Adherence to the WCRF/AICR cancer prevention recommendations and cancer-specific mortality: results from the Vitamins and Lifestyle (VITAL) Study
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In 2007, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) released eight recommendations related to body fatness, physical activity, and diet aimed at preventing the most common cancers worldwide. The purpose of this paper is to estimate the association between meeting these recommendations and cancer-specific mortality.
We operationalized six recommendations (related to body fatness; physical activity; and consumption of foods that promote weight gain, plant foods, red and processed meat, and alcohol) and examined their association with cancer-specific mortality over 7.7 years of follow-up in the Vitamins and Lifestyle (VITAL) Study cohort. Participants included 57,841 men and women ages 50–76 in 2000–2002 who had not been diagnosed with cancer prior to baseline. Cancer-specific deaths (n = 1,595) were tracked through the Washington State death file.
Meeting the recommendations related to plant foods and foods that promote weight gain were most strongly associated with lower cancer-specific mortality [hazard ratio (HR) 0.82, 95 % confidence interval (CI) 0.67, 1.00 and HR 0.82, 95 % CI 0.70, 0.96, respectively]. Cancer-specific mortality was 61 % lower in respondents who met at least five recommendations compared to those who met none (HR 0.39, 95 % CI 0.24, 0.62). Cancer-specific mortality was 10 % lower on an average with each additional recommendation met (per-recommendation HR 0.90, 95 % CI 0.85, 0.94; p trend < 0.001). This association did not differ by sex or age but was stronger in non-smokers (HR 0.84, 95 % CI 0.76, 0.92) than in smokers (HR 0.93, 95 % CI 0.87, 0.98; p interaction = 0.086).
Adherence to the WCRF/AICR cancer prevention recommendations developed to reduce incidence of common cancers could substantially reduce cancer-specific mortality in older adults.
KeywordsAlcohol Cancer-specific mortality Cancer prevention Diet Physical activity Recommendations
World Cancer Research Fund
American Institute for Cancer Research
This work was financially supported by the Biobehavioral Cancer Prevention and Control Training Program at the University of Washington funded by the National Cancer Institute R25CA92408 (to T. A. Hastert) and by the National Cancer Institute and the National Institutes of Health Office of Dietary Supplements K05CA154337 (to E. White).
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington, DCGoogle Scholar
- 2.Thomson CA, McCullough ML, Wertheim BC, Chlebowski RT, Martinez ME, Stefanick ML, Rohan TE, Manson JE, Tindle HA, Ockene J, Vitolins MZ, Wactawski-Wende J, Sarto GE, Lane DS, Neuhouser ML (2014) Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the Women’s Health Initiative. Cancer Prev Res 7(1):42–53. doi: 10.1158/1940-6207.CAPR-13-0258 CrossRefGoogle Scholar
- 3.Romaguera D, Vergnaud AC, Peeters PH, van Gils CH, Chan DS, Ferrari P, Romieu I, Jenab M, Slimani N, Clavel-Chapelon F, Fagherazzi G, Perquier F, Kaaks R, Teucher B, Boeing H, von Rusten A, Tjonneland A, Olsen A, Dahm CC, Overvad K, Quiros JR, Gonzalez CA, Sanchez MJ, Navarro C, Barricarte A, Dorronsoro M, Khaw KT, Wareham NJ, Crowe FL, Key TJ, Trichopoulou A, Lagiou P, Bamia C, Masala G, Vineis P, Tumino R, Sieri S, Panico S, May AM, Bueno-de-Mesquita HB, Buchner FL, Wirfalt E, Manjer J, Johansson I, Hallmans G, Skeie G, Benjaminsen Borch K, Parr CL, Riboli E, Norat T (2012) Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am J Clin Nutr 96(1):150–163. doi: 10.3945/ajcn.111.031674 PubMedCrossRefGoogle Scholar
- 5.Heidemann C, Boeing H, Pischon T, Nothlings U, Joost HG, Schulze MB (2009) Association of a diabetes risk score with risk of myocardial infarction, stroke, specific types of cancer, and mortality: a prospective study in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort. Eur J Epidemiol 24(6):281–288. doi: 10.1007/s10654-009-9338-7 PubMedCrossRefGoogle Scholar
- 7.Kvaavik E, Batty GD, Ursin G, Huxley R, Gale CR (2010) Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey. Arch Intern Med 170(8):711–718. doi: 10.1001/archinternmed.2010.76 PubMedCrossRefGoogle Scholar
- 8.Nechuta SJ, Shu XO, Li HL, Yang G, Xiang YB, Cai H, Chow WH, Ji B, Zhang X, Wen W, Gao YT, Zheng W (2010) Combined impact of lifestyle-related factors on total and cause-specific mortality among Chinese women: prospective cohort study. PLoS Med 7 (9). doi: 10.1371/journal.pmed.1000339
- 9.Vergnaud AC, Romaguera D, Peeters PH, van Gils CH, Chan DS, Romieu I, Freisling H, Ferrari P, Clavel-Chapelon F, Fagherazzi G, Dartois L, Li K, Tikk K, Bergmann MM, Boeing H, Tjonneland A, Olsen A, Overvad K, Dahm CC, Redondo ML, Agudo A, Sanchez MJ, Amiano P, Chirlaque MD, Ardanaz E, Khaw KT, Wareham NJ, Crowe F, Trichopoulou A, Orfanos P, Trichopoulos D, Masala G, Sieri S, Tumino R, Vineis P, Panico S, Bueno-de-Mesquita HB, Ros MM, May A, Wirfalt E, Sonestedt E, Johansson I, Hallmans G, Lund E, Weiderpass E, Parr CL, Riboli E, Norat T (2013) Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study 1,4. Am J Clin Nutr 97(5):1107–1120. doi: 10.3945/ajcn.112.049569 PubMedCrossRefGoogle Scholar
- 11.McCullough ML, Patel AV, Kushi LH, Patel R, Willett WC, Doyle C, Thun MJ, Gapstur SM (2011) Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality. Cancer Epidemiol Biomark Prev 20(6):1089–1097. doi: 10.1158/1055-9965.EPI-10-1173 CrossRefGoogle Scholar
- 13.Cerhan JR, Potter JD, Gilmore JM, Janney CA, Kushi LH, Lazovich D, Anderson KE, Sellers TA, Folsom AR (2004) Adherence to the AICR cancer prevention recommendations and subsequent morbidity and mortality in the Iowa Women’s Health Study cohort. Cancer Epidemiol Biomark Prev 13(7):1114–1120Google Scholar
- 17.World Health Organization (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Technical report series 894:i–xii, 1–253Google Scholar
- 18.International Statistical Classification of Diseases and Related Health Problems 10th Revision. (2010) World Health Organization. http://apps.who.int/classifications/icd10/browse/2010/en. Accessed 6 Feb 2014
- 19.Vergnaud AC, Norat T, Romaguera D, Mouw T, May AM, Romieu I, Freisling H, Slimani N, Boutron-Ruault MC, Clavel-Chapelon F, Morois S, Kaaks R, Teucher B, Boeing H, Buijsse B, Tjonneland A, Halkjaer J, Overvad K, Jakobsen MU, Rodriguez L, Agudo A, Sanchez MJ, Amiano P, Huerta JM, Gurrea AB, Wareham N, Khaw KT, Crowe F, Orfanos P, Naska A, Trichopoulou A, Masala G, Pala V, Tumino R, Sacerdote C, Mattiello A, Bueno-de-Mesquita HB, van Duijnhoven FJ, Drake I, Wirfalt E, Johansson I, Hallmans G, Engeset D, Braaten T, Parr CL, Odysseos A, Riboli E, Peeters PH (2012) Fruit and vegetable consumption and prospective weight change in participants of the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home, and Obesity study. Am J Clin Nutr 95(1):184–193. doi: 10.3945/ajcn.111.019968 PubMedCrossRefGoogle Scholar
- 26.McCullough ML, Patel AV, Kushi LH, Patel R, Willett WC, Doyle C, Thun MJ, Gapstur SM (2011) Following cancer prevention guidelines reduces risk of cancer, cardiovascular disease, and all-cause mortality. Cancer Epidemiol Biomarkers Prev 20(6):1089–1097. doi: 10.1158/1055-9965.EPI-10-1173 PubMedCrossRefGoogle Scholar
- 28.Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D, Million Women Study C (2007) Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 335(7630):1134. doi: 10.1136/bmj.39367.495995.AE
- 30.U.S. Cancer Statistics Working Group (2012) United States Cancer Statistics: 1998–2008 Incidence and Mortality Web-based Report. U.S. Department of Health and Human Services, Centers for disease Control and Prevention and National Cancer InstituteGoogle Scholar