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Healthy lifestyle index and risk of pancreatic cancer in the Women’s Health Initiative

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A Correction to this article was published on 26 July 2023

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Abstract

Purpose

Lifestyle factors such as smoking, alcohol, body weight, physical activity, and diet quality have been associated with the risk of pancreatic cancer. However, studies of their combined association in women are limited.

Methods

Data on smoking habits, alcohol intake, diet composition, recreational physical activity, body weight, and waist circumference, obtained at recruitment for 136,945 postmenopausal women (aged 50–79 years) participating in the Women’s Health Initiative study, were categorized separately, with higher scores for each variable assigned to the categories representing healthier behaviors. The combined healthy lifestyle index (HLI) score, created by summing the scores for each risk factor, was grouped into quartiles. We used multivariable-adjusted Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for pancreatic cancer risk in association with the HLI.

Results

Over an average follow-up period of approximately 16.0 years, 1,119 incident cases of pancreatic cancer were ascertained. Compared to women in the lowest HLI quartile, those in the upper quartiles (qt) had a reduced risk of pancreatic cancer (multivariable-adjusted HRqt3rd 0.83, 95% CI 0.74–0.99; and HRqt4th 0.74, 95% CI 0.62–0.88, respectively, p trend = 0.001). Use of waist circumference instead of BMI in the HLI score yielded similar results. Among women who were either non-diabetic or non-smokers, high HLI was also associated with reduced risk (HRqt4th 0.78, 95% CI 0.65–0.85 and HRqt4th 0.80, 95% CI 0.66–0.97, respectively). Stratification by BMI categories (18.5− < 25.0, 25.0− < 30.0 and > 30.0 kg/m2) showed similar results in all groups.

Conclusions

Our findings suggest that in postmenopausal women, a healthy lifestyle is associated with reduced risk of pancreatic cancer.

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Data availability

Data are available through the WHI online resource, https://www.whi.org/researchers/data/Pages/Home.aspx, and the WHI remains funded indefinitely through BioLINCC, https://biolincc.nhlbi.nih.gov/studies/whi_ctos/.

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Acknowledgments

We thank the Women's Health Initiative investigators, staff, and the trial participants for their outstanding dedication and commitment. Program Office: (National Heart, Lung, and Blood Institute, Bethesda, MD) Jacques Roscoe, Shari Ludlum, Dale Burden, Joan McGowan, Leslie Ford, and Nancy Geller. Clinical Coordinating Center: (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix, and Charles Kopperberg). Investigators and Academic Centers: (Brigham and Women's Hospital, Harvard Medical School, Boston, MA) JoAnn E, Manson; (MedStar Health Research Institute/Howard University, Washington, DC) Barbara V Howard; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ) Cynthia A. Thompson; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; (City of Hope Comprehensive Cancer Center, Duarte, CA) Rowan T. Chlebowski; (Wake Forest University School of Medicine, Winston–Salem, NC) Sally Shumaker. Women's Health Initiative Memory Study: (Wake Forest University School of Medicine, Winston Salem, NC) Sally Shumaker. A full list of all the investigators who have contributed to Women's Health Initiative science appears at https://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Long%20List.pdf

Funding

This work was supported by Women’s Health Initiative. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.

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Authors and Affiliations

  1. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA

    Rita Peila & Thomas E. Rohan

  2. Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Mace Coday

  3. Behavioral Measurement and Interventions Cancer Prevention and Control Program, University of Arizona, Tucson, AZ, USA

    Tracy E. Crane

  4. College of Medicine at Sulaiman, Al Rajhi University, Al Bukayriyah, Saudi Arabia

    Nazmus Saquib

  5. Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA

    Aladdin H. Shadyab

  6. Internal Medicine, Division of Medical Oncology, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH, USA

    Fred K. Tabung

  7. Division of Epidemiology, College of Public Health, Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA

    Xiaochen Zhang

  8. Department of Epidemiology and Environmental Health, School of Public Health, University of Buffalo, Buffalo, NY, USA

    Jean Wactawski-Wende

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  1. Rita Peila
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Contributions

Conceptualization—TER. Data curation, formal analysis, and investigation RP. Methodology—RP: writing—original draft—RP, TER. Writing—rewriting and editing—all authors.

Corresponding authors

Correspondence to Rita Peila or Thomas E. Rohan.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by institutional review boards at all 40 clinical centers and at the coordinating center.

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All participants in the WHI gave written-informed consent.

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Peila, R., Coday, M., Crane, T.E. et al. Healthy lifestyle index and risk of pancreatic cancer in the Women’s Health Initiative. Cancer Causes Control 33, 737–747 (2022). https://doi.org/10.1007/s10552-022-01558-x

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