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@ARTICLE{Botteri:182074,
      author       = {E. Botteri and G. Peveri and P. Berstad and V. Bagnardi and
                      S. L. F. Chen and T. M. Sandanger and G. Hoff and C. C. Dahm
                      and C. S. Antoniussen and A. Tjønneland and A. K. Eriksen
                      and G. Skeie and A. Perez-Cornago and J. M. Huerta and P.
                      Jakszyn and S. Harlid and B. Sundström and A. Barricarte
                      and E. M. Monninkhof and J. W. G. Derksen and M. B. Schulze
                      and B. Bueno-de-Mesquita and M.-J. Sánchez and A. J. Cross
                      and K. K. Tsilidis and M. S. De Magistris and R. Kaaks$^*$
                      and V. Katzke$^*$ and J. A. Rothwell and N. Laouali and G.
                      Severi and P. Amiano and P. Contiero and C. Sacerdote and M.
                      Goldberg and M. Touvier and H. Freisling and V. Viallon and
                      E. Weiderpass and E. Riboli and M. J. Gunter and M. Jenab
                      and P. Ferrari},
      title        = {{C}hanges in lifestyle and risk of colorectal cancer in the
                      {E}uropean {P}rospective {I}nvestigation into {C}ancer and
                      {N}utrition.},
      journal      = {The American journal of gastroenterology},
      volume       = {118},
      number       = {4},
      issn         = {0002-9270},
      address      = {Alphen aan den Rijn, The Netherlands},
      publisher    = {Wolters Kluwer Health, Inc.},
      reportid     = {DKFZ-2022-02402},
      pages        = {702-711},
      year         = {2023},
      note         = {2023 / 118(4), pp. 702-711},
      abstract     = {We investigated the impact of changes in lifestyle habits
                      on colorectal cancer (CRC) risk in a multi-country European
                      cohort.We used baseline and follow-up questionnaire data
                      from the EPIC cohort to assess changes in lifestyle habits
                      and their associations with CRC development. We calculated a
                      healthy lifestyle index (HLI) score based on smoking status,
                      alcohol consumption, body mass index and physical activity
                      collected at the two timepoints. HLI ranged from 0 (most
                      unfavourable) to 16 (most favourable). We estimated the
                      association between HLI changes and CRC risk using Cox
                      regression models and reported hazard ratios (HR) with
                      $95\%$ confidence intervals (CI).Among 295,865 participants,
                      2,799 CRC cases were observed over a median of 7.8 years.
                      Median time between questionnaires was 5.7 years. Each unit
                      increase in HLI from the baseline to the follow-up
                      assessment was associated with a statistically significant
                      $3\%$ lower CRC risk. Among participants in the top tertile
                      at baseline (HLI>11), those in the bottom tertile at
                      follow-up (HLI≤9) had a higher CRC risk (HR 1.34; $95\%CI$
                      1.02-1.75) than those remaining in the top tertile. Among
                      individuals in the bottom tertile at baseline, those in the
                      top tertile at follow-up had a lower risk (HR 0.77; $95\%CI$
                      0.59-1.00) than those remaining in the bottom
                      tertile.Improving adherence to a healthy lifestyle was
                      inversely associated with CRC risk, while worsening
                      adherence was positively associated with CRC risk. These
                      results justify and support recommendations for healthy
                      lifestyle changes and healthy lifestyle maintenance for CRC
                      prevention.},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36227801},
      doi          = {10.14309/ajg.0000000000002065},
      url          = {https://inrepo02.dkfz.de/record/182074},
}