Cancer Causes & Control

, Volume 26, Issue 2, pp 277–286 | Cite as

Concordance with World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines for cancer prevention and obesity-related cancer risk in the Framingham Offspring cohort (1991–2008)

  • Nour Makarem
  • Yong Lin
  • Elisa V. Bandera
  • Paul F. Jacques
  • Niyati ParekhEmail author
Original Paper



This prospective cohort study evaluates associations between healthful behaviors consistent with WCRF/AICR cancer prevention guidelines and obesity-related cancer risk, as a third of cancers are estimated to be preventable.


The study sample consisted of adults from the Framingham Offspring cohort (n = 2,983). From 1991 to 2008, 480 incident doctor-diagnosed obesity-related cancers were identified. Data on diet, measured by a food frequency questionnaire, anthropometric measures, and self-reported physical activity, collected in 1991 was used to construct a 7-component score based on recommendations for body fatness, physical activity, foods that promote weight gain, plant foods, animal foods, alcohol, and food preservation, processing, and preparation. Multivariable Cox regression models were used to estimate associations between the computed score, its components, and subcomponents in relation to obesity-related cancer risk.


The overall score was not associated with obesity-related cancer risk after adjusting for age, sex, smoking, energy, and preexisting conditions (HR 0.94, 95 % CI 0.86–1.02). When score components were evaluated separately, for every unit increment in the alcohol score, there was 29 % lower risk of obesity-related cancers (HR 0.71, 95 % CI 0.51–0.99) and 49–71 % reduced risk of breast, prostate, and colorectal cancers. Every unit increment in the subcomponent score for non-starchy plant foods (fruits, vegetables, and legumes) among participants who consume starchy vegetables was associated with 66 % reduced risk of colorectal cancer (HR 0.44, 95 % CI 0.22–0.88).


Lower alcohol consumption and a plant-based diet consistent with the cancer prevention guidelines were associated with reduced risk of obesity-related cancers in this population.


Healthful behaviors American Institute for Cancer Research Cancer prevention guidelines Cancer Framingham Heart Study 



This research was supported by the American Cancer Society Research Scholar Grant (#RSG-12-005-01-CNE) awarded to Niyati Parekh, PhD RD. The Framingham Heart Study is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with Boston University (Contract No. N01-HC-25195). Funding support for the Framingham Food Frequency Questionnaire datasets was provided by ARS Contract #53-3k06-5-10, ARS Agreement #’s 58-1950-9-001, 58-1950-4-401, and 58-1950-7-707. This manuscript was not prepared in collaboration with investigators of the Framingham Heart Study and does not necessarily reflect the opinions or views of the Framingham Heart Study, Boston University, or NHLBI.

Conflict of interest

The American Cancer Society did not have a role in study design, collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication. The authors have no conflicts of interest to report.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Nour Makarem
    • 1
  • Yong Lin
    • 2
    • 3
  • Elisa V. Bandera
    • 2
    • 3
  • Paul F. Jacques
    • 4
  • Niyati Parekh
    • 1
    • 5
    Email author
  1. 1.Department of Nutrition, Food Studies and Public Health Steinhardt SchoolNew York UniversityNew YorkUSA
  2. 2.Rutgers School of Public HealthRutgers The State University of New JerseyPiscatawayUSA
  3. 3.Rutgers Cancer Institute of New JerseyNew BrunswickUSA
  4. 4.Jean Mayer USDA Human Nutrition Research Center on Aging, Friedman School of Nutrition Science and PolicyTufts UniversityBostonUSA
  5. 5.Department of Population HealthNYU Langone School of MedicineNew YorkUSA

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