The 2018 World Cancer Research Fund /American Institute for Cancer Research Score and Cancer Risk: Results from the Diabetes Prevention Program Outcomes Study

Document Type

Journal Article

Publication Date

7-15-2025

Journal

The American journal of clinical nutrition

DOI

10.1016/j.ajcnut.2025.07.011

Keywords

alcohol; diet; disease prevention; obesity; physical activity; weight

Abstract

BACKGROUND: Modifying lifestyle factors may reduce the incidence of obesity, diabetes, and cancer. OBJECTIVE: We examined how alignment with the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations using the 2018 WCRF/AICR Score was associated with incident lifestyle-related cancer in adults with prediabetes in the Diabetes Prevention Program (DPP, 1996-2001) and DPP Outcomes Study (DPPOS, 2002-2020), an observational follow-up of a randomized clinical trial. METHODS: Participants were randomized to lifestyle, metformin, or placebo interventions (mean 3y) and followed for an additional 19y. The 2018 WCRF/AICR Score (0-7 points; higher score, better alignment) was calculated from body weight, physical activity, diet, and alcohol components at 0, 1, 5, 6, 9, and 15y after randomization. Incident cancer was based on the 2018 WCRF/AICR 3rd Expert Report (18 cancers associated with lifestyle). Adjusted Cox proportional hazard models estimated associations between the Score (baseline [0], change from 0-1y, time-dependent) and lifestyle-related cancer. RESULTS: Participants' (N=3000) mean baseline WCRF/AICR Score was 3.2 (SD=1.1). There were 403 incident lifestyle-related cancer cases. Scores improved after 1y and 15y (mean increase=0.43 and 0.27pts, respectively, both p<0.001). The baseline Score was not associated with cancer risk. However, a 1-unit Score improvement from 0-1y and time-dependent Scores were significantly associated with a 14% (Hazard Ratio (HR)=0.86; 95% Confidence Interval (CI) 0.76, 0.97) and 9% (HR=0.91; 95% CI 0.83, 0.997) lower risk, respectively, with no effect modification by intervention group or diabetes status. In exploratory by-component analyses, no single component was associated with risk. CONCLUSIONS: Alignment with WCRF/AICR Recommendations may lower cancer risk in adults with prediabetes and type 2 diabetes, highlighting the importance of considering lifestyle factors for cancer prevention. TRIAL REGISTRATION NUMBER: Diabetes Prevention Program, NCT00004992; Diabetes Prevention Program Outcomes Study, NCT00038727 DPP STUDY REGISTRATION PAGE: https://clinicaltrials.gov/study/NCT00004992 DPPOS STUDY REGISTRATION PAGE: https://clinicaltrials.gov/study/NCT00038727.

Department

Biostatistics and Bioinformatics

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