• Heinz Freisling, Vivian Viallon, Hannah Lennon, Vincenzo Bagnardi, Cristian Ricci, Adam S Butterworth, Michael Sweeting, David Muller, Isabelle Romieu, Pauline Bazelle, Marina Kvaskoff, Patrick Arveux, Gianluca Severi, Christina Bamia, Tilman Kühn, Rudolf Kaaks, Manuela Bergmann, Heiner Boeing, Anne Tjønneland, Anja Olsen, Kim Overvad, Christina C Dahm, Virginia Menéndez, Antonio Agudo, Maria-Jose Sánchez, Pilar Amiano, Carmen Santiuste, Aurelio Barricarte Gurrea, Tammy Y N Tong, Julie A Schmidt, Ioanna Tzoulaki, Konstantinos K Tsilidis, Heather Ward, Domenico Palli, Claudia Agnoli, Rosario Tumino, Fulvio Ricceri, Salvatore Panico, PicavetH Susan JHSJCentre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands., Marije Bakker, Evelyn Monninkhof, Peter Nilsson, Jonas Manjer, Olov Rolandsson, Elin Thysell, Elisabete Weiderpass, Mazda Jenab, Elio Riboli, Paolo Vineis, John Danesh, Nick J Wareham, Marc J Gunter, and Pietro Ferrari.
• Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France. freislingh@iarc.fr.
• Bmc Med. 2020 Jan 10; 18 (1): 55.

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.

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