardi, Cristian Ricci, Adam S Butterworth, Michael Sweeting, David Muller, Isabelle Romieu, Pauline Bazelle and 43 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 200 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
200citing papers in PubMed, 7 pooled it
30.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

200 citing papers in PubMed, 7 syntheses or guidelines pooled it, 386 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Trial
  9. Article
  10. Article
  11. Review
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article

140 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

53 authors at 20 institutions in 10 countries.

Heinz FreislingNutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France. freislingh@iarc.fr.
Vivian ViallonNutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France.
Hannah LennonNutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France.
Vincenzo BagnardiDepartment of Statistics and Quantitative Methods, University of Milan Bicocca, Milan, Italy.
Cristian RicciCentre of Excellence for Nutrition (CEN), North-West University, Potchefstroom, South Africa.
Adam S ButterworthMedical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Michael SweetingDepartment of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
David MullerDepartment Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Isabelle RomieuNutritional Epidemiology Group, International Agency for Research on Cancer, Lyon, France.
Pauline BazelleNutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France.
Marina KvaskoffCentre for Research in Epidemiology and Population Health (CESP), Inserm, Facultés de Médecine Universités Paris Sud, UVSQ, Université Paris Saclay, Gustave Roussy, Villejuif, France.
Patrick ArveuxCentre for Research in Epidemiology and Population Health (CESP), Inserm, Facultés de Médecine Universités Paris Sud, UVSQ, Université Paris Saclay, Gustave Roussy, Villejuif, France.
Gianluca SeveriCentre for Research in Epidemiology and Population Health (CESP), Inserm, Facultés de Médecine Universités Paris Sud, UVSQ, Université Paris Saclay, Gustave Roussy, Villejuif, France.
Christina BamiaWHO Collaborating Center for Nutrition and Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Tilman KühnGerman Cancer Research Center (DKFZ), Heidelberg, Germany.
Rudolf KaaksGerman Cancer Research Center (DKFZ), Heidelberg, Germany.
Manuela BergmannDepartment of Epidemiology, German Institute of Human Nutrition Potsdam Rehbrücke, Nuthetal, Germany.
Heiner BoeingDepartment of Epidemiology, German Institute of Human Nutrition Potsdam Rehbrücke, Nuthetal, Germany.
Anne TjønnelandDanish Cancer Society Research Center, Copenhagen, Denmark.
Anja OlsenDanish Cancer Society Research Center, Copenhagen, Denmark.
Kim OvervadDepartment of Public Health, Aarhus University, Aarhus, Denmark.
Christina C DahmDepartment of Public Health, Aarhus University, Aarhus, Denmark.
Virginia MenéndezPublic Health Directorate, Asturias, Spain.
Antonio AgudoUnit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Maria-Jose SánchezCIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Pilar AmianoCIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Carmen SantiusteDepartment of Epidemiology, Murcia Regional Health Council, IMIB Arrixaca, Murcia, Spain.
Aurelio Barricarte GurreaCIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Tammy Y N TongCancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Julie A SchmidtCancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Ioanna TzoulakiDepartment Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Konstantinos K TsilidisDepartment Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Heather WardDepartment Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Domenico PalliCancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy.
Claudia AgnoliEpidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Rosario TuminoCivi M. Arezzo Hospital, ASP Ragusa, Italy.
Fulvio RicceriCittà della Salute e della Scienza di Torino Hospital, Turin, Italy.
Salvatore PanicoDepartment of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
H Susan J PicavetCentre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Marije BakkerJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Evelyn MonninkhofJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Peter NilssonPublic Health and Clinical Medicine, Nutritional Research, Umeå University, and Arctic Research Centre at Umeå University, Umeå, Sweden.
Jonas ManjerDepartment of Surgery, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
Olov RolandssonDepartment of Public Health and Clinical Medicine, Section of Family Medicine, Umeå University, Umeå, Sweden.
Elin ThysellDepartment of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden.
Elisabete WeiderpassDirector's Office, International Agency for Research on Cancer, Lyon, France.
Mazda JenabNutritional Epidemiology Group, International Agency for Research on Cancer, Lyon, France.
Elio RiboliDepartment Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Paolo VineisDepartment Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
John DaneshMedical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Nick J WarehamMRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
Marc J GunterNutritional Epidemiology Group, International Agency for Research on Cancer, Lyon, France.
Pietro FerrariNutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France.
Centre International de Recherche sur le Cancer · FRImperial College London · GBUmeå University · SEAarhus University · DKCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública · ESDanish Cancer Society · DKGerman Institute of Human Nutrition · DEUniversité de Versailles Saint-Quentin-en-Yvelines · FRUniversity of Cambridge · GBUniversity of Oxford · GBUtrecht University · NLAndalusian School of Public Health · ESAzienda Ospedaliera Citta' della Salute e della Scienza di Torino · ITAzienda Usl 8 Arezzo · ITFederico II University Hospital · ITFondazione IRCCS Istituto Nazionale dei Tumori · ITGerman Cancer Research Center · DEGobierno del Principado de Asturias · ESHeidelberg University · DEInserm · FR

Funding

British Heart Foundation 26 RG/08/014British Heart Foundation RG/13/13/30194British Heart Foundation RG/18/13/33946British Heart Foundation SP/09/002Cancer Research UK 14136Cancer Research UK 24390Cancer Research UK C570/A16491Cancer Research UK C8221/A19170Medical Research Council 1000143Medical Research Council G0401527Medical Research Council G0800270Medical Research Council G1000143Medical Research Council MC_UU_12015/1Medical Research Council MR/L003120/1Medical Research Council MR/M012190/1Medical Research Council MR/N003284/1Medical Research Council MR/S019669/1World Health Organization 001
6 · The paper itself

Abstract

backgroundAlthough 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.

methodsIn 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.

resultsDuring 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.

conclusionPre-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.

Indexed as

Life StyleMultimorbidityAdultAlcohol DrinkingBody Mass IndexCardiovascular DiseasesCohort StudiesDiabetes Mellitus, Type 2FemaleHumansIncidenceMaleMiddle AgedNeoplasmsProportional Hazards ModelsProspective StudiesCancerCancer and cardiometabolic multimorbidityCardiovascular diseaseDiabetesHealthy lifestyleObesityPrevention

Identifiers

PMID31918762
PMCPMC6953215
OpenAlexW2999284773

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.