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)

Authors: MAKAREM, NOUR - New York University; LIN, YONG - Rutgers University; BANDERA, ELISA - Rutgers Cancer Institute Of New Jersey; JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; PAREKH, NIYATI - New York University

Submitted to: Cancer Causes and Control
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/4/2014
Publication Date: 1/6/2015
Citation: Makarem, N., Lin, Y., Bandera, E.V., Jacques, P.F., Parekh, N. 2015. 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). Cancer Causes and Control. 26(2):277-286.

Interpretive Summary: In the U.S., cancer incidence has risen over the past two decades with over 1.6 million incident cancer cases anticipated in 2014. The World Cancer Research Funds (WCRF) estimates that approximately one third of incident cancers are related to adiposity, poor diet, and physical inactivity and are, therefore, preventable. In 1997, the WCRF and the American Institute for Cancer Research (AICR) released cancer prevention recommendations for the general population advising on weight management, diet, and physical activity. These recommendations were updated in their Second Expert Report in 2007. These guidelines provided an integrated approach for establishing healthy eating and physical activity habits and serve as a basis for policies, programs, and personal choices that reduce cancer incidence. Since the release of the 1997 WCRF/AICR cancer prevention guidelines, several studies have operationalized these recommendations to elucidate how they are associated with cardiovascular disease, cancer, and mortality. Concordance with these guidelines has been studied in relation to cancer risk in post-menopausal females and Europeans. These results need to be confirmed in an American context, where social and environmental factors that influence diet and physical activity patterns and cancer risk may be different. It is important to evaluate whether lifestyle choices, collectively and individually, that are consistent with current cancer prevention guidance are in fact effective in reducing the cancer burden due to the multifactorial and cumulative nature of cancer risk. The objective of the present study is to investigate whether healthful behaviors in concordance with the WCRF/AICR cancer prevention guidelines are associated with risk of obesity-related cancers and three of the most common cancers (breast, prostate, and colon) in the Framingham Offspring Cohort. The analysis was restricted to obesity-related cancers due to their hypothesized association with lifestyle factors. The study sample consisted of 2,983 Framingham Offspring Cohort adults. From 1991-2008, 480 incident doctor-diagnosed obesity-related cancers were identified. Data on diet collected in 1991 that was measured by a food frequency questionnaire, anthropometric measures, and self-reported physical activity was used to construct a 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. The overall score was not associated with obesity-related cancer risk after adjusting for age, sex, smoking, energy, and pre-existing conditions. When score components were evaluated separately, for every unit increment in the alcohol score, there was 29% lower risk of obesity-related cancers 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. 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 American population.

Technical Abstract: Purpose: 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. Methods: 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. Results: 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). Conclusions: 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.