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Song R, Riseberg E, Petimar J, Wang M, Mucci LA, Wu K, Zhang X, Willett WC, Giovannucci EL, Smith-Warner SA. Different operationalizations of the 2018 WCRF/AICR cancer prevention recommendations and risk of cancer. Br J Cancer 2023; 129:982-992. [PMID: 37500788 PMCID: PMC10491614 DOI: 10.1038/s41416-023-02314-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 05/14/2023] [Accepted: 06/08/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The standardized scoring system assessing adherence to the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) cancer prevention recommendations assigns equal weight for each recommendation, thereby giving higher weight to dietary factors collectively (5 points) than adiposity (1 point) and physical activity (1 point). An alternative score assigning equal weights to the adiposity, physical activity, alcohol, and other dietary (composite) recommendations may better predict cancer associations. METHODS We examined associations between standardized and alternative scores with cancer risk in two US prospective cohorts. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression. RESULTS During 28 years of follow-up, 16,342 incident cancer cases in women and 8729 cases in men occurred. Individuals in the highest versus lowest quintile of the standardized score had a reduced overall cancer risk (women: HR = 0.89, 95% CI: 0.85, 0.94; men: HR = 0.87, 95% CI: 0.81, 0.94). Results were slightly stronger for the alternative score (women: HR = 0.83, 95% CI: 0.79, 0.87; men: HR = 0.81, 95% CI: 0.75, 0.86). Similar patterns were observed for obesity-related, alcohol-related, smoking-related, and digestive system cancers. CONCLUSIONS Greater adherence to the WCRF/AICR cancer prevention recommendations was associated with lower cancer risk. A score assigning equal weights to the adiposity, physical activity, alcohol, and all remaining diet components yielded stronger associations than the standardized score.
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Affiliation(s)
- Rui Song
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Emily Riseberg
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joshua Petimar
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xuehong Zhang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephanie A Smith-Warner
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Minian N, Ivanova A, Voci S, Veldhuizen S, Zawertailo L, Baliunas D, Noormohamed A, Giesbrecht N, Selby P. Computerized Clinical Decision Support System for Prompting Brief Alcohol Interventions with Treatment Seeking Smokers: A Sex-Based Secondary Analysis of a Cluster Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1024. [PMID: 32041190 PMCID: PMC7037372 DOI: 10.3390/ijerph17031024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/11/2022]
Abstract
Although brief alcohol intervention can reduce alcohol use for both men and women, health care providers (HCPs) are less likely to discuss alcohol use or deliver brief intervention to women compared to men. This secondary analysis examined whether previously reported outcomes from a cluster randomized trial of a clinical decision support system (CDSS)-prompting delivery of a brief alcohol intervention (an educational alcohol resource) for patients drinking above cancer guidelines-were moderated by patients' sex. Patients (n = 5702) enrolled in a smoking cessation program at primary care sites across Ontario, Canada, were randomized to either the intervention (CDSS) or control arm (no CDSS). Logistic generalized estimating equations models were fit for the primary and secondary outcome (HCP offer of resource and patient acceptance of resource, respectively). Previously reported results showed no difference between treatment arms in HCP offers of an educational alcohol resource to eligible patients, but there was increased acceptance of the alcohol resource among patients in the intervention arm. The results of this study showed that these CDSS intervention effects were not moderated by sex, and this can help inform the development of a scalable strategy to overcome gender disparities in alcohol intervention seen in other studies.
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Affiliation(s)
- Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON M6J 1H4, Canada
| | - Anna Ivanova
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
| | - Sabrina Voci
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
| | - Scott Veldhuizen
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
| | - Laurie Zawertailo
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
- Department of Pharmacology and Toxicology, University of Toronto, 1 King’s College Cir, Toronto, ON M5S 1A8, Canada
| | - Dolly Baliunas
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
- Dalla Lana School of Public Health, University of Toronto, 155 College, Toronto, ON M5T 3M7, Canada
| | - Aliya Noormohamed
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
| | - Norman Giesbrecht
- Dalla Lana School of Public Health, University of Toronto, 155 College, Toronto, ON M5T 3M7, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell St, Toronto, ON M5S 2S1, Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON M6J 1H4, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College, Toronto, ON M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
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