Cancer-Specific and General Nutritional Scores and Cancer Risk: Results from the Prospective NutriNet-Santé Cohort

Abstract

Several national and international authorities have proposed nutritional and lifestyle recommendations with the aim of improving health of the general population. Scores of adherence to these recommendations can be calculated at the individual level. Here, we investigated the associations between four nutritional scores and overall, breast, prostate, and colorectal cancer risk in a large prospective population-based cohort: the cancer-specific World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) score, the Alternate Healthy Eating Index 2010 (AHEI-2010), a score based on adherence to the Mediterranean diet (MEDI-LITE), and the French National Nutrition Health Program-Guideline Score (PNNS-GS). This study included 41,543 participants aged ≥40 years from the NutriNet-Santé cohort (2009-2017). A total of 1,489 overall incident cancers were diagnosed. A one-point increment of the WCRF/AICR score was significantly associated with decreased overall [12%; 95% confidence interval (CI), 8%-16%; < 0.0001], breast (14%; 95% CI, 6%-21%; = 0.001), and prostate (12%; 95% CI, 0%-22%; = 0.05) cancer risks. Hazard ratio for colorectal cancer risk was 0.86 (95% CI, 0.72-1.03; = 0.09). The PNNS-GS score was associated with reduced colorectal cancer risk ( = 0.04) and AHEI-2010 was associated with reduced overall cancer risk ( = 0.03). The WCRF/AICR score performed best. Compared with other tested scores, it included a stronger penalty for alcohol, which is a major risk factor for several cancer sites. Better adherence to nutritional recommendations, especially those designed for cancer prevention, could substantially contribute to decreased cancer incidence. This large prospective population-based cohort study suggests that following dietary recommendations such as the ones proposed by the World Cancer Research Fund/American Institute for Cancer Research could significantly contribute to cancer prevention. .

Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention guidelines and colorectal cancer incidence among African Americans and whites: The Atherosclerosis Risk in Communities study

“…After publication of the second expert report, numerous studies developed a composite score to measure adherence to the WCRF/AICR cancer prevention guidelines, which hereafter is called an adherence score. These studies reported a link between a higher adherence score and better quality of life, lower morbidity, and lower mortality from several types of cancer, including CRC …”

“…These studies reported a link between a higher adherence score and better quality of life, lower morbidity, and lower mortality from several types of cancer, including CRC. [1][2][3][6][7][8][11][12][13][14][15][16][17][18][19][20][21] Among studies that showed an inverse association between a higher adherence score and lower CRC incidence were the European Prospective Investigation Into Cancer and Nutrition (EPIC) cohort 2 and the Vitamins and Lifestyle (VITAL) cohort. These studies found a stronger association in men than women 3 ; however, they included predominantly white participants.…”

Impact of healthy lifestyles on cancer risk in the Chinese population

“…Based on studies evaluating the associations between lifestyle factors and cancer risk, the objective of these recommendations was to empower individuals to take actions to lead cancer‐free lives. Many studies conducted in Western populations have shown that adopting a favorable lifestyle pattern was associated with lower risks of overall and site‐specific cancers . For example, the European Prospective Investigation into Cancer and Nutrition (EPIC) study found that adherence to the 2007 WCRF/AICR guidelines was associated with reduced risks of overall or site‐specific cancers .…”

“…3,4 The World Cancer Research Fund International (WCRF) and American Institute for Cancer Research (AICR) have jointly issued and updated healthy lifestyle recommendations for cancer prevention since 1997. 5 Based on studies evaluating the associations between lifestyle factors and cancer risk, the objective of these recommendations was to empower individuals to take actions to lead cancer-free lives. Many studies conducted in Western populations have shown that adopting a favorable lifestyle pattern was associated with lower risks of overall and site-specific cancers.…”

“…Many studies conducted in Western populations have shown that adopting a favorable lifestyle pattern was associated with lower risks of overall and site-specific cancers. [5][6][7][8][9][10] For example, the European Prospective Investigation into Cancer and Nutrition (EPIC) study found that adherence to the 2007 WCRF/AICR guidelines was associated with reduced risks of overall or site-specific cancers. 6 There also was evidence indicating that the health benefits of the WCRF guidelines could be different in diverse populations.…”