@article{3078614,
    title = "Healthy lifestyle and the risk of lymphoma in the European Prospective Investigation into Cancer and Nutrition study",
    author = "Naudin, S. and Solans Margalef, M. and Saberi Hosnijeh, F. and Nieters, A. and Kyrø, C. and Tjønneland, A. and Dahm, C.C. and Overvad, K. and Mahamat-Saleh, Y. and Besson, C. and Boutron-Ruault, M.-C. and Kühn, T. and Canzian, F. and Schulze, M.B. and Peppa, E. and Karakatsani, A. and Trichopoulou, A. and Sieri, S. and Masala, G. and Panico, S. and Tumino, R. and Ricceri, F. and Chen, S.L.F. and Barroso, L.L. and Huerta, J.M. and Sánchez, M.-J. and Ardanaz, E. and Menéndez, V. and Amiano Exezarreta, P. and Spaeth, F. and Jerkeman, M. and Jirstom, K. and Schmidt, J.A. and Aune, D. and Weiderpass, E. and Riboli, E. and Vermeulen, R. and Casabonne, D. and Gunter, M. and Brennan, P. and Ferrari, P.",
    journal = "International Journal  of Cancer",
    year = "2020",
    volume = "147",
    number = "6",
    pages = "1649-1656",
    publisher = "Wiley-Liss, Inc.",
    issn = "0020-7136",
    doi = "10.1002/ijc.32977",
    keywords = "adult;  alcohol consumption;  Article;  B cell lymphoma;  body mass;  cancer risk;  carcinogenesis;  chronic lymphatic leukemia;  cohort analysis;  controlled study;  diet;  diffuse large B cell lymphoma;  exposure variable;  female;  follicular lymphoma;  follow up;  healthy lifestyle;  healthy lifestyle index;  Hodgkin disease;  human;  lymphoma;  major clinical study;  male;  multiple myeloma;  NK T cell lymphoma;  nonhodgkin lymphoma;  physical activity;  plasmacytoma;  priority journal;  prospective study;  scoring system;  sensitivity analysis;  small lymphocytic leukemia;  smoking;  adverse event;  aged;  clinical trial;  drinking behavior;  Europe;  exercise;  feeding behavior;  healthy lifestyle;  incidence;  lymphoma;  middle aged;  multicenter study;  physiology;  risk factor, Adult;  Aged;  Alcohol Drinking;  Body Mass Index;  Diet Surveys;  Europe;  Exercise;  Feeding Behavior;  Female;  Follow-Up Studies;  Healthy Lifestyle;  Humans;  Incidence;  Lymphoma;  Male;  Middle Aged;  Prospective Studies;  Risk Factors;  Smoking",
    abstract = "Limited evidence exists on the role of modifiable lifestyle factors on the risk of lymphoma. In this work, the associations between adherence to healthy lifestyles and risks of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) were evaluated in a large-scale European prospective cohort. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 2,999 incident lymphoma cases (132 HL and 2,746 NHL) were diagnosed among 453,808 participants after 15 years (median) of follow-up. The healthy lifestyle index (HLI) score combined information on smoking, alcohol intake, diet, physical activity and BMI, with large values of HLI expressing adherence to healthy behavior. Cox proportional hazards models were used to estimate lymphoma hazard ratios (HR) and 95% confidence interval (CI). Sensitivity analyses were conducted by excluding, in turn, each lifestyle factor from the HLI score. The HLI was inversely associated with HL, with HR for a 1-standard deviation (SD) increment in the score equal to 0.78 (95% CI: 0.66, 0.94). Sensitivity analyses showed that the association was mainly driven by smoking and marginally by diet. NHL risk was not associated with the HLI, with HRs for a 1-SD increment equal to 0.99 (0.95, 1.03), with no evidence for heterogeneity in the association across NHL subtypes. In the EPIC study, adherence to healthy lifestyles was not associated with overall lymphoma or NHL risk, while an inverse association was observed for HL, although this was largely attributable to smoking. These findings suggest a limited role of lifestyle factors in the etiology of lymphoma subtypes. © 2020 UICC"
}