Table 1.

WCRF/AICR cancer prevention recommendations (20), their operationalization in this study, and percentage who met each recommendation

VITAL cohort (N = 30,797)Breast cancer cases (N = 899)
WCRF/AICR recommendationAssociated personal recommendationsMet/did not meet recommendation in this study if:N (%)N (%)
1. Body fatness: Be as lean as possible within the normal range of body weight
  • Ensure that weight through childhood and adolescent growth projects toward the lower end of the normal BMI range at age 21

  • Maintain body weight within the normal range from age 21

  • Avoid weight gain and increases in waist circumference throughout adulthood

Met: 18.5 kg/m2 ≤ BMI <25 kg/m211,946 (38.8)327 (36.4)
Did not meet: BMI <18.5 kg/m2 or BMI ≥25 kg/m218,851 (61.2)572 (63.6)
2. Physical activity: Be physically active as part of everyday life
  • Be moderately physically active, equivalent to brisk walking, for at least 30 minutes every day

  • As fitness improves, aim for 60 minutes or more of moderate, or for 30 minutes or more of vigorous, physical activity every day

  • Limit sedentary habits such as watching television

Met: ≥30 minutes per day of moderate or fast walking and/or moderate or strenuous activity on at least 5 days per week in at least 7 of the past 10 years5,288 (17.2)155 (17.2)
Did not meet: <30 minutes per day or <5 days per week or <7 of the previous 10 years of moderate or fast walking and/or moderate or strenuous activity25,509 (82.8)744 (82.8)
3. Energy density: Limit consumption of energy dense foods; avoid sugary drinks
  • Consume energy-dense foods sparingly

  • Avoid sugary drinks

  • Consume ‘fast foods’ sparingly, if at all

Met: Energy density of diet <125 kcal per 100 g and <1 sugary drink per week7,657 (24.9)227 (25.3)
Did not meet: Energy density of diet ≥125 kcal per 100 g or ≥1 sugary drink per week23,140 (75.1)672 (74.8)
4. Plant foods: Eat mostly foods of plant origin
  • Eat at least five portions/servings (at least 400 g or 14 oz) of a variety of non-starchy vegetables and of fruits every day

  • Eat relatively unprocessed cereals (grains) and/or pulses (legumes) with every meal

  • Limit refined starchy foods

  • People who consume starchy roots or tubers as staples also to ensure intake of sufficient non-starchy vegetables, fruits, and pulses (legumes)

Met: ≥5 servings of fruits and vegetables and ≥1 serving of whole grains and/or legumes per day4,565 (14.8)114 (12.7)
Did not meet: <5 servings of fruits and vegetables and/or <1 serving of whole grains and/or legumes per day26,232 (85.2)785 (87.3)
5. Red meat: Limit intake of red meat and avoid processed meat
  • People who eat red meat to consume less than 500 g (18 oz) a week, very little if any to be processed

Met: <18 oz red and/or processed meat per week22,648 (73.5)653 (72.6)
Did not meet: ≥18 oz red and/or processed meat per week8,149 (26.5)246 (27.4)
6. Alcohol: Limit alcoholic drinks
  • If alcoholic drinks are consumed, limit consumption to no more than two drinks a day for men and one drink a day for women

Met: ≤1 drink per day26,639 (86.5)719 (80.0)
Did not meet: >1 drink per day4,158 (13.5)180 (20.0)
7. Salt-preserved foods: Limit consumption of salt; avoid moldy grains or legumes
  • Avoid salt-preserved, salted, or salty foods; preserve foods without using salt

  • Limit consumption of processed foods with added salt to ensure an intake of less than 6 g (2.4 g sodium) a day

  • Do not eat moldy cereals (grains) or pulses (legumes)

Not operationalized————
8. Supplements: Aim to meet nutritional needs through diet alone
  • Dietary supplements are not recommended for cancer prevention

Not operationalized————

NOTE: Italicized text indicates portions of the WCRF/AICR recommendations operationalized in this study. These represent the key components of the recommendations selected by an expert panel.