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.
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 Rüsten A., Tjønneland A., Olsen A., Dahm CC., Overvad K., Quirós JR., Gonzalez CA., Sánchez 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., Büchner FL., Wirfält E., Manjer J., Johansson I., Hallmans G., Skeie G., Benjaminsen Borch K., Parr CL., Riboli E., Norat T.
BACKGROUND: In 2007 the World Cancer Research Fund (WCRF) and the American Institute of Cancer Research (AICR) issued 8 recommendations (plus 2 special recommendations) on diet, physical activity, and weight management for cancer prevention on the basis of the most comprehensive collection of available evidence. OBJECTIVE: We aimed to investigate whether concordance with the WCRF/AICR recommendations was related to cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. DESIGN: The present study included 386,355 EPIC participants from 9 European countries. At recruitment, dietary, anthropometric, and lifestyle information was collected. A score was constructed based on the WCRF/AICR recommendations on weight management, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, alcoholic drinks, and breastfeeding for women; the score range was 0-6 for men and 0-7 for women. Higher scores indicated greater concordance with WCRF/AICR recommendations. The association between the score and cancer risk was estimated by using multivariable Cox regression models. RESULTS: Concordance with the score was significantly associated with decreased risk of cancer. A 1-point increment in the score was associated with a risk reduction of 5% (95% CI: 3%, 7%) for total cancer, 12% (95% CI: 9%, 16%) for colorectal cancer, and 16% (95% CI: 9%, 22%) for stomach cancer. Significant associations were also observed for cancers of the breast, endometrium, lung, kidney, upper aerodigestive tract, liver, and esophagus but not for prostate, ovarian, pancreatic, and bladder cancers. CONCLUSION: Adherence to the WCRF/AICR recommendations for cancer prevention may lower the risk of developing most types of cancer.