BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.

中文翻译：

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生活方式因素以及癌症和心脏代谢疾病多发病的风险：一项跨国队列研究。

背景技术尽管已经研究了关于个体非传染性疾病（NCD）的生活方式因素，但很少研究其与随后的NCD的发展相关性，即多发病。这项研究的目的是调查五种生活方式因素与癌症和心脏代谢疾病的多发病率之间的关联。方法在这项前瞻性队列研究中，纳入了来自七个欧洲国家的291,778名参与者（64％为女性），其中大多数年龄在43至58岁之间，并且在招募时没有癌症，心血管疾病（CVD）和2型糖尿病（T2D）。癌症和心脏代谢疾病的多发病率被定义为随后发展出两种疾病，包括任何部位的第一种癌症，CVD和个体中的T2D。基于Cox回归的多状态建模用于计算发展中的癌症，CVD或T2D的危险比（HR）和95％置信区间（95％CI），以及随后相对于体重指数（BMI）的多发病率转变），吸烟状况，酒精摄入量，体育锻炼，对地中海饮食的遵守情况以及健康生活方式指数（HLI）分数的组合。估计累积发病率函数（CIF）可以计算出任何部位从健康到癌症，CVD（致命和非致命）或T2D从健康过渡到癌症以及随后在三个NCD之后发生多发病的10年绝对风险。结果在11年的中位随访中，有1910名男性和1334名女性患有多种癌症和心血管代谢疾病。HLI较高，反映出健康的生活方式，与多发病率呈极显着负相关，在癌症，CVD和T2D后，每3单位递增的危险比分别为0.75（95％CI，0.71至0.81），0.84（0.79至0.90）和0.82（0.77至0.88）。 。在T2D之后，生活方式不健康的男性和女性的10年多重发病绝对风险分别为40％和25％，健康生活方式的男性和女性分别为30％和18％。结论诊断前的健康生活方式与癌症和心脏代谢疾病的风险以及通过降低多发性疾病的风险与这些疾病的预后密切相关。生活方式不健康的男性和女性在10年内发生多发病的绝对风险分别为40％和25％，生活方式健康的男性和女性分别为30％和18％。结论诊断前的健康生活方式与癌症和心脏代谢疾病的风险以及通过降低多发性疾病的风险与这些疾病的预后密切相关。生活方式不健康的男性和女性在10年内发生多发病的绝对风险分别为40％和25％，生活方式健康的男性和女性分别为30％和18％。结论诊断前的健康生活方式与癌症和心脏代谢疾病的风险以及通过降低多发性疾病的风险与这些疾病的预后密切相关。