A systematic review and meta-analysis of the 2007 WCRF/AICR score in relation to cancer-related health outcomes

M Solans; D S M Chan; P Mitrou; T Norat; D Romaguera

doi:10.1016/j.annonc.2020.01.001

A systematic review and meta-analysis of the 2007 WCRF/AICR score in relation to cancer-related health outcomes

Ann Oncol. 2020 Mar;31(3):352-368. doi: 10.1016/j.annonc.2020.01.001. Epub 2020 Jan 8.

Authors

M Solans¹, D S M Chan², P Mitrou³, T Norat², D Romaguera⁴

Affiliations

¹ CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.
² Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
³ World Cancer Research Fund International, London, UK.
⁴ Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain; Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain. Electronic address: mariaadoracion.romaguera@ssib.es.

PMID: 32067678
DOI: 10.1016/j.annonc.2020.01.001

Abstract

Background: We conducted a systematic literature review and meta-analysis of observational studies investigating adherence to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations for cancer prevention and health outcomes.

Patients and methods: We searched PubMed and the in-house database of the WCRF Continuous Update Project for publications up to June 2019. Cross-sectional studies were only narratively reviewed given their heterogeneity while findings of cohort/case-control studies were synthesized in umbrella reviews and meta-analyses. Summary relative risks (RRs) and 95% confidence intervals (CI) were estimated using a random-effects model when at least two studies reported results on a specific outcome.

Results: Thirty-eight articles (17 prospective, 8 case-control, and 13 cross-sectional studies) were included. The summary RR per each point increment in the 2007 WCRF/AICR score was 0.90 (95% CI: 0.87-0.93, n = 11) for breast cancer, regardless of hormone receptor and menopausal status, 0.86 (95% CI: 0.82-0.89, n = 10) for colorectal cancer, and 0.93 (95% CI: 0.89-0.96, n = 2) for lung cancer risk. No statistically significant associations were reported for prostate (n = 6) and pancreatic cancers (n = 2). Adherence to the recommendations was associated with lower overall mortality (RR = 0.90, 95% CI 0.84-0.96, n = 3) and cancer-specific mortality (RR = 0.91, 95% CI 0.89-0.92; n = 3) in healthy populations, as well as with higher survival in cancer patients (n = 2). In cross-sectional studies, a healthier plasma marker profile and lower cancer risk factors in the general population and a better health status and quality of life in cancer patients/survivors were reported.

Conclusions: Adhering to the 2007 WCRF/AICR recommendations is associated with lower risks of cancer incidence, namely breast and colorectal cancers, and mortality. Primary prevention of cancer should emphasize modification of multiple lifestyle factors. Upcoming studies examining the recently updated 2018 guidelines will further clarify such associations.

Keywords: 2007 WCRF/AICR recommendations; cancer; diet; meta-analysis; mortality; physical activity.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Cross-Sectional Studies
Financial Management*
Humans
Male
Neoplasms* / epidemiology
Outcome Assessment, Health Care*
Prospective Studies
Quality of Life
Risk Factors
United States