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Extended healthy lifestyle index and colorectal cancer risk in the Moroccan population

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European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

Little is known about the combined effect of different lifestyle factors on CRC incidence among populations living in developing countries. In this study, we sought to create an Extended Healthy Lifestyle Index (EHLI) and to investigate its association with CRC risk in the Moroccan population.

Methods

A large case–control study including 1516 cases and 1516 controls, matched on age, sex and center were recruited in 5 Moroccan university hospital centers between 2009 and 2017. EHLI scores, including 9 modifiable factors (smoking, alcohol consumption, physical activity intensity, BMI, fruit and vegetables consumption, drinks that promote weight gain, red and processed meat, relatively unprocessed cereals and/or pulses, and dairy products consumption) were assigned to lifestyle information derived from the participants. We assessed the score based on the answers on each of the nine lifestyle components as unhealthy/un-compliant (0 point), healthy/compliant (1 point) and 0.5 for partial compliance to the recommendation. Conditional logistic regression models were used to assess the association between the EHLI and CRC risk and to estimate multivariate ORs and their 95% confidence intervals (CIs). All potential confounder variables were considered.

Results

After adjusting for potential confounding factors, a significant decrease in the risk of overall CRC was observed when comparing the highest EHLI category with the lowest index category (0.39, 95% CI: 0.33–0.47). These results did not differ by colon or rectum subsite.

Conclusion

Combined healthy lifestyle factors are associated with a significantly lower incidence of CRC in Moroccan populations. Prevention strategies should consider targeting of multiple lifestyle factors.

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Data availability

Under the ethical committee policy of the University of Fez, data involving participants or patients cannot be publicly shared. Individual requests for further information on the study can be sent to the corresponding author.

Abbreviations

BMI:

Body Mass Index

CI:

Confident interval

CRC:

Colorectal cancer

EHLI:

Extended healthy Lifestyle Index

FFQ:

Food Frequency Questionnaire

HLI:

Healthy Lifestyle Index

IARC:

International Agency for Research on Cancer

GPAQ:

Global Physical Activity Questionnaire

MLIC:

Middle- and Low-Income Countries

MET:

Metabolic Equivalent Task

NSAID:

Non-Steroidal Anti-Inflammatory Drugs

SD:

Standard deviation

WCRF/AICR:

World Cancer Research Fund/American Institute for Cancer Research

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Acknowledgements

Many thanks to Lalla Salma Foundation, Prevention and Treatment of Cancers (FLSC) and Moroccan Society of Diseases of the Digestive System (SMMAD) for the financing of this study. Many thanks also to all contributors to this work in the Five University Hospitals centers; the directors of UHCs: Fez (Pr. Ait Taleb K), Casablanca (Pr. Afif My H); Rabat (Pr. Chefchaouni Al Mountacer C); Oujda (Pr Daoudi A); and Marrakech (Pr. Nejmi H). The heads of medical services and their teams: Casablanca (Pr. Benider A; Pr Alaoui R; Pr. Hliwa W; Pr. Badre W, Pr. Bendahou K, Pr. Karkouri M.), Rabat (Pr. Ahallat M; Pr. Errabih I; Pr. El Feydi AE; Pr. Chad B; Pr. Belkouchi A; Pr. Errihani H; Pr. Mrabti H; Pr. Znati K), Fez (Pr. Nejjari C; Pr Ibrahimi SA; Pr. El Abkari M; Pr. Mellas N; Pr. Chbani L; Pr. Benjelloun MC), Oujda (Pr. Ismaili N; Pr. Chraïbi M; Pr. Abda N, Pr. Abbaoui S) and Marrakech (Pr. Khouchani M; Pr. Samlani Z; Pr. Belbaraka R; Pr. Amine M)

Funding

Not applicable. All participants voluntarily agreed to take part.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco

    Zineb Hatime, Khaoula El Kinany, Meimouna Deoula, Hanae Abir Boudouaya, Abdelilah Benslimane, Chakib Nejjari & Karima El Rhazi

  2. Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France

    Inge Huybrechts & Marc J. Gunter

  3. School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco

    Mohamed Khalis

  4. Department of Medical Oncology, Ibn Rochd University Hospital Center, Casablanca, Morocco

    Abdellatif Benider

Authors
  1. Zineb Hatime
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Contributions

ZH and KhE conceived the study idea, its design, and led the analyses and interpretation of the data. IH, MG, MK, MD, HAB, BA and CN contributed to the conception and the design of the study. AB contributed to the conception of the study, and the acquisition of data. All authors have read and approved the manuscript. KaE conceived the study idea, its design, and led the analyses and interpretation of the data and supervised the drafting.

Corresponding author

Correspondence to Zineb Hatime.

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Conflict of interest

None.

Ethical approval

The study protocol was approved by the ethical committee at University of Fez.

Informed consent

All participants provided written informed consent for participation in the study.

IARC disclaimer

Where authors are identified as personnel of the International Agency for Research on Cancer / World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer / World Health Organization.

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Hatime, Z., El Kinany, K., Huybrechts, I. et al. Extended healthy lifestyle index and colorectal cancer risk in the Moroccan population. Eur J Nutr 60, 1013–1022 (2021). https://doi.org/10.1007/s00394-020-02311-3

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  • DOI: https://doi.org/10.1007/s00394-020-02311-3

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