The 2018 WCRF/AICR Score and All-Cause and Cancer-Specific Mortality Risk: A Longitudinal Analysis in the NIH-AARP Diet and Health Study

Abstract

Objectives To examine how adherence to the 2018 World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) Cancer Prevention Recommendations may impact risk for all-cause and cancer-specific mortality among older adults in the NIH-AARP Diet and Health Study. Methods The seven components of the 2018 WCRF/AICR Score were calculated using baseline data (1995–1997) for dietary intake (124-item food frequency questionnaire), height, weight, and waist circumference, and a follow-up questionnaire (2004) for moderate and vigorous physical activity (N = 220,389). Total Scores were categorized (0–2 (ref), > 2–5, and 5–7 points). Covariates included age, race/ethnicity, marital status, education, total energy, and diabetes, and hormone replacement therapy (women only). Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated, stratified by sex and smoking status (never, former, current). Results There were 24,119 and 8170 all-cause and cancer deaths, respectively, through 2011 during a mean 14.7 person-years of follow-up. Men with the highest (5–7 points) compared to the lowest 2018 WCRF/AICR Scores had a reduced risk of all-cause mortality depending on smoking history: never HR: 0.46 (95% CI 0.38–0.55); former HR: 0.42 (95% CI 0.36–0.48); current HR: 0.56 (95% CI 0.39–0.80). Findings were similar among women (never HR: 0.45 (95% CI 0.38–0.53); former HR: 0.41 (95% CI 0.35–0.49); current HR: 0.48 (95% CI 0.38–0.61)). For cancer mortality, there was a reduced risk for former smokers (men HR: 0.52 (95% CI 0.42– 0.66); women HR: 0.67 (95% CI 0.51– 0.89)) and never smokers (women only, HR: 0.55 (95% CI 0.40–0.75)), but this was not seen for current smokers or men who reported never smoking. Conclusions We found greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations to be associated with a lower risk for all-cause mortality in older adults, as well as cancer-specific mortality among former smokers and female never smokers. Future research is warranted to further explore how smoking modifies these relationships, and the influence of the different constructs included in the Score in different populations and in different cancer-relevant outcomes. Funding Sources All authors contributed their efforts without receiving funding or salary support.

COVID-19 Related Protocol Considerations and Modifications within a Rural, Community-Engaged Health Promotion Randomized Trial

“…Second, we added items to the questionnaire that enabled us to calculate the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention score [ 45 ]. Although the 2018 WCRF/AICR score is correlated with cancer incidence and mortality [ 46 , 47 , 48 , 49 , 50 , 51 ] and is recommended for use in intervention studies as a standardized cancer prevention score [ 45 ], published data from intervention studies using the score as designed are still very limited. We added diet-related survey questions adapted from the National Health and Nutrition Examination Survey (NHANES) dietary screener questionnaire [ 19 ] and the Beverage and Snack Questionnaire [ 20 ] to assess: (1) fiber intake (g/day); (2) frequency of consuming ultra-processed foods (times/month); and (3) red and processed meat consumption (g/week) [ 19 , 21 ]; and (4) two questions adapted from the Alcohol Use Disorders Screening Test [ 22 ] to assess alcohol consumption (drinks/day).…”