Dataset Information

The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score and All-Cause, Cancer, and Cardiovascular Disease Mortality Risk: A Longitudinal Analysis in the NIH-AARP Diet and Health Study.

ABSTRACT:

Background

The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) published Cancer Prevention Recommendations in 2018 focused on modifiable lifestyle factors.

Objectives

The aim was to examine how adherence to WCRF/AICR recommendations via the 2018 WCRF/AICR score is associated with risk for all-cause, cancer, and cardiovascular disease (CVD) mortality outcomes among older US adults.

Methods

Baseline and follow-up questionnaire data (n = 177,410) were used to calculate weight, physical activity, and diet components of the 2018 WCRF/AICR score (0-7 total points). Adjusted HRs and 95% CIs were estimated, stratified by sex and smoking status.

Results

There were 16,055 deaths during a mean of 14.2 person-years. Each 1-point score increase was associated with a 9-26% reduced mortality risk for all outcomes, except for current male smokers' cancer mortality risk. When the score was categorized comparing highest (5-7 points) with lowest (0-2 points) scores, associations with reduced all-cause mortality risk were strongest in former smokers (HR_males: 0.51; 95% CI: 0.43, 0.61; HR_females: 0.38; 95% CI: 0.31, 0.46), followed by current smokers (HR_males: 0.55; 95% CI: 0.34, 0.89; HR_females: 0.44; 95% CI: 0.32, 0.59) and never smokers (HR_males: 0.57; 95% CI: 0.47, 0.70; HR_females: 0.50; 95% CI: 0.41, 0.60). An association with cancer mortality risk was also seen in former smokers (HR_males: 0.59; 95% CI: 0.43, 0.81; HR_females: 0.52; 95% CI: 0.37, 0.73) and female current (HR_females: 0.55; 95% CI: 0.32, 0.96) and never (HR_females: 0.57; 95% CI: 0.40, 0.80) smokers; findings were not statistically significant in other strata. For CVD mortality, highest compared with lowest scores were associated with a 49-73% risk reduction, except in male never and current smokers. In exploratory analysis, physical activity, body weight, alcohol, and plant-based foods were found to be predominant components in the score.

Conclusions

Greater 2018 WCRF/AICR scores were associated with lower mortality risk among older adults. Future research can explore how smoking modifies these relations, and further examine different populations and other cancer-relevant outcomes.

SUBMITTER: Shams-White MM

PROVIDER: S-EPMC9217081 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score and All-Cause, Cancer, and Cardiovascular Disease Mortality Risk: A Longitudinal Analysis in the NIH-AARP Diet and Health Study.

Shams-White Marissa M MM Brockton Nigel T NT Mitrou Panagiota P Kahle Lisa L LL Reedy Jill J

Current developments in nutrition 20220602 6

<h4>Background</h4>The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) published Cancer Prevention Recommendations in 2018 focused on modifiable lifestyle factors.<h4>Objectives</h4>The aim was to examine how adherence to WCRF/AICR recommendations via the 2018 WCRF/AICR score is associated with risk for all-cause, cancer, and cardiovascular disease (CVD) mortality outcomes among older US adults.<h4>Methods</h4>Baseline and follow-up questionnaire data (<i>n</i> = 17 ...[more]

PMID: 35755938

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Project description:BackgroundThe 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 3rd expert report highlights up-to-date Cancer Prevention Recommendations that may reduce burdens of many chronic diseases, including diabetes. This study examined if following a lifestyle that aligns with the recommendations - assessed via the 2018 WCRF/AICR Score - was associated with lower risk of type 2 diabetes in high-risk adults participating in the Diabetes Prevention Program Outcomes Study (DPPOS).MethodsThe Diabetes Prevention Program (DPP) randomized adults at high risk for diabetes to receive a lifestyle intervention (ILS), metformin (MET) or a placebo (PLB) (mean: 3.2 years), with additional follow-up in DPPOS for 11 years (mean: 15 years total). 2018 WCRF/AICR Scores included seven components: body weight, physical activity, plant-based foods, fast foods, red and processed meat, sugar-sweetened beverages, and alcohol; the optional breastfeeding component was excluded. Scores ranged 0-7 points (with greater scores indicating greater alignment with the recommendations) and were estimated at years 0, 1, 5, 6, 9, and 15 (N=3,147). Fasting glucose and HbA1c were measured every six months and oral glucose tolerance tests were performed annually. Adjusted Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were used to examine the association of both Score changes from years 0-1 and time-dependent Score changes on diabetes risk through DPP and year 15.ResultsScores improved within all groups over 15 years (p<0.001); ILS Scores improved more than MET or PLB Scores after 1 year (p<0.001). For every 1-unit improvement from years 0-1, there was a 31% and 15% lower diabetes risk in ILS (95% CI: 0.56-0.84) and PLB (95% CI: 0.72-0.97) through DPP, and no significant association in MET. Associations were greatest among American Indian participants, followed by non-Hispanic White and Hispanic participants. Score changes from years 0-1 and time-dependent Score changes in ILS and PLB remained associated with lower risk through year 15.ConclusionsScore improvements were associated with long-term, lower diabetes risk among high-risk adults randomized to ILS and PLB, but not MET. Future research should explore impact of the Score on cancer risk.Trial registrationDiabetes Prevention Program: NCT00004992 ; Diabetes Prevention Program Outcomes Study: NCT00038727.

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Dataset Information

The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score and All-Cause, Cancer, and Cardiovascular Disease Mortality Risk: A Longitudinal Analysis in the NIH-AARP Diet and Health Study.

Background

Objectives

Methods

Results

Conclusions

Publications

The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score and All-Cause, Cancer, and Cardiovascular Disease Mortality Risk: A Longitudinal Analysis in the NIH-AARP Diet and Health Study.

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