Associations of lifestyle factors and Neuroendocrine Tumor Development: Results from the EPIC cohort

Abstract

Methods: A cohort of in total 450,111 participants from 9 participating countries was established from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Information on lifestyle and diet was obtained at baseline through questionnaires. For this study, lifestyle factors including smoking, alcohol consumption, Mediterranean diet score, body mass index and Cambridge Physical Activity Index were assessed. Results: 193 carcinoid cases were diagnosed. Smoking was significantly associated with NET development in multivariable analysis in all NETs (HR 1.46, 95% CI 1.02 – 2.11) and gastroenteropancreatic (GEP) NETs (HR 1.58, 95% CI 1.04 – 2.41). Alcohol consumption was not associated with NET development. Hazard ratios for medium (7-10 points) and high adherence (11-18 points) to the Mediterranean diet were 0.71 (95% CI 0.51 – 0.98) and 0.39 (95% CI 0.25 – 0.62) for all NETs, 0.47 (95% CI 0.25 – 0.90) and 0.36 (95% CI 0.15 – 0.86) in lung NETs, and 0.80 (95% CI 0.55 – 1.16) and 0.40 (95% CI 0.23 – 0.69) in GEP NETs. Obesity was statistically not-significantly associated with NET development (HR 1.54, 95% CI 0.99 – 2.41). Physical activity was not found as an associated factor with NET development. Conclusion: Smoking is strongly associated with NET development in both the entire NET population and GEP NETs in the EPIC cohort. Body mass index increases the risk of NET development. Increased adherence to the Mediterranean diet has a protective association with NETs.