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. 2020 Apr 23;9(4):1215.
doi: 10.3390/jcm9041215.

Association between the 2018 WCRF/AICR and the Low-Risk Lifestyle Scores with Colorectal Cancer Risk in the Predimed Study

Laura Barrubés  1   2 , Nancy Babio  1   2 , Pablo Hernández-Alonso  1   2   3 , Estefania Toledo  2   4 , Judith B Ramírez Sabio  5   6 , Ramón Estruch  2   7   8 , Emilio Ros  2   8   9 , Montserrat Fitó  2   10 , Angel M Alonso-Gómez  2   11 , Miquel Fiol  2   12 , Jose Lapetra  2   13 , Lluís Serra-Majem  2   14 , Xavier Pintó  2   15 , Miguel Ruiz-Canela  2   4 , Dolores Corella  2   6 , Olga Castañer  2   10 , Manuel Macías-González  2   3 , Jordi Salas-Salvadó  1   2
Affiliations

Association between the 2018 WCRF/AICR and the Low-Risk Lifestyle Scores with Colorectal Cancer Risk in the Predimed Study

Laura Barrubés et al. J Clin Med. .

Abstract

Limited longitudinal studies have been conducted to evaluate colorectal cancer (CRC) incidence based on the updated 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations or other global lifestyle indices, and none in aged populations at high cardiovascular risk. We aimed to assess the association between CRC incidence and adherence to two emerging lifestyles indices (2018 WCRF/AICR score and another low-risk lifestyle (LRL) score comprising smoking status, alcohol consumption, physical activity, diet, and body mass index) in the Spanish PREvencion con DIeta MEDiterranea (PREDIMED) cohort. We studied 7216 elderly men and women at high cardiovascular risk. The 2018 WCRF/AICR and LRL scores were calculated. Multivariable Cox proportional regression models were fitted to estimate the HRs (hazard ratios) and 95% confidence intervals (CIs) for incident CRC events. During a median interquartile range (IQR) follow-up of 6.0 (4.4-7.3) years, 97 CRC events were considered. A significant linear association was observed between each 1-point increment in the WCRF/AICR score (score range from 0 to 7) and CRC risk (HR (95% CI) = 0.79 (0.63-0.99)). Similarly, each 1-point increment in the LRL score (score range from 0 to 5) was associated with a 22% reduction in CRC risk (0.78 (0.64-0.96)). Adhering to emergent lifestyle scores might substantially reduce CRC incidence in elderly individuals. Further longitudinal studies, which take different lifestyle indexes into account, are warranted in the future.

Keywords: PREDIMED; WCRF/AICR score; colorectal cancer; lifestyle patterns; low-risk lifestyle index.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Colorectal cancer risk associated with 2018 WCRF/AICR and low-risk lifestyle scores and the individual components of each index in the PREvención con DIeta MEDiterránea (PREDIMED) cohort (n = 7216). Multivariable Cox proportional regression models were used. Results were the HRs (95% CIs) for the comparison between the highest vs. the lowest quantile for each overall score (2018 WCRF/AICR score: Quartile (Q) 4 vs. Q1; low-risk lifestyle score: Tertile (T) 3 vs. T1) and the comparison for the highest vs. the lowest category for each individual component of the score (see Table 3 and Table 4). * p-value < 0.05. p for trend stands for linear trend. Abbreviations: AHEI, alternate healthy eating index; BMI, body mass index; CI, confidence interval; HR, hazard ratio; MVPA, moderate-to-vigorous physical activity; WCRF/AICR, World Cancer Research Fund/American Institute for Cancer Research. The triangle represents the HR for the WCRF/AICR score; the square represents the HRs for the individual components of each score, and the diamond represents the HR for the LRL score; Double slash appears when CI > 2.
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