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@ARTICLE{Viallon:291781,
      author       = {V. Viallon and H. Freisling and K. Matta and A. Ø. Nannsen
                      and C. C. Dahm and A. Tjønneland and A. K. Eriksen and R.
                      Kaaks$^*$ and V. A. Katzke$^*$ and M. B. Schulze and G.
                      Masala and G. Tagliabue and V. Simeon and R. Tumino and L.
                      Milani and J. W. G. Derksen and Y. T. van der Schouw and T.
                      H. Nøst and K. B. Borch and T. M. Sandanger and J. R.
                      Quirós and M. Rodriguez-Barranco and C. Bonet and A.
                      Aizpurua-Atxega and L. Cirera and M. Guevara and B.
                      Sundström and A. Winkvist and A. K. Heath and M. J. Gunter
                      and E. Weiderpass and M. Johansson and P. Ferrari},
      title        = {{O}n the use of the healthy lifestyle index to investigate
                      specific disease outcomes.},
      journal      = {Scientific reports},
      volume       = {14},
      number       = {1},
      issn         = {2045-2322},
      address      = {[London]},
      publisher    = {Macmillan Publishers Limited, part of Springer Nature},
      reportid     = {DKFZ-2024-01517},
      pages        = {16330},
      year         = {2024},
      abstract     = {The healthy lifestyle index (HLI), defined as the
                      unweighted sum of individual lifestyle components, was used
                      to investigate the combined role of lifestyle factors on
                      health-related outcomes. We introduced weighted
                      outcome-specific versions of the HLI, where individual
                      lifestyle components were weighted according to their
                      associations with disease outcomes. Within the European
                      Prospective Investigation into Cancer and Nutrition (EPIC),
                      we examined the association between the standard and the
                      outcome-specific HLIs and the risk of T2D, CVD, cancer, and
                      all-cause premature mortality. Estimates of the hazard
                      ratios (HRs), the Harrell's C-index and the population
                      attributable fractions (PAFs) were compared. For T2D, the HR
                      for 1-SD increase of the standard and T2D-specific HLI were
                      0.66 $(95\%$ CI: 0.64, 0.67) and 0.43 (0.42, 0.44),
                      respectively, and the C-index were 0.63 (0.62, 0.64) and
                      0.72 (0.72, 0.73). Similar, yet less pronounced differences
                      in HR and C-index were observed for standard and
                      outcome-specific estimates for cancer, CVD and all-cause
                      mortality. PAF estimates for mortality before age 80 were
                      $57\%$ $(55\%,$ $58\%)$ and $33\%$ $(32\%,$ $34\%)$ for
                      standard and mortality-specific HLI, respectively. The use
                      of outcome-specific HLI could improve the assessment of the
                      role of lifestyle factors on disease outcomes, thus
                      enhancing the definition of public health recommendations.},
      keywords     = {Humans / Healthy Lifestyle / Male / Female / Middle Aged /
                      Neoplasms: mortality / Neoplasms: epidemiology /
                      Cardiovascular Diseases: mortality / Cardiovascular
                      Diseases: epidemiology / Prospective Studies / Aged / Adult
                      / Diabetes Mellitus, Type 2: mortality / Diabetes Mellitus,
                      Type 2: epidemiology / Risk Factors / Proportional Hazards
                      Models / Europe: epidemiology / Mortality, Premature / Life
                      Style / Cancer (Other) / Cardiovascular diseases (Other) /
                      Composite score (Other) / Healthy lifestyle index (Other) /
                      Lifestyle factors (Other) / Mortality (Other) / Type 2
                      diabetes (Other)},
      cin          = {C020},
      ddc          = {600},
      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:39009699},
      pmc          = {pmc:PMC11250810},
      doi          = {10.1038/s41598-024-66772-w},
      url          = {https://inrepo02.dkfz.de/record/291781},
}