Association between meeting the WCRF/AICR cancer prevention recommendations and colorectal cancer incidence: results from the VITAL cohort

In 2007, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) published eight recommendations regarding body weight, physical activity, and dietary behaviors aimed at reducing cancer incidence worldwide. In this paper, we assess whether meeting the WCRF/AICR recommendations is associated with lower colorectal cancer (CRC) incidence; evaluate whether particular recommendations are most strongly associated with lower CRC incidence; and assess whether associations differ by sex. We operationalized six of the recommendations (related to body weight, physical activity, energy density, plant foods, red and processed meat, and alcohol) and examined their association with CRC incidence over 7.6 years of follow-up in the prospective VITamins And Lifestyle Study cohort. Participants included 66,920 adults aged 50-76 years at baseline (2000-2002) with no history of CRC and with complete data for the recommendations evaluated. Incident colorectal cancers (n = 546) were tracked through 2009. Compared with meeting no recommendations, meeting 1-3 recommendations was associated with 34-45 % lower CRC incidence, and meeting 4-6 was associated with 58 % lower incidence (95 % CI 34 %, 74 %) in fully adjusted analyses. The recommendations most strongly associated with lower CRC risk for women were related to body fatness and red and processed meat, while for men these were alcohol intake and red and processed meat. Differences by sex were statistically significant (p < 0.05) for the recommendations related to body weight and to alcohol. Meeting the WCRF/AICR recommendations, particularly those related to alcohol, body weight, and red and processed meat, could substantially reduce CRC incidence; however, associations differ by sex.