The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score and All-Cause, Cancer, and Cardiovascular Disease Mortality Risk: A Longitudinal Analysis in the NIH-AARP Diet and Health Study

Marissa M Shams-White; Nigel T Brockton; Panagiota Mitrou; Lisa L Kahle; Jill Reedy

doi:10.1093/cdn/nzac096

The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score and All-Cause, Cancer, and Cardiovascular Disease Mortality Risk: A Longitudinal Analysis in the NIH-AARP Diet and Health Study

Curr Dev Nutr. 2022 Jun 2;6(6):nzac096. doi: 10.1093/cdn/nzac096. eCollection 2022 Jun.

Authors

Marissa M Shams-White¹, Nigel T Brockton², Panagiota Mitrou³, Lisa L Kahle⁴, Jill Reedy¹

Affiliations

¹ Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
² American Institute for Cancer Research, Arlington, VA, USA.
³ World Cancer Research Fund International, London, United Kingdom.
⁴ Information Management Services, Inc., Rockville, MD, USA.

Abstract

Background: The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) published Cancer Prevention Recommendations in 2018 focused on modifiable lifestyle factors.

Objectives: The aim was to examine how adherence to WCRF/AICR recommendations via the 2018 WCRF/AICR score is associated with risk for all-cause, cancer, and cardiovascular disease (CVD) mortality outcomes among older US adults.

Methods: Baseline and follow-up questionnaire data (n = 177,410) were used to calculate weight, physical activity, and diet components of the 2018 WCRF/AICR score (0-7 total points). Adjusted HRs and 95% CIs were estimated, stratified by sex and smoking status.

Results: There were 16,055 deaths during a mean of 14.2 person-years. Each 1-point score increase was associated with a 9-26% reduced mortality risk for all outcomes, except for current male smokers' cancer mortality risk. When the score was categorized comparing highest (5-7 points) with lowest (0-2 points) scores, associations with reduced all-cause mortality risk were strongest in former smokers (HR_males: 0.51; 95% CI: 0.43, 0.61; HR_females: 0.38; 95% CI: 0.31, 0.46), followed by current smokers (HR_males: 0.55; 95% CI: 0.34, 0.89; HR_females: 0.44; 95% CI: 0.32, 0.59) and never smokers (HR_males: 0.57; 95% CI: 0.47, 0.70; HR_females: 0.50; 95% CI: 0.41, 0.60). An association with cancer mortality risk was also seen in former smokers (HR_males: 0.59; 95% CI: 0.43, 0.81; HR_females: 0.52; 95% CI: 0.37, 0.73) and female current (HR_females: 0.55; 95% CI: 0.32, 0.96) and never (HR_females: 0.57; 95% CI: 0.40, 0.80) smokers; findings were not statistically significant in other strata. For CVD mortality, highest compared with lowest scores were associated with a 49-73% risk reduction, except in male never and current smokers. In exploratory analysis, physical activity, body weight, alcohol, and plant-based foods were found to be predominant components in the score.

Conclusions: Greater 2018 WCRF/AICR scores were associated with lower mortality risk among older adults. Future research can explore how smoking modifies these relations, and further examine different populations and other cancer-relevant outcomes.

Keywords: adherence score; cancer prevention; diet; dietary guidelines; index score; nutrition; obesity; older adults; physical activity; weight.

Published by Oxford University Press on behalf of the American Society for Nutrition 2022.