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@ARTICLE{Carr:141994,
      author       = {P. Carr$^*$ and K. Weigl$^*$ and L. Jansen$^*$ and V.
                      Walter and V. Erben$^*$ and J. Chang-Claude$^*$ and H.
                      Brenner$^*$ and M. Hoffmeister$^*$},
      title        = {{H}ealthy {L}ifestyle {F}actors {A}ssociated {W}ith {L}ower
                      {R}isk of {C}olorectal {C}ancer {I}rrespective of {G}enetic
                      {R}isk.},
      journal      = {Gastroenterology},
      volume       = {155},
      number       = {6},
      issn         = {0016-5085},
      address      = {Philadelphia, Pa. [u.a.]},
      publisher    = {Saunders},
      reportid     = {DKFZ-2018-02224},
      pages        = {1805 - 1815.e5},
      year         = {2018},
      abstract     = {The combined effects of healthy lifestyle factors on
                      colorectal cancer (CRC) risk are unclear. We aimed to
                      develop a healthy lifestyle score, to investigate the joint
                      effects of modifiable lifestyle factors on reduction of CRC
                      risk and determine whether associations differ with genetic
                      risk.We collected data from a large population-based
                      case-control study in Germany and used multiple logistic
                      regression analyses to examine associations between the
                      healthy lifestyle score (derived from 5 modifiable lifestyle
                      factors: smoking, alcohol consumption, diet, physical
                      activity, and body fatness) and CRC risk. We created a
                      genetic risk score, based on 53 risk variants, to
                      investigate the association of the healthy lifestyle score
                      and risk of CRC, stratified by genetic risk.We included 4092
                      patients with CRC and 3032 individuals without CRC
                      (controls) in our analysis. In adjusted models, compared
                      with participants with 0 or 1 healthy lifestyle factor,
                      participants with 2 (odds ratio [OR] 0.85; $95\%$ confidence
                      interval [CI] 0.67-1.06), 3 (OR 0.62; $95\%$ CI 0.50-0.77),
                      4 (OR 0.53; $95\%$ CI 0.42-0.66), or 5 (OR 0.33; $95\%$ CI
                      0.26-0.43) healthy lifestyle factors had increasingly lower
                      risks of CRC (P trend <.0001). We found no differences
                      among subgroups stratified by genetic risk score, history
                      of colonoscopy, or family history of CRC. Overall, $45\%$ of
                      CRC cases $(95\%$ CI $34\%-53\%)$ could be attributed to
                      nonadherence to all 5 healthy lifestyle behaviors.In a large
                      population-based case-control study, we identified a
                      combination of lifestyle factors that appears to reduce risk
                      of CRC, regardless of the patient's genetic profile. These
                      results reinforce the importance of primary prevention of
                      CRC.},
      cin          = {C070 / C020 / G110 / L101},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)C020-20160331 /
                      I:(DE-He78)G110-20160331 / I:(DE-He78)L101-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:30201362},
      pmc          = {pmc:PMC6279591},
      doi          = {10.1053/j.gastro.2018.08.044},
      url          = {https://inrepo02.dkfz.de/record/141994},
}