Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: A cohort study

Dora Romaguera; Heather Ward; Petra A. Wark; Anne Claire Vergnaud; Petra H. Peeters; Carla H. van Gils; Pietro Ferrari; Veronika Fedirko; Mazda Jenab; Marie Christine Boutron-Ruault; Laure Dossus; Laureen Dartois; Camilla Plambeck Hansen; Christina Catherine Dahm; Genevieve Buckland; María José Sánchez; Miren Dorronsoro; Carmen Navarro; Aurelio Barricarte; Timothy J. Key; Antonia Trichopoulou; Christos Tsironis; Pagona Lagiou; Giovanna Masala; Valeria Pala; Rosario Tumino; Paolo Vineis; Salvatore Panico; H. Bas Bueno-de-Mesquita; PD Siersema; Bodil Ohlsson; Karin Jirström; Maria Wennberg; Lena M. Nilsson; Elisabete Weiderpass; Tilman Kühn; Verena Katzke; Kay Tee Khaw; Nick J. Wareham; Anne Tjønneland; Heiner Boeing; José R. Quirós; Marc J. Gunter; Elio Riboli; Teresa Norat

doi:10.1186/s12916-015-0332-5

Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: A cohort study

Dora Romaguera^*, Heather Ward, Petra A. Wark, Anne Claire Vergnaud, Petra H. Peeters, Carla H. van Gils, Pietro Ferrari, Veronika Fedirko, Mazda Jenab, Marie Christine Boutron-Ruault, Laure Dossus, Laureen Dartois, Camilla Plambeck Hansen, Christina Catherine Dahm, Genevieve Buckland, María José Sánchez, Miren Dorronsoro, Carmen Navarro, Aurelio Barricarte, Timothy J. KeyAntonia Trichopoulou, Christos Tsironis, Pagona Lagiou, Giovanna Masala, Valeria Pala, Rosario Tumino, Paolo Vineis, Salvatore Panico, H. Bas Bueno-de-Mesquita, PD Siersema, Bodil Ohlsson, Karin Jirström, Maria Wennberg, Lena M. Nilsson, Elisabete Weiderpass, Tilman Kühn, Verena Katzke, Kay Tee Khaw, Nick J. Wareham, Anne Tjønneland, Heiner Boeing, José R. Quirós, Marc J. Gunter, Elio Riboli, Teresa Norat

^*Corresponding author for this work

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Abstract

Background: Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients. Methods: The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. Results: The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0-2/0-3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models. Conclusions: Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.

Original language	English
Article number	107
Number of pages	12
Journal	BMC Medicine
Volume	13
Issue number	1
DOIs	https://doi.org/10.1186/s12916-015-0332-5
Publication status	Published - 7 May 2015

Keywords

Colorectal cancer
Diet
Healthy lifestyle
Physical activity
Survival
Weight
BODY-MASS INDEX
RESEARCH FUND/AMERICAN INSTITUTE
RECREATIONAL PHYSICAL-ACTIVITY
LIFE-STYLE FACTORS
BREAST-CANCER
REPRODUCTIVE HISTORY
COLON-CANCER
RISK
NUTRITION
DIAGNOSIS

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Romaguera, D., Ward, H., Wark, P. A., Vergnaud, A. C., Peeters, P. H., van Gils, C. H., Ferrari, P., Fedirko, V., Jenab, M., Boutron-Ruault, M. C., Dossus, L., Dartois, L., Hansen, C. P., Dahm, C. C., Buckland, G., Sánchez, M. J., Dorronsoro, M., Navarro, C., Barricarte, A., ... Norat, T. (2015). Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: A cohort study. BMC Medicine, 13(1), Article 107. https://doi.org/10.1186/s12916-015-0332-5

@article{7e2ffc8b75614ac28861bd11ecf7eef4,

title = "Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: A cohort study",

abstract = "Background: Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients. Methods: The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. Results: The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0-2/0-3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models. Conclusions: Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.",

keywords = "Colorectal cancer, Diet, Healthy lifestyle, Physical activity, Survival, Weight, BODY-MASS INDEX, RESEARCH FUND/AMERICAN INSTITUTE, RECREATIONAL PHYSICAL-ACTIVITY, LIFE-STYLE FACTORS, BREAST-CANCER, REPRODUCTIVE HISTORY, COLON-CANCER, RISK, NUTRITION, DIAGNOSIS",

author = "Dora Romaguera and Heather Ward and Wark, {Petra A.} and Vergnaud, {Anne Claire} and Peeters, {Petra H.} and {van Gils}, {Carla H.} and Pietro Ferrari and Veronika Fedirko and Mazda Jenab and Boutron-Ruault, {Marie Christine} and Laure Dossus and Laureen Dartois and Hansen, {Camilla Plambeck} and Dahm, {Christina Catherine} and Genevieve Buckland and S{\'a}nchez, {Mar{\'i}a Jos{\'e}} and Miren Dorronsoro and Carmen Navarro and Aurelio Barricarte and Key, {Timothy J.} and Antonia Trichopoulou and Christos Tsironis and Pagona Lagiou and Giovanna Masala and Valeria Pala and Rosario Tumino and Paolo Vineis and Salvatore Panico and Bueno-de-Mesquita, {H. Bas} and PD Siersema and Bodil Ohlsson and Karin Jirstr{\"o}m and Maria Wennberg and Nilsson, {Lena M.} and Elisabete Weiderpass and Tilman K{\"u}hn and Verena Katzke and Khaw, {Kay Tee} and Wareham, {Nick J.} and Anne Tj{\o}nneland and Heiner Boeing and Quir{\'o}s, {Jos{\'e} R.} and Gunter, {Marc J.} and Elio Riboli and Teresa Norat",

year = "2015",

month = may,

day = "7",

doi = "10.1186/s12916-015-0332-5",

language = "English",

volume = "13",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BioMed Central Ltd.",

number = "1",

}

Romaguera, D, Ward, H, Wark, PA, Vergnaud, AC, Peeters, PH, van Gils, CH, Ferrari, P, Fedirko, V, Jenab, M, Boutron-Ruault, MC, Dossus, L, Dartois, L, Hansen, CP, Dahm, CC, Buckland, G, Sánchez, MJ, Dorronsoro, M, Navarro, C, Barricarte, A, Key, TJ, Trichopoulou, A, Tsironis, C, Lagiou, P, Masala, G, Pala, V, Tumino, R, Vineis, P, Panico, S, Bueno-de-Mesquita, HB, Siersema, PD, Ohlsson, B, Jirström, K, Wennberg, M, Nilsson, LM, Weiderpass, E, Kühn, T, Katzke, V, Khaw, KT, Wareham, NJ, Tjønneland, A, Boeing, H, Quirós, JR, Gunter, MJ, Riboli, E & Norat, T 2015, 'Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: A cohort study', BMC Medicine, vol. 13, no. 1, 107. https://doi.org/10.1186/s12916-015-0332-5

TY - JOUR

T1 - Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients

T2 - A cohort study

AU - Romaguera, Dora

AU - Ward, Heather

AU - Wark, Petra A.

AU - Vergnaud, Anne Claire

AU - Peeters, Petra H.

AU - van Gils, Carla H.

AU - Ferrari, Pietro

AU - Fedirko, Veronika

AU - Jenab, Mazda

AU - Boutron-Ruault, Marie Christine

AU - Dossus, Laure

AU - Dartois, Laureen

AU - Hansen, Camilla Plambeck

AU - Dahm, Christina Catherine

AU - Buckland, Genevieve

AU - Sánchez, María José

AU - Dorronsoro, Miren

AU - Navarro, Carmen

AU - Barricarte, Aurelio

AU - Key, Timothy J.

AU - Trichopoulou, Antonia

AU - Tsironis, Christos

AU - Lagiou, Pagona

AU - Masala, Giovanna

AU - Pala, Valeria

AU - Tumino, Rosario

AU - Vineis, Paolo

AU - Panico, Salvatore

AU - Bueno-de-Mesquita, H. Bas

AU - Siersema, PD

AU - Ohlsson, Bodil

AU - Jirström, Karin

AU - Wennberg, Maria

AU - Nilsson, Lena M.

AU - Weiderpass, Elisabete

AU - Kühn, Tilman

AU - Katzke, Verena

AU - Khaw, Kay Tee

AU - Wareham, Nick J.

AU - Tjønneland, Anne

AU - Boeing, Heiner

AU - Quirós, José R.

AU - Gunter, Marc J.

AU - Riboli, Elio

AU - Norat, Teresa

PY - 2015/5/7

Y1 - 2015/5/7

N2 - Background: Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients. Methods: The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. Results: The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0-2/0-3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models. Conclusions: Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.

AB - Background: Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients. Methods: The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. Results: The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0-2/0-3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models. Conclusions: Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.

KW - Colorectal cancer

KW - Diet

KW - Healthy lifestyle

KW - Physical activity

KW - Survival

KW - Weight

KW - BODY-MASS INDEX

KW - RESEARCH FUND/AMERICAN INSTITUTE

KW - RECREATIONAL PHYSICAL-ACTIVITY

KW - LIFE-STYLE FACTORS

KW - BREAST-CANCER

KW - REPRODUCTIVE HISTORY

KW - COLON-CANCER

KW - RISK

KW - NUTRITION

KW - DIAGNOSIS

UR - http://www.scopus.com/inward/record.url?scp=84928893101&partnerID=8YFLogxK

U2 - 10.1186/s12916-015-0332-5

DO - 10.1186/s12916-015-0332-5

M3 - Article

C2 - 25948112

AN - SCOPUS:84928893101

SN - 1741-7015

VL - 13

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 107

ER -

Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: A cohort study

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