1
|
Armenta-Guirado BI, González-Rocha A, Mérida-Ortega Á, López-Carrillo L, Denova-Gutiérrez E. Lifestyle Quality Indices and Female Breast Cancer Risk: A Systematic Review and Meta-Analysis. Adv Nutr 2023; 14:685-709. [PMID: 37085092 PMCID: PMC10334144 DOI: 10.1016/j.advnut.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 04/23/2023] Open
Abstract
Breast cancer (BC) poses an important burden of disease, which probably could be reduced by adopting healthy lifestyles like healthy body weight, healthy diet, and physical activity, among others. Many studies have reported that adherence to healthy lifestyles may decrease BC risk. The main objective of this study was to estimate a summary association of studies evaluating a healthy lifestyle index and BC risk. A systematic review and meta-analysis following the Cochrane methodology were carried out. Observational studies, including healthy lifestyle indices and their association with BC, were searched from 4 databases. For the meta-analysis, random-effects model was used to evaluate overall BC risk, BC by molecular subtype and menopausal status. Thirty-one studies were included in the systematic review, and 29 studies in the meta-analysis. When the highest vs. the lowest category to a healthy lifestyle index were compared, the study identified a 20% risk reduction for BC in prospective studies (hazard ratio [HR] 0.80 95% CI: 0.78, 0.83) and an odds ratio (OR) of 0.74 (95% CI: 0.63, 0.86) for retrospective studies. The inverse association remained statistically significant when stratified by menopausal status, except for premenopausal BC in prospective studies. Furthermore, an inverse association was found for molecular subtypes estrogen receptor (ER+)/progesterone receptor (PR+): HR = 0.68 (95%CI: 0.63, 0.73), ER+/PR-: HR = 0.78 (95% CI: 0.67, 0.90) and ER-/PR-: HR = 0.77 (95% CI: 0.64, 0.92). Most studies scored at a low risk of bias and a moderate score for the certainty of the evidence. Adherence to a healthy lifestyle reduces the risk of BC, regardless of its molecular subtypes, which should be considered a priority to generate recommendations for BC prevention at a population level. International prospective register of systematic reviews (PROSPERO) ID: CRD42021267759.
Collapse
Affiliation(s)
- Brianda I Armenta-Guirado
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico; Department of Health Sciences, University of Sonora, México
| | - Alejandra González-Rocha
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Ángel Mérida-Ortega
- Center of Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Lizbeth López-Carrillo
- Center of Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Edgar Denova-Gutiérrez
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico.
| |
Collapse
|
2
|
Shams-White MM, Romaguera D, Mitrou P, Reedy J, Bender A, Brockton NT. Further Guidance in Implementing the Standardized 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score. Cancer Epidemiol Biomarkers Prev 2020; 29:889-894. [DOI: 10.1158/1055-9965.epi-19-1444] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022] Open
|
3
|
Turati F, Dalmartello M, Bravi F, Serraino D, Augustin L, Giacosa A, Negri E, Levi F, La Vecchia C. Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations and the Risk of Breast Cancer. Nutrients 2020; 12:nu12030607. [PMID: 32110887 PMCID: PMC7146587 DOI: 10.3390/nu12030607] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) introduced in 2007, and updated in 2018, nutrition-related recommendations for cancer prevention. Previous studies generally reported inverse associations of breast cancer with the 2007 recommendations, while no study has yet evaluated the association with the 2018 guidelines. We investigated the association between adherence to the 2018 WCRF/AICR recommendations and breast cancer risk in a case–control study from Italy and Switzerland (1991–2008) including 3034 incident histologically-confirmed breast cancer cases and 3392 hospital controls. Adherence to the 2018 guidelines was summarized through a score incorporating eight recommendations (body fatness, physical activity, consumption of wholegrains/vegetables/fruit/beans, “fast foods” and other processed foods high in fat, starches, or sugars, red/processed meat, sugar-sweetened drinks, alcohol, breastfeeding), with higher scores indicating higher adherence. Odds ratios (OR) were estimated using multiple logistic regression models. We also conducted a meta-analysis including 15 additional studies using random-effects models. In our case–control study, adherence to the 2018 WCRF/AICR guidelines was inversely associated with breast cancer, with ORs of 0.60 (95% confidence interval (CI), 0.51–0.70) for a score ≥5.5 vs. ≤4.25, and of 0.83 (95% CI, 0.79–0.88) for a 1-point increment. In our study, 25% of breast cancers were attributable to low-to-moderate guideline adherence. In the meta-analysis, the pooled relative risks (RRs) were 0.73 (95% CI, 0.65–0.82, p heterogeneity among studies < 0.001) for the highest vs. the lowest WCRF/AICR score category, and 0.91 (95% CI, 0.88–0.94, p heterogeneity < 0.001) for a 1-point increment. This work provides quantitative evidence that higher adherence to the WCRF/AICR recommendations reduces the risk of breast cancer, thus opening perspectives for prevention.
Collapse
Affiliation(s)
- Federica Turati
- Unit of Medical Statistics and Biometry, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, via Venezian 1, 20133 Milan, Italy; or
| | - Michela Dalmartello
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, via A. Vanzetti 5, 20133 Milan, Italy; (M.D.); (F.B.)
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, via A. Vanzetti 5, 20133 Milan, Italy; (M.D.); (F.B.)
| | - Diego Serraino
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, IRCCS, via F. Gallini 2, 33080 Aviano, Italy;
| | - Livia Augustin
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, via M. Semmola 1, 80131 Naples, Italy;
| | - Attilio Giacosa
- Department of Gastroenterology and Clinical Nutrition, Policlinico di Monza, via Amati 111, 20900 Monza, Italy;
| | - Eva Negri
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, via G.B. Grassi 74, 20157 Milan, Italy;
| | - Fabio Levi
- Institute of Social and Preventive Medicine (IUMSP), Unisanté, University of Lausanne, Route de la Corniche 10, 1010 Lausanne, Switzerland;
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, via A. Vanzetti 5, 20133 Milan, Italy; (M.D.); (F.B.)
- Correspondence: ; Tel.: +39-02-5032-0863; Fax: +39-02-5032-0866
| |
Collapse
|
4
|
Solans M, Chan DSM, Mitrou P, Norat T, Romaguera D. A systematic review and meta-analysis of the 2007 WCRF/AICR score in relation to cancer-related health outcomes. Ann Oncol 2020; 31:352-368. [PMID: 32067678 DOI: 10.1016/j.annonc.2020.01.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We conducted a systematic literature review and meta-analysis of observational studies investigating adherence to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations for cancer prevention and health outcomes. PATIENTS AND METHODS We searched PubMed and the in-house database of the WCRF Continuous Update Project for publications up to June 2019. Cross-sectional studies were only narratively reviewed given their heterogeneity while findings of cohort/case-control studies were synthesized in umbrella reviews and meta-analyses. Summary relative risks (RRs) and 95% confidence intervals (CI) were estimated using a random-effects model when at least two studies reported results on a specific outcome. RESULTS Thirty-eight articles (17 prospective, 8 case-control, and 13 cross-sectional studies) were included. The summary RR per each point increment in the 2007 WCRF/AICR score was 0.90 (95% CI: 0.87-0.93, n = 11) for breast cancer, regardless of hormone receptor and menopausal status, 0.86 (95% CI: 0.82-0.89, n = 10) for colorectal cancer, and 0.93 (95% CI: 0.89-0.96, n = 2) for lung cancer risk. No statistically significant associations were reported for prostate (n = 6) and pancreatic cancers (n = 2). Adherence to the recommendations was associated with lower overall mortality (RR = 0.90, 95% CI 0.84-0.96, n = 3) and cancer-specific mortality (RR = 0.91, 95% CI 0.89-0.92; n = 3) in healthy populations, as well as with higher survival in cancer patients (n = 2). In cross-sectional studies, a healthier plasma marker profile and lower cancer risk factors in the general population and a better health status and quality of life in cancer patients/survivors were reported. CONCLUSIONS Adhering to the 2007 WCRF/AICR recommendations is associated with lower risks of cancer incidence, namely breast and colorectal cancers, and mortality. Primary prevention of cancer should emphasize modification of multiple lifestyle factors. Upcoming studies examining the recently updated 2018 guidelines will further clarify such associations.
Collapse
Affiliation(s)
- M Solans
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
| | - D S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - P Mitrou
- World Cancer Research Fund International, London, UK
| | - T Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - D Romaguera
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain; Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain.
| |
Collapse
|
5
|
Karavasiloglou N, Hüsing A, Masala G, van Gils CH, Turzanski Fortner R, Chang-Claude J, Huybrechts I, Weiderpass E, Gunter M, Arveux P, Fournier A, Kvaskoff M, Tjønneland A, Kyrø C, Dahm CC, Vistisen HT, Bakker MF, Sánchez MJ, Chirlaque López MD, Santiuste C, Ardanaz E, Menéndez V, Agudo A, Trichopoulou A, Karakatsani A, La Vecchia C, Peppa E, Palli D, Agnoli C, Panico S, Tumino R, Sacerdote C, Butt ST, Borgquist S, Skeie G, Schulze M, Key T, Khaw KT, Tsilidis KK, Ellingjord-Dale M, Riboli E, Kaaks R, Dossus L, Rohrmann S, Kühn T. Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and risk of in situ breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. BMC Med 2019; 17:221. [PMID: 31787099 PMCID: PMC6886197 DOI: 10.1186/s12916-019-1444-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/08/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Even though in situ breast cancer (BCIS) accounts for a large proportion of the breast cancers diagnosed, few studies have investigated potential risk factors for BCIS. Their results suggest that some established risk factors for invasive breast cancer have a similar impact on BCIS risk, but large population-based studies on lifestyle factors and BCIS risk are lacking. Thus, we investigated the association between lifestyle and BCIS risk within the European Prospective Investigation into Cancer and Nutrition cohort. METHODS Lifestyle was operationalized by a score reflecting the adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations. The recommendations utilized in these analyses were the ones pertinent to healthy body weight, physical activity, consumption of plant-based foods, energy-dense foods, red and processed meat, and sugary drinks and alcohol, as well as the recommendation on breastfeeding. Cox proportional hazards regression was used to assess the association between lifestyle score and BCIS risk. The results were presented as hazard ratios (HR) and corresponding 95% confidence intervals (CI). RESULTS After an overall median follow-up time of 14.9 years, 1277 BCIS cases were diagnosed. Greater adherence to the WCRF/AICR cancer prevention recommendations was not associated with BCIS risk (HR = 0.98, 95% CI 0.93-1.03; per one unit of increase; multivariable model). An inverse association between the lifestyle score and BCIS risk was observed in study centers, where participants were recruited mainly via mammographic screening and attended additional screening throughout follow-up (HR = 0.85, 95% CI 0.73-0.99), but not in the remaining ones (HR = 0.99, 95% CI 0.94-1.05). CONCLUSIONS While we did not observe an overall association between lifestyle and BCIS risk, our results indicate that lifestyle is associated with BCIS risk among women recruited via screening programs and with regular screening participation. This suggests that a true inverse association between lifestyle habits and BCIS risk in the overall cohort may have been masked by a lack of information on screening attendance. The potential inverse association between lifestyle and BCIS risk in our analyses is consistent with the inverse associations between lifestyle scores and breast cancer risk reported from previous studies.
Collapse
Affiliation(s)
- Nena Karavasiloglou
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland.
- Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland.
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Elisabete Weiderpass
- International Agency for Research on Cancer, Lyon, France
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Marc Gunter
- International Agency for Research on Cancer, Lyon, France
| | - Patrick Arveux
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre, UNICANCER, Dijon, France
| | - Agnès Fournier
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Marina Kvaskoff
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Gustave Roussy, F-94805, Villejuif, France
| | - Anne Tjønneland
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Cecilie Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maria-Jose Sánchez
- Andalusian School of Public Health (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Universidad de Granada, Granada, Spain
| | - María Dolores Chirlaque López
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Murcia University, Murcia, Spain
| | - Carmen Santiuste
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Eva Ardanaz
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | | | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, "ATTIKON" University Hospital, National and Kapodistrian University of Athens, Haidari, Greece
| | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Azienda Sanitaria Provinciale (ASP), Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Salma Tunå Butt
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Signe Borgquist
- Department of Oncology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
- Division of Oncology and Pathology, Clinical Sciences, Lund University, Lund, Sweden
| | - Guri Skeie
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Matthias Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE), Nuthetal, Germany
| | - Timothy Key
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Kostantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Merete Ellingjord-Dale
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| |
Collapse
|
6
|
Shams-White MM, Brockton NT, Mitrou P, Romaguera D, Brown S, Bender A, Kahle LL, Reedy J. Operationalizing the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations: A Standardized Scoring System. Nutrients 2019; 11:nu11071572. [PMID: 31336836 PMCID: PMC6682977 DOI: 10.3390/nu11071572] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 02/01/2023] Open
Abstract
Background: Following the publication of the 2018 World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) Third Expert Report, a collaborative group was formed to develop a standardized scoring system and provide guidance for research applications. Methods: The 2018 WCRF/AICR Cancer Prevention Recommendations, goals, and statements of advice were examined to define components of the new Score. Cut-points for scoring were based on quantitative guidance in the 2018 Recommendations and other guidelines, past research that operationalized 2007 WCRF/AICR Recommendations, and advice from the Continuous Update Project Expert Panel. Results: Eight of the ten 2018 WCRF/AICR Recommendations concerning weight, physical activity, diet, and breastfeeding (optional), were selected for inclusion. Each component is worth one point: 1, 0.5, and 0 points for fully, partially, and not meeting each recommendation, respectively (Score: 0 to 7–8 points). Two recommendations on dietary supplement use and for cancer survivors are not included due to operational redundancy. Additional guidance stresses the importance of accounting for other risk factors (e.g., smoking) in relevant models. Conclusions: The proposed 2018 WCRF/AICR Score is a practical tool for researchers to examine how adherence to the 2018 WCRF/AICR Recommendations relates to cancer risk and mortality in various adult populations.
Collapse
Affiliation(s)
- Marissa M Shams-White
- Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA.
| | - Nigel T Brockton
- American Institute for Cancer Research, Arlington, VA 22209, USA
| | - Panagiota Mitrou
- World Cancer Research Fund International, 22 Bedford Square, London, WC1B 3HH, UK
| | - Dora Romaguera
- Balearic Islands Health Research Institute (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
- Barcelona Institute for Global Health (ISGlobal), 08003 Barcelona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), 28029 Madrid, Spain
| | - Susannah Brown
- World Cancer Research Fund International, 22 Bedford Square, London, WC1B 3HH, UK
| | - Alice Bender
- American Institute for Cancer Research, Arlington, VA 22209, USA
| | - Lisa L Kahle
- Information Management Services, Inc., Rockville, MD 20850, USA
| | - Jill Reedy
- Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| |
Collapse
|
7
|
Di Sebastiano KM, Murthy G, Campbell KL, Desroches S, Murphy RA. Nutrition and Cancer Prevention: Why is the Evidence Lost in Translation? Adv Nutr 2019; 10:410-418. [PMID: 30915435 PMCID: PMC6520044 DOI: 10.1093/advances/nmy089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/27/2018] [Accepted: 10/08/2018] [Indexed: 01/20/2023] Open
Abstract
With the high burden of cancer worldwide, primary prevention has been identified as a key cancer control strategy to reduce this burden. Diet and nutrition are important modifiable factors that may alter the risk of developing cancer, because several dietary components including alcohol consumption, fruit and vegetable intake, and dietary fiber have been shown to significantly impact cancer risk. Consequently, a number of organizations have developed cancer prevention guidelines that highlight the importance of nutrition (and related factors including body size and physical activity) to reduce the risk of cancer. However, there are barriers to the uptake of these guidelines, particularly with respect to diet and nutrition including awareness, communication, and other factors that influence eating behavior. Improved knowledge translation (KT) of recommendations may help facilitate uptake. The purposes of this narrative review are: 1) to examine issues and challenges related to KT of diet and nutrition evidence in the context of cancer prevention, including public awareness and attitudes towards cancer prevention, engagement in cancer prevention strategies, and effects of KT on diet-cancer preventive behaviors; 2) to discuss examples of effective and ineffective KT of diet and nutrition evidence; and 3) to provide recommendations for improving KT to help move the field of diet, nutrition, and cancer prevention forward. Evidence shows that adherence to nutrition recommendations for cancer prevention significantly reduces the risk of cancer; however, engagement in nutrition-based preventative behaviors is low. Skepticism and confusion around evidence linking diet and nutrition with cancer may arise, in part, through ineffective media KT; the primary source of health information for many people. Simple, tailored, targeted KT communication strategies aimed at increasing the general public's awareness, attitudes, and engagement in cancer preventive behavior should be emphasized to encourage cancer control.
Collapse
Affiliation(s)
| | | | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | |
Collapse
|
8
|
Khalis M, Chajès V, Moskal A, Biessy C, Huybrechts I, Rinaldi S, Dossus L, Charaka H, Mellas N, Nejjari C, Dorn J, Soliman AS, Romieu I, El Rhazi K, Charbotel B. Healthy lifestyle and breast cancer risk: A case-control study in Morocco. Cancer Epidemiol 2019; 58:160-166. [PMID: 30597481 DOI: 10.1016/j.canep.2018.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/29/2018] [Accepted: 12/21/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Some modifiable risk factors have been independently associated with breast cancer (BC) risk in Moroccan women, but no studies have investigated their joint association. This study aimed to investigate the association between a Healthy Lifestyle Index (HLI) score and BC risk among Moroccan women. METHODS In this case-control study, 300 incident BC cases and 300 controls, matched by age and area of residence were recruited. Cases were women newly-diagnosed with histopathologically-confirmed BC at the University Hospital in Fez, Morocco. Controls were randomly selected healthy women recruited from 6 primary health centers in Fez. HLI scores developed within this study were assigned to participants based on 11 factors (red and processed meat, white meat, cream, cheese, fish, fruit and vegetables, physical activity, BMI, smoking, alcohol consumption, and breastfeeding), where 0 was given to unhealthy and 0.5 or 1 to healthy levels of each factor. Conditional and unconditional logistic regression models were used to assess the association between HLI scores and BC risk. RESULTS Mean of HLI scores were 8.1 (±1.1) and 9.0 (±0.9) in cases and controls, respectively, p < 0.01. After adjusting for potential confounders, one-point increment in the HLI score was associated with 56% (95% CI, CI: 39-68%), 49% (95% CI: 30-63%), and 59% (95% CI: 40-72%) lower risks of BC in all, premenopausal, and postmenopausal women, respectively. CONCLUSION High HLI scores were associated with decreased risk of BC in Moroccan women. These findings suggest that BC prevention policies should include strategies for engaging Moroccan women in healthy lifestyles.
Collapse
Affiliation(s)
- Mohamed Khalis
- Department of Epidemiology, Faculty of Medicine and Pharmacy, Fez, Morocco; University of Lyon, UCBL, Ifsttar, UMRESTTE, Lyon, France; Department of Community Health and Social Medicine, City University of New York, School of Medicine, NY, USA.
| | - Véronique Chajès
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Aurelie Moskal
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Carine Biessy
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Inge Huybrechts
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Laure Dossus
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Hafida Charaka
- Department of Research and Development, Hassan II University Hospital of Fez, Morocco
| | - Nawfel Mellas
- Department of Oncology, Hassan II University Hospital of Fez, Morocco
| | - Chakib Nejjari
- Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Joan Dorn
- Department of Community Health and Social Medicine, City University of New York, School of Medicine, NY, USA
| | - Amr S Soliman
- Department of Community Health and Social Medicine, City University of New York, School of Medicine, NY, USA
| | - Isabelle Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Karima El Rhazi
- Department of Epidemiology, Faculty of Medicine and Pharmacy, Fez, Morocco
| | | |
Collapse
|
9
|
Turati F, Bravi F, Di Maso M, Bosetti C, Polesel J, Serraino D, Dalmartello M, Giacosa A, Montella M, Tavani A, Negri E, La Vecchia C. Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations and colorectal cancer risk. Eur J Cancer 2017; 85:86-94. [DOI: 10.1016/j.ejca.2017.08.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/26/2017] [Accepted: 08/07/2017] [Indexed: 02/07/2023]
|
10
|
Voortman T, Kiefte-de Jong JC, Ikram MA, Stricker BH, van Rooij FJA, Lahousse L, Tiemeier H, Brusselle GG, Franco OH, Schoufour JD. Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study. Eur J Epidemiol 2017; 32:993-1005. [PMID: 28825166 PMCID: PMC5684301 DOI: 10.1007/s10654-017-0295-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/12/2017] [Indexed: 02/07/2023]
Abstract
We aimed to evaluate the criterion validity of the 2015 food-based Dutch dietary guidelines, which were formulated based on evidence on the relation between diet and major chronic diseases. We studied 9701 participants of the Rotterdam Study, a population-based prospective cohort in individuals aged 45 years and over [median 64.1 years (95%-range 49.0-82.8)]. Dietary intake was assessed at baseline with a food-frequency questionnaire. For all participants, we examined adherence (yes/no) to fourteen items of the guidelines: vegetables (≥200 g/day), fruit (≥200 g/day), whole-grains (≥90 g/day), legumes (≥135 g/week), nuts (≥15 g/day), dairy (≥350 g/day), fish (≥100 g/week), tea (≥450 mL/day), ratio whole-grains:total grains (≥50%), ratio unsaturated fats and oils:total fats (≥50%), red and processed meat (<300 g/week), sugar-containing beverages (≤150 mL/day), alcohol (≤10 g/day) and salt (≤6 g/day). Total adherence was calculated as sum-score of the adherence to the individual items (0-14). Information on disease incidence and all-cause mortality during a median follow-up period of 13.5 years (range 0-27.0) was obtained from data collected at our research center and from medical records. Using Cox proportional-hazards models adjusted for confounders, we observed every additional component adhered to was associated with a 3% lower mortality risk (HR 0.97, 95% CI 0.95; 0.98), lower risk of stroke (HR 0.95, 95% CI 0.92; 0.99), chronic obstructive pulmonary disease (HR 0.94, 95% CI 0.91; 0.98), colorectal cancer (HR 0.90, 95% CI 0.84; 0.96), and depression (HR 0.97, 95% CI 0.95; 0.999), but not with incidence of coronary heart disease, type 2 diabetes, heart failure, lung cancer, breast cancer, or dementia. These associations were not driven by any of the individual dietary components. To conclude, adherence to the Dutch dietary guidelines was associated with a lower mortality risk and a lower risk of developing some but not all of the chronic diseases on which the guidelines were based.
Collapse
Affiliation(s)
- Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Leiden University College, The Hague, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Frank J A van Rooij
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Guy G Brusselle
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Josje D Schoufour
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
11
|
Romaguera D, Gracia-Lavedan E, Molinuevo A, de Batlle J, Mendez M, Moreno V, Vidal C, Castelló A, Pérez-Gómez B, Martín V, Molina AJ, Dávila-Batista V, Dierssen-Sotos T, Gómez-Acebo I, Llorca J, Guevara M, Castilla J, Urtiaga C, Llorens-Ivorra C, Fernández-Tardón G, Tardón A, Lorca JA, Marcos-Gragera R, Huerta JM, Olmedo-Requena R, Jimenez-Moleon JJ, Altzibar J, de Sanjosé S, Pollán M, Aragonés N, Castaño-Vinyals G, Kogevinas M, Amiano P. Adherence to nutrition-based cancer prevention guidelines and breast, prostate and colorectal cancer risk in the MCC-Spain case-control study. Int J Cancer 2017; 141:83-93. [PMID: 28380695 DOI: 10.1002/ijc.30722] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/16/2017] [Indexed: 01/02/2023]
Abstract
Prostate, breast and colorectal cancer are the most common tumours in Spain. The aim of the present study was to evaluate the association between adherence to nutrition-based guidelines for cancer prevention and prostate, breast and colorectal cancer, in the MCC-Spain case-control study. A total of 1,718 colorectal, 1,343 breast and 864 prostate cancer cases and 3,431 population-based controls recruited between 2007 and 2012, were included in the present study. The World Cancer Research Fund/American Institute for Cancer Research (WCRC/AICR) score based on six recommendations for cancer prevention (on body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods and alcoholic drinks; score range 0-6) was constructed. We used unconditional logistic regression analysis adjusting for potential confounders. One-point increment in the WCRF/AICR score was associated with 25% (95% CI 19-30%) lower risk of colorectal, and 15% (95% CI 7-22%) lower risk of breast cancer; no association with prostate cancer was detected, except for cases with a Gleason score ≥7 (poorly differentiated/undifferentiated tumours) (OR 0.87, 95% CI 0.76-0.99). These results add to the wealth of evidence indicating that a great proportion of common cancer cases could be avoided by adopting healthy lifestyle habits.
Collapse
Affiliation(s)
- Dora Romaguera
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Balearic Islands Health Research Institute (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain.,CIBER Fisiopathology of Obesity and Nutrition (CIBER-OBN), Health Research Institute Carlos III, Madrid, Spain
| | - Esther Gracia-Lavedan
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain
| | - Amaia Molinuevo
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain
| | - Jordi de Batlle
- IRBLleida, Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Michelle Mendez
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.,Carolina Population Center and Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Victor Moreno
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,IDIBELL-Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Campus de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Carmen Vidal
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,IDIBELL-Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Campus de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Adela Castelló
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Majadahonda, Madrid, Spain
| | - Beatriz Pérez-Gómez
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Majadahonda, Madrid, Spain
| | - Vicente Martín
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Research Group on Gene-Environment Interactions and Health, University of León, León, Spain
| | - Antonio J Molina
- Research Group on Gene-Environment Interactions and Health, University of León, León, Spain
| | | | - Trinidad Dierssen-Sotos
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,University of Cantabria-IDIVAL, Santander, Spain
| | - Inés Gómez-Acebo
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,University of Cantabria-IDIVAL, Santander, Spain
| | - Javier Llorca
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,University of Cantabria-IDIVAL, Santander, Spain
| | - Marcela Guevara
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
| | - Jesús Castilla
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
| | - Carmen Urtiaga
- Health Department, Public Health Division of Gipuzkoa, Basque Region, Spain
| | - Cristóbal Llorens-Ivorra
- Centro de Salud Pública de Dénia. Consellería de Sanidad Universal y Salud Pública, Generalitat Valenciana, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | - Guillermo Fernández-Tardón
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,IUOPA University of Oviedo, Oviedo, Spain
| | - Adonina Tardón
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,IUOPA University of Oviedo, Oviedo, Spain
| | - José Andrés Lorca
- Centro de Investigación en Salud y Medio Ambiente (CYSMA), Universidad de Huelva, Huelva, Spain
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - José María Huerta
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Rocío Olmedo-Requena
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Complejo Hospitales Universitarios de Granada/Universidad de Granada, Spain
| | - José Juan Jimenez-Moleon
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Complejo Hospitales Universitarios de Granada/Universidad de Granada, Spain
| | - Jone Altzibar
- Breast Cancer Detection Programme, Osakidetza-Health Basque Service, San Sebastian, Gipuzkoa, Spain
| | - Silvia de Sanjosé
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology, Barcelona, Spain
| | - Marina Pollán
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Majadahonda, Madrid, Spain
| | - Núria Aragonés
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.,Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro (IDIPHIM), Majadahonda, Madrid, Spain
| | - Gemma Castaño-Vinyals
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain.,University Pompeu Fabra (UPF), Barcelona, Spain
| | - Manolis Kogevinas
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain.,University Pompeu Fabra (UPF), Barcelona, Spain
| | - Pilar Amiano
- CIBER Epidemiology and Public Health (CIBER-ESP), Health Research Institute Carlos III, Madrid, Spain.,Health Department, Public Health Division of Gipuzkoa, Basque Region, Spain
| |
Collapse
|
12
|
Physical activity and breast cancer risk by pathological subtype. Gynecol Oncol 2017; 144:577-585. [DOI: 10.1016/j.ygyno.2016.12.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 12/21/2022]
|
13
|
Tabung FK, Fung TT, Chavarro JE, Smith-Warner SA, Willett WC, Giovannucci EL. Associations between adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations and biomarkers of inflammation, hormonal, and insulin response. Int J Cancer 2017; 140:764-776. [PMID: 27798951 PMCID: PMC5167632 DOI: 10.1002/ijc.30494] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/28/2016] [Accepted: 10/17/2016] [Indexed: 12/26/2022]
Abstract
Adherence to the 2007 WCRF/AICR cancer prevention recommendations has been associated with lower cancer risk but the underlying biological mechanisms have not been elucidated. We utilized dietary and lifestyle data from 11,342 women in the Nurses' Health Study and 8,136 men in the Health Professionals Follow-up Study, to investigate associations between adherence scores and markers of inflammation, hormonal and insulin response. Two scores ranging from 0 to 3 were constructed to assess adherence to the energy balance-related recommendations (weight management, physical activity, energy density); and the plant, animal foods and alcohol intake recommendations; with higher scores indicating greater adherence. The following biomarkers were assessed in plasma samples donated by chronic disease-free women (1990) and men (1994): C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α receptor 2 (TNFαR2) and adiponectin for inflammation; estrone and estradiol for hormonal response in women, C-peptide for hyperinsulinemia; and triglycerides/high density lipoprotein-cholesterol (TG/HDL) ratio for insulin resistance. In multivariable-adjusted linear regression analyses, we estimated relative concentrations of biomarkers across adherence categories. There was a significant trend of lower (higher for adiponectin) biomarker concentrations with higher adherence to the energy balance recommendations (all p trend <0.0001). Comparing the highest (3) to the lowest recommendation category (0-1), the percent difference in relative concentrations of biomarkers was CRP, -69%; IL6, -41%; TNFαR2, -13%; adiponectin, +36%; C-peptide, -43%; TG/HDL, -43%; estrone, -31%; and estradiol, -43%; in women; and CRP, -59%; IL6, -42%; TNFαR2, -10%; adiponectin, +22%; C-peptide, -44%; and TG/HDL, -40%; in men. In contrast, associations between adherence to the plant, animal foods and alcohol intake recommendations and biomarker concentrations were weaker, and mostly nonsignificant. The healthier biomarker profile associated with greater adherence to the WCRF/AICR cancer prevention recommendations is driven mainly by adherence to the energy balance-related recommendations.
Collapse
Affiliation(s)
- Fred K Tabung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Teresa T Fung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Nutrition, Simmons College, Boston, MA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Womens' Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Stephanie A Smith-Warner
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Womens' Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Brigham and Womens' Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| |
Collapse
|
14
|
Bravi F, Polesel J, Garavello W, Serraino D, Negri E, Franchin G, La Vecchia C, Bosetti C. Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations and head and neck cancers risk. Oral Oncol 2016; 64:59-64. [PMID: 28024725 DOI: 10.1016/j.oraloncology.2016.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/26/2016] [Accepted: 11/24/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) have proposed eight recommendations for cancer prevention, related to body fatness, diet, and physical activity. Our aim is to evaluate the role of adherence to these recommendations on head and neck cancers risk. MATERIALS AND METHODS We obtained an overall score including seven of the WCRF/AICR recommendations, and examined its relationship with head and neck cancers risk in two Italian case-control studies including 946 patients with oral cavity and pharyngeal (OCP) cancer and 2492 controls, and 689 patients with laryngeal cancer and 1605 controls. RESULTS Higher adherence to WCRF/AICR recommendations was associated to a reduced risk of OCP cancer (odds ratio, OR=0.45, 95% confidence interval, CI: 0.33-0.62 for a score of 4-<5, and OR=0.32, 95% CI: 0.22-0.49 for a score of ⩾5 as compared to <3). The ORs for laryngeal cancer were 0.68 (95% CI: 0.50-0.92) for a score of 3-<4, 0.39 (95% CI: 0.28-0.55) for a score of 4-<5, and 0.24 (95% CI: 0.15-0.38) for a score of ⩾5. CONCLUSION Our study indicates that high adherence to the WCRF/AICR recommendations for cancer prevention is associated with a substantially decreased risk of head and neck cancers.
Collapse
Affiliation(s)
- Francesca Bravi
- Dipartimento di Epidemiologia, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via G. La Masa 19, 20156 Milan, Italy.
| | - Jerry Polesel
- S.O.C. Epidemiologia Oncologica, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano (PN), Italy
| | - Werner Garavello
- Clinica Otorinolaringoiatrica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, via Cadore 48, 20052 Monza, Italy
| | - Diego Serraino
- S.O.C. Epidemiologia Oncologica, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano (PN), Italy
| | - Eva Negri
- Dipartimento di Epidemiologia, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via G. La Masa 19, 20156 Milan, Italy
| | - Gianni Franchin
- S.O.C. Oncologia Radioterapica, CRO Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano (PN), Italy
| | - Carlo La Vecchia
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, via A. Vanzetti 5, 20133 Milan, Italy
| | - Cristina Bosetti
- Dipartimento di Epidemiologia, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via G. La Masa 19, 20156 Milan, Italy
| |
Collapse
|
15
|
Nomura SJO, Dash C, Rosenberg L, Yu J, Palmer JR, Adams-Campbell LL. Adherence to diet, physical activity and body weight recommendations and breast cancer incidence in the Black Women's Health Study. Int J Cancer 2016; 139:2738-2752. [PMID: 27578546 DOI: 10.1002/ijc.30410] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 12/26/2022]
Abstract
Adherence to cancer prevention recommendations has been associated with lower incidence of breast cancer in previous studies, but evidence in African American women is limited. This project evaluated the association between adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and breast cancer incidence among African American women. The Black Women's Health Study (analytic cohort = 49,103) is an ongoing prospective cohort study of African American women, ages 21-69 years at baseline (1995). Adherence scores for seven WCRF/AICR recommendations (adherent = 1, partial adherence = 0.5, non-adherence = 0) were calculated using questionnaire data and summed for overall (maximum = 7) and diet only (maximum = 5) scores. Associations between baseline and time-varying adherence scores and breast cancer incidence (N = 1,827 incident cases through 2011) were evaluated using proportional hazards regression. In this cohort, 8.5% adhered >4 recommendations. Adherence at baseline was not associated with breast cancer incidence. Higher overall time-varying adherence (per 0.5 point increase) was associated with lower breast cancer incidence (HR: 0.90, 95% CI: 0.84-0.96). Adherence to physical activity, sugar beverage and red and processed meat recommendations were also associated with reduced risk. Adherence to the WCRF/AICR recommendations was low and may be associated with lower breast cancer incidence in African American women.
Collapse
Affiliation(s)
- Sarah J O Nomura
- Division of Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
| | - Chiranjeev Dash
- Division of Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA
| | - Jeffrey Yu
- Slone Epidemiology Center, Boston University, Boston, MA
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, MA
| | - Lucile L Adams-Campbell
- Division of Cancer Prevention and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| |
Collapse
|
16
|
Lohse T, Faeh D, Bopp M, Rohrmann S. Adherence to the cancer prevention recommendations of the World Cancer Research Fund/American Institute for Cancer Research and mortality: a census-linked cohort. Am J Clin Nutr 2016; 104:678-85. [PMID: 27488239 DOI: 10.3945/ajcn.116.135020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/23/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Modifiable lifestyle factors linked to cancer offer great potential for prevention. Previous studies suggest an association between adherence to recommendations on healthy lifestyle and cancer mortality. OBJECTIVES The aim of this study was to examine whether adherence to the cancer prevention recommendations of the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) is associated with reduced all-cause, total cancer, and specific cancer type mortality. DESIGN We built a lifestyle score that included 3 categories, based on the recommendations of the WCRF/AICR. Applying Cox regression models, we investigated the association with all-cause, total cancer, and specific cancer type mortality; in addition, we included cardiovascular disease (CVD) mortality. We used census- and death registry-linked survey data allowing a mortality follow-up for ≤32 y. Our analysis included 16,722 participants. Information on lifestyle score components and confounders was collected at baseline. RESULTS Over a mean follow-up of 21.7 y, 3730 deaths were observed (1332 cancer deaths). Comparing best with poorest category of the lifestyle score showed an inverse association with all-cause (HR: 0.82; 95% CI: 0.75, 0.89) and total cancer (men only, HR: 0.69; 95% CI: 0.57, 0.84) mortality. We estimated that ∼13% of premature cancer deaths in men would have been preventable if lifestyle score levels had been high. Inverse associations were observed for lung, upper aerodigestive tract, stomach, and prostate cancer mortality [men and women combined, HR: 0.72; 95% CI: 0.51, 0.99; HR: 0.49; 95% CI: 0.26, 0.92; HR: 0.34; 95% CI: 0.14, 0.83; HR: 0.48; 95% CI: 0.28, 0.82 (men only), respectively]. CVD mortality was not associated with the lifestyle score (men and women combined, HR: 0.96; 95% CI: 0.82, 1.13). CONCLUSIONS Our results support the importance of adhering to recommendations for a healthy lifestyle with regard to all-cause and cancer mortality. To reduce the burden of cancer in the population, preventive measures should stress the potential of low-risk health behavior patterns rather than of specific risk factors only.
Collapse
Affiliation(s)
- Tina Lohse
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and
| | - David Faeh
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and Health Division-Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland
| | - Matthias Bopp
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and
| | | |
Collapse
|
17
|
Harris HR, Bergkvist L, Wolk A. Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations and breast cancer risk. Int J Cancer 2016; 138:2657-64. [DOI: 10.1002/ijc.30015] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/19/2015] [Accepted: 01/19/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Holly R. Harris
- Division of Nutritional Epidemiology; The National Institute for Environmental Medicine, Karolinska Institutet; Stockholm Sweden
- Obstetrics and Gynecology Epidemiology Center; Brigham and Women's Hospital; Boston MA
| | - Leif Bergkvist
- Department of Surgery and Centre for Clinical Research; Central Hospital; Västerås Sweden
| | - Alicja Wolk
- Division of Nutritional Epidemiology; The National Institute for Environmental Medicine, Karolinska Institutet; Stockholm Sweden
| |
Collapse
|
18
|
Lucas AL, Bravi F, Boffetta P, Polesel J, Serraino D, La Vecchia C, Bosetti C. Adherence to World Cancer Research Fund/American Institute for Cancer Research recommendations and pancreatic cancer risk. Cancer Epidemiol 2015; 40:15-21. [PMID: 26605429 DOI: 10.1016/j.canep.2015.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/22/2015] [Accepted: 10/27/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pancreatic cancer is a leading cause of cancer death. A role of dietary factors in pancreatic carcinogenesis has been suggested. The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published 8 recommendations for cancer prevention. We evaluated the effect of adherence to the WCRF/AICR recommendations on pancreatic cancer risk. METHODS We operationalized 7 of the 8 WCRF/AICR recommendations to generate a WCRF/AICR score. We examined the association of WCRF/AICR score with pancreatic cancer in data from an Italian case-control study of 326 incident cases and 652 controls. RESULTS Adherence to WCRF/AICR recommendations was associated with a significantly decreased risk of pancreatic cancer. Using a WCRF/AICR score <3.5 as a reference, the adjusted odds ratio (OR) for a score 3.5-<4 was 0.80 (95% CI 0.49, 1.28), for a score 4-<5 0.54 (95% CI 0.35, 0.82), and for score 5 or more 0.41 (95% CI 0.24, 0.68; p-value for trend 0.0002). The OR for a continuous increment of one unit of the WCRF/AICR score was 0.72 (95% CI 0.60, 0.87). CONCLUSION Adherence to the WCRF/AICR recommendations may reduce pancreatic cancer risk.
Collapse
Affiliation(s)
- Aimee L Lucas
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, NY, USA.
| | - Francesca Bravi
- Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri"-IRCCS, Milan, Italy
| | - Paolo Boffetta
- Tisch Cancer Institute and Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Jerry Polesel
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano (PN), Italy
| | - Diego Serraino
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano (PN), Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Cristina Bosetti
- Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri"-IRCCS, Milan, Italy
| |
Collapse
|