Combined lifestyle factors, incident cancer, and cancer mortality: a systematic review and meta-analysis of prospective cohort studies

• Published in: British journal of cancer Vol. 122; no. 7; pp. 1085 - 1093
• Main Authors: Zhang, Yan-Bo, Pan, Xiong-Fei, Chen, Junxiang, Cao, Anlan, Zhang, Yu-Ge, Xia, Lu, Wang, Jing, Li, Huiqi, Liu, Gang, Pan, An
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-03-2020; Nature Publishing Group
• Subjects: 692/308/174; 692/499; 692/699/67/2195; 692/699/67/2324; Adult; Aged; Biomedical and Life Sciences; Biomedicine; Body weight; Breast; Cancer; Cancer Research; Cohort analysis; Cohort Studies; Colon; Drug Resistance; Endometrium; Epidemiology; Esophagus; Female; Gastric cancer; Health behavior; Healthy Lifestyle - physiology; Humans; Incidence; Lifestyles; Lung cancer; Male; Meta-analysis; Middle Aged; Molecular Medicine; Morbidity; Mortality; Neoplasms - mortality; Oncology; Physical activity; Prospective Studies; Rectum; Risk Factors; Systematic review
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-020-0741-x

Background
Cancer poses a huge disease burden, which could be reduced by adopting healthy lifestyles mainly composed of healthy diet, body weight, physical activity, limited alcohol consumption, and avoidance of smoking. However, no systematic review has summarised the relations of combined lifestyle factors with cancer morbidity and mortality.
Methods
EMBASE and PubMed were searched up to April 2019. Cohort studies investigating the association of combined lifestyle factors with risks of incident cancer and cancer mortality were selected. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity and publication bias tests were conducted.
Results
The HRs (95% CIs) comparing individuals with the healthiest versus the least healthy lifestyles were 0.71 (0.66–0.76; 16 studies with 1.9 million participants) for incident cancer and 0.48 (0.42–0.54; 30 studies with 1.8 million participants) for cancer mortality. Adopting the healthiest lifestyles was also associated with 17 to 58% lower risks of bladder, breast, colon, endometrial, oesophageal, kidney, liver, lung, rectal, and gastric cancer. The relations were largely consistent and significant among participants with different characteristics in the subgroup analyses.
Conclusions
Adopting healthy lifestyles is associated with substantial risk reduction in cancer morbidity and mortality, and thus should be given priority for cancer prevention.