Compliance with the 2018 World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations and Prostate Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Participants
2.3. Data Sources and Variables
2.3.1. WCRF/AICR Score Construction
2.3.2. Measurement of Tumor Aggressiveness
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Components | Personal Recommendations (Goals) | Operationalization | Scoring |
---|---|---|---|
1. Have a healthy weight | Ensure that body weight during childhood and adolescence projects toward the lower end of the healthy adult BMI range | No information for operationalization | n.a |
Keep your weight as low as you can within the healthy range throughout life | BMI ≥ 18.5–< 25 kg/m2 | 0.5 | |
BMI ≥ 25–< 30 kg/m2 | 0.25 | ||
BMI ≥ 30 kg/m2 or < 18.5–25 kg/m2 | 0 | ||
Avoid weight gain (measured as body weight or waist circumference) throughout adulthood | WC < 94 cm | 0.5 | |
WC ≥ 94–<102 cm | 0.25 | ||
WC ≥ 102 cm | 0 | ||
2. Be physically active | Be at least moderately physically active, and follow or exceed national guidelines | Total moderate-vigorous PA ≥ 150 min/week | 1 |
Total moderate-vigorous PA ≥ 75–< 150 min/week | 0.5 | ||
Total moderate-vigorous PA < 75 min/week | 0 | ||
Limit sedentary habits | No information for operationalization | n.a | |
3. Eat a diet rich in whole grains, vegetables, fruit, and beans | Consume a diet that provides at least 30 g/day of fiber from food sources | Dietary fiber intake ≥ 30 g/day | 0.5 |
Dietary fiber intake ≥ 15–<30 g/day | 0.25 | ||
Dietary fiber intake < 15 g/day | 0 | ||
Include more foods containing wholegrains, non-starchy vegetables, fruit, and pulses (legumes) such as beans and lentils | No information for operationalization | n.a. | |
Eat a diet high in all types of plant foods including at least five portions or servings (at least 400 g or 15 oz in total) of a variety of non-starchy vegetables and fruit every day | Fruits and vegetables intake a ≥ 400 g/day | 0.5 | |
Fruits and vegetables intake a ≥ 200–< 400 g/day | 0.25 | ||
Fruits and vegetables intake a < 200 g/day | 0 | ||
If you eat starchy roots and tubers as staple foods, eat non-starchy vegetables, fruit, and pulses (legumes) regularly too if possible | No information for operationalization | n.a. | |
4. Limit consumption of ”fast foods” and other processed foods high in fat, starches, or sugars | Limit consumption of processed foods high in fat, starches or sugars including “fast foods”, many prepared dishes, snacks, bakery foods and desserts, and confectionery (candy) | Percent of total kcal from ultra-processed foods (aUPFs): Tercile 1 | 1 |
Tercile 2 | 0.5 | ||
Tercile 3 | 0 | ||
5. Limit consumption of red and processed meat | If you eat red meat, limit consumption to no more than about three portions per week. Three portions are equivalent to about 350 to 500 g (about 12 to 18 oz) cooked weight of red meat. Consume very little, if any, processed meat. | Red meat <500 g/wk and processed meat < 21 g/wk | 1 |
Red meat <500 g/wk and processed meat ≥ 21–<100 g/wk | 0.5 | ||
Red meat ≥500 g/wk or processed meat ≥ 100g/wk | 0 | ||
6. Limit consumption of sugar-sweetened drinks | Do not consume sugar-sweetened drinks | Sugary drinks intake b = 0 g/day | 1 |
Sugary drinks intakeb >0–≤ 250 g/day | 0.5 | ||
Sugary drinks intake b > 250 g/day | 0 | ||
7. Limit alcohol consumption | For cancer prevention, it is best not to drink alcohol | No ethanol intake = 0 g/day | 1 |
Current ethanol intake > 0–< 28 g/day | 0.5 | ||
Current ethanol intake ≥ 28 g/day | 0 | ||
8. Do not use supplements for cancer prevention | High-dose dietary supplements are not recommended for cancer prevention-aim to meet nutritional needs through diet alone | No information for operationalization | n.a |
9. For mothers: breastfeed your baby, if you can | This recommendation aligns with the advice of the World Health Organization, which recommends infants are exclusively breastfed to 6 months, and then up to 2 years of age or beyond alongside appropriate complementary foods. | Not applicable to this population | n.a. |
10. After a cancer diagnosis: follow our recommendations if you can | All cancer survivors should receive nutritional care and guidance on physical activity from trained professionals. | Not applicable to this study | n.a. |
Unless otherwise advised, and if you can, all cancer survivors are advised to follow the Cancer Prevention Recommendations as far as possible after the acute stage of treatment | Not applicable to this study | n.a. |
Controls | PCa Cases | p-Value | |
---|---|---|---|
(n = 302) | (n = 398) | ||
Age (years), mean (SD) | 65.3 (8.2) | 67.7 (7.4) | <0.01 |
Age (years), n (%) | <0.01 | ||
40–54 | 39 (12.9) | 21 (5.3) | |
55–69 | 162 (53.7) | 217 (54.5) | |
70–80 | 101 (33.4) | 160 (40.2) | |
Education, n (%) | 0.38 | ||
Primary | 92 (30.4) | 119 (29.9) | |
Secondary | 147 (48.7) | 211 (53.0) | |
University | 63 (20.9) | 68 (17.1) | |
Energy intake (kcal/day), mean (SD) | 2438.1 (705.7) | 2511.8 (617.6) | 0.14 |
Alcohol consumption 1, n (%) | 0.05 | ||
No consumption | 56 (18.5) | 69 (17.4) | |
Moderate | 215 (71.2) | 262 (65.8) | |
High | 31 (10.3) | 67 (16.8) | |
Smoking status, n (%) | 0.70 | ||
Never | 88 (29.1) | 105 (26.4) | |
Former | 157 (52.0) | 212 (53.3) | |
Current | 57 (18.9) | 81 (20.3) | |
First-degree family history of PCa 2, n (%) | 0.46 | ||
No | 287 (95.0) | 373 (93.7) | |
Yes | 15 (5.0) | 25 (6.3) | |
Aggressiveness, n (%) | |||
ISUP 1–2 | – | 307 (77.1) | |
ISUP 3–5 | – | 91 (22.9) | |
WCRF/AICR score, mean (SD) (Minimum–Maximum) | 3.42 (1.01) (1.00–6.25) | 3.27 (0.93) (0.75–6.25) | 0.05 |
WCRF/AICR score, n (%) | 0.08 | ||
≤1 | 1 (0.3) | 3 (0.7) | |
>1–≤2 | 27 (8.9) | 30 (7.6) | |
>2–≤3 | 98 (32.4) | 160 (40.2) | |
>3–≤4 | 105 (34.8) | 132 (33.2) | |
>4–≤5 | 51 (16.9) | 63 (15.8) | |
>5–≤6 | 18 (6.0) | 8 (2.0) | |
>6–≤7 | 2 (0.7) | 1 (0.5) | |
WCRF/AICR score 3, n (%) | 0.69 | ||
Minimum compliance (T1) | 101 (33.4) | 140 (35.2) | |
Intermediate compliance (T2) | 111 (36.8) | 151 (37.9) | |
Maximum compliance (T3) | 90 (29.8) | 107 (26.9) |
Tercile 1 n = 101 | Tercile 2 n = 111 | Tercile 3 n = 90 | p-Value | |
---|---|---|---|---|
min–max 0.75–2.75 | min–max 3.00–3.75 | min–max 4.00–6.50 | ||
Age (years), mean (SD) | 62.7 (7.8) | 65.9 (7.3) | 67.3 (8.9) | 0.01 |
Age (years), n (%) | 0.01 | |||
40–54 | 18 (17.8) | 9 (8.1) | 12 (13.3) | |
55–69 | 62 (61.4) | 64 (57.7) | 36 (40.0) | |
70–80 | 21 (20.8) | 38 (34.2) | 42 (46.7) | |
Education, n (%) | 0.74 | |||
Primary | 30 (39.7) | 35 (31.5) | 27 (30.0) | |
Secondary | 54 (53.5) | 51 (46.0) | 42 (46.7) | |
University | 17 (16.8) | 25 (22.5) | 21 (23.3) | |
Energy intake (kcal/day), mean (SD) | 2510.5 (720.0) | 2557.0 (685.3) | 2210.3 (668.4) | <0.01 |
Alcohol consumption 1, n (%) | <0.01 | |||
No consumption | 10 (9.9) | 18 (16.2) | 28 (31.1) | |
Moderate | 71 (70.3) | 85 (76.6) | 59 (65.6) | |
High | 20 (19.8) | 8 (7.2) | 3 (3.3) | |
Smoking status, n (%) | 0.26 | |||
Never | 22 (21.8) | 37 (33.3) | 29 (32.2) | |
Former | 57 (56.4) | 52 (46.9) | 48 (53.3) | |
Current | 22 (21.8) | 22 (19.8) | 13 (14.4) | |
First-degree history of PCa 2, n (%) | 0.12 | |||
No | 98 (97.0) | 107 (96.4) | 82 (91.1) | |
Yes | 3 (3.0) | 3 (3.6) | 8 (8.9) |
WCRF/AICR Score Categories | |||||||
---|---|---|---|---|---|---|---|
N Control/Cases 1 | Tercile 1 | Tercile 2 | Tercile 3 | p-Trend | 1-Unit Increase | p-Value | |
aOR 2 (95% CI) | aOR 2 (95% CI) | aOR 2 (95% CI) | aOR 2 (95% CI) | ||||
Overall | |||||||
302/398 | 1.00 | 0.88 (0.61–1.27) | 0.79 (0.53–1.19) | 0.26 | 0.81 (0.69–0.96) | 0.02 | |
Aggressiveness 2 | |||||||
ISUP 1–2 | 302/307 | 1.00 | 0.87 (0.59–1.28) | 0.73 (0.48–1.13) | 0.16 | 0.79 (0.66–0.95) | 0.01 |
ISUP 3–5 | 302/91 | 1.00 | 0.84 (0.47–1.53) | 0.87 (0.46–1.66) | 0.67 | 0.86 (0.69–1.06) | 0.16 |
Components of the Score | N Controls/Cases | aOR (95% CI) 1 | p-Trend |
---|---|---|---|
1. Be a healthy weight 2 | 0.81 | ||
0–0.25 | 129/181 | 1 | |
0.5 | 85/87 | 0.69 (0.46–1.02) | |
0.75–1 | 88/130 | 1.09 (0.75–1.60) | |
2. Be physical active | 0.63 | ||
0 | 227/315 | 1 | |
0.5 | 17/14 | 0.55 (0.26–1.19) | |
1 | 58/69 | 0.94 (0.62–1.44) | |
3. Eat a diet rich in whole grains, vegetables, fruit and beans 2 | 0.89 | ||
0–0.25 | 14/15 | 1 | |
0.5 | 16/26 | 1.35 (0.48–3.76) | |
0.75–1 | 272/357 | 1.08 (0.47–2.50) | |
4. Limit consumption of ‘fast foods’ and other processed foods high in fat, starches or sugars | 0.02 | ||
0 | 101/163 | 1 | |
0.5 | 100/125 | 0.75 (0.51–1.10) | |
1 | 101/110 | 0.63 (0.42–0.94) | |
5. Limit consumption of red and processed meat | 0.22 | ||
0 | 231/297 | 1 | |
0.5 | 65/82 | 0.96 (0.63–1.46) | |
1 | 6/19 | 2.82 (1.05–7.59) | |
6. Limit consumption of sugar-sweetened drinks | 0.02 | ||
0 | 7/25 | 1 | |
0.5 | 132/179 | 0.39 (0.16–0.97) | |
1 | 163/194 | 0.30 (0.12–0.77) | |
7. Limit alcohol consumption | 0.03 | ||
0 | 31/67 | 1 | |
0.5 | 215/262 | 0.57 (0.34–0.95) | |
1 | 56/69 | 0.49 (0.27–0.91) |
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Rocío, O.-R.; Macarena, L.-L.; Inmaculada, S.-B.; Antonio, J.-P.; Fernando, V.-A.; Marta, G.-C.; María-José, S.; José-Juan, J.-M. Compliance with the 2018 World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations and Prostate Cancer. Nutrients 2020, 12, 768. https://doi.org/10.3390/nu12030768
Rocío O-R, Macarena L-L, Inmaculada S-B, Antonio J-P, Fernando V-A, Marta G-C, María-José S, José-Juan J-M. Compliance with the 2018 World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations and Prostate Cancer. Nutrients. 2020; 12(3):768. https://doi.org/10.3390/nu12030768
Chicago/Turabian StyleRocío, Olmedo-Requena, Lozano-Lorca Macarena, Salcedo-Bellido Inmaculada, Jiménez-Pacheco Antonio, Vázquez-Alonso Fernando, García-Caballos Marta, Sánchez María-José, and Jiménez-Moleón José-Juan. 2020. "Compliance with the 2018 World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations and Prostate Cancer" Nutrients 12, no. 3: 768. https://doi.org/10.3390/nu12030768
APA StyleRocío, O. -R., Macarena, L. -L., Inmaculada, S. -B., Antonio, J. -P., Fernando, V. -A., Marta, G. -C., María-José, S., & José-Juan, J. -M. (2020). Compliance with the 2018 World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations and Prostate Cancer. Nutrients, 12(3), 768. https://doi.org/10.3390/nu12030768