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@ARTICLE{Freisling:153085,
      author       = {H. Freisling and V. Viallon and H. Lennon and V. Bagnardi
                      and C. Ricci and A. S. Butterworth and M. Sweeting and D.
                      Muller and I. Romieu and P. Bazelle and M. Kvaskoff and P.
                      Arveux and G. Severi and C. Bamia and T. Kühn$^*$ and R.
                      Kaaks$^*$ and M. Bergmann and H. Boeing and A. Tjønneland
                      and A. Olsen and K. Overvad and C. C. Dahm and V. Menéndez
                      and A. Agudo and M.-J. Sánchez and P. Amiano and C.
                      Santiuste and A. B. Gurrea and T. Y. N. Tong and J. A.
                      Schmidt and I. Tzoulaki and K. K. Tsilidis and H. Ward and
                      D. Palli and C. Agnoli and R. Tumino and F. Ricceri and S.
                      Panico and H. S. J. Picavet and M. Bakker and E. Monninkhof
                      and P. Nilsson and J. Manjer and O. Rolandsson and E.
                      Thysell and E. Weiderpass and M. Jenab and E. Riboli and P.
                      Vineis and J. Danesh and N. J. Wareham and M. J. Gunter and
                      P. Ferrari},
      title        = {{L}ifestyle factors and risk of multimorbidity of cancer
                      and cardiometabolic diseases: a multinational cohort study.},
      journal      = {BMC medicine},
      volume       = {18},
      number       = {1},
      issn         = {1741-7015},
      address      = {Heidelberg [u.a.]},
      publisher    = {Springer},
      reportid     = {DKFZ-2020-00167},
      pages        = {5},
      year         = {2020},
      abstract     = {Although 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.In 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.During 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.Pre-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.},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {323 - Metabolic Dysfunction as Risk Factor (POF3-323)},
      pid          = {G:(DE-HGF)POF3-323},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:31918762},
      doi          = {10.1186/s12916-019-1474-7},
      url          = {https://inrepo02.dkfz.de/record/153085},
}