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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Adherence to the WCRF/AICR Dietary Recommendations for Cancer Prevention and Risk of Cancer in Elderly from Europe and the United States: A Meta-Analysis within the CHANCES Project

Nicole Jankovic, Anouk Geelen, Renate M. Winkels, Blaise Mwungura, Veronika Fedirko, Mazda Jenab, Anne K. Illner, Hermann Brenner, José M. Ordóñez-Mena, Jessica C. Kiefte de Jong, Oscar H. Franco, Philippos Orfanos, Antonia Trichopoulou, Paolo Boffetta, Antonio Agudo, Petra H. Peeters, Anne Tjønneland, Göran Hallmans, H. Bas Bueno-de-Mesquita, Yikyung Park, Edith J. Feskens, Lisette C. de Groot and Ellen Kampman
Nicole Jankovic
1Department Agrotechnology and Food Sciences, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
2Institute for Medical Informatics, Biometry and Epidemiology, Centre of Clinical Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
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  • For correspondence: Nicole.Jankovic@uk-essen.de
Anouk Geelen
1Department Agrotechnology and Food Sciences, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
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Renate M. Winkels
1Department Agrotechnology and Food Sciences, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
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Blaise Mwungura
1Department Agrotechnology and Food Sciences, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
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Veronika Fedirko
3Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia.
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Mazda Jenab
4Department Nutritional Epidemiology, International Agency for Research on Cancer, Lyon, France.
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Anne K. Illner
5Department of Nutrition & Health Sciences, Institut Polytechnique LaSalle Beauvais, Beauvais, France.
6Department of Dietary Exposure Assessment, Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
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Hermann Brenner
7Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
8Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
9German Cancer Research Center (DKFZ), Heidelberg, Germany.
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José M. Ordóñez-Mena
7Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Jessica C. Kiefte de Jong
10Department of Epidemiology, Erasmus Medical Centre Rotterdam, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
11Global Public Health, Leiden University College, The Hague, The Netherlands.
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Oscar H. Franco
10Department of Epidemiology, Erasmus Medical Centre Rotterdam, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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Philippos Orfanos
12Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
13Hellenic Health Foundation, Athens, Greece.
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Antonia Trichopoulou
12Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
13Hellenic Health Foundation, Athens, Greece.
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Paolo Boffetta
13Hellenic Health Foundation, Athens, Greece.
14The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, New York.
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Antonio Agudo
15Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
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Petra H. Peeters
16Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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Anne Tjønneland
17Danish Cancer Society Research Centre, Copenhagen, Denmark.
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Göran Hallmans
18Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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H. Bas Bueno-de-Mesquita
19Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
20Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
21Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom.
22Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Yikyung Park
23Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
24Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
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Edith J. Feskens
1Department Agrotechnology and Food Sciences, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
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Lisette C. de Groot
1Department Agrotechnology and Food Sciences, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
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Ellen Kampman
1Department Agrotechnology and Food Sciences, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
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DOI: 10.1158/1055-9965.EPI-16-0428 Published January 2017
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Abstract

Background: It is unknown whether dietary recommendations for cancer prevention are applicable to the elderly. We analyzed WCRF/AICR recommendations in cohorts of European and U.S. adults ages 60 years and above.

Methods: Individual participant data meta-analysis included 362,114 participants (43% women), from seven prospective cohort studies, free from cancer at enrollment. The WCRF/AICR diet score was based on: (i) energy-dense foods and sugary drinks, (ii) plant foods, (iii) red and processed meat, and (iv) alcoholic drinks. Cox proportional hazards regression was used to examine the association between the diet score and cancer risks. Adjusted, cohort-specific HRs were pooled using random-effects meta-analysis. Risk advancement periods (RAP) were calculated to quantify the time period by which the risk of cancer was postponed among those adhering to the recommendations.

Results: After a median follow-up of 11 to 15 years across cohorts, 70,877 cancer cases were identified. Each one-point increase in the WCRF/AICR diet score [range, 0 (no) to 4 (complete adherence)] was significantly associated with a lower risk of total cancer [HR, 0.94; 95% confidence interval (CI), 0.92–0.97], cancers of the colorectum (HR, 0.84; 95% CI, 0.80–0.89) and prostate (HR, 0.94; 95% CI, 0.92–0.97), but not breast or lung. Adherence to an additional component of the WCRF/AICR diet score significantly postponed the incidence of cancer at any site by 1.6 years (RAP, −1.6; 95% CI, −4.09 to −2.16).

Conclusions: Adherence to WCRF/AICR dietary recommendations is associated with lower risk of cancer among older adults.

Impact: Dietary recommendations for cancer prevention are applicable to the elderly. Cancer Epidemiol Biomarkers Prev; 26(1); 136–44. ©2016 AACR.

  • Received May 20, 2016.
  • Revision received September 16, 2016.
  • Accepted September 23, 2016.
  • ©2016 American Association for Cancer Research.
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Cancer Epidemiology Biomarkers & Prevention: 26 (1)
January 2017
Volume 26, Issue 1
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Adherence to the WCRF/AICR Dietary Recommendations for Cancer Prevention and Risk of Cancer in Elderly from Europe and the United States: A Meta-Analysis within the CHANCES Project
Nicole Jankovic, Anouk Geelen, Renate M. Winkels, Blaise Mwungura, Veronika Fedirko, Mazda Jenab, Anne K. Illner, Hermann Brenner, José M. Ordóñez-Mena, Jessica C. Kiefte de Jong, Oscar H. Franco, Philippos Orfanos, Antonia Trichopoulou, Paolo Boffetta, Antonio Agudo, Petra H. Peeters, Anne Tjønneland, Göran Hallmans, H. Bas Bueno-de-Mesquita, Yikyung Park, Edith J. Feskens, Lisette C. de Groot and Ellen Kampman on behalf of the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES)
Cancer Epidemiol Biomarkers Prev January 1 2017 (26) (1) 136-144; DOI: 10.1158/1055-9965.EPI-16-0428

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Adherence to the WCRF/AICR Dietary Recommendations for Cancer Prevention and Risk of Cancer in Elderly from Europe and the United States: A Meta-Analysis within the CHANCES Project
Nicole Jankovic, Anouk Geelen, Renate M. Winkels, Blaise Mwungura, Veronika Fedirko, Mazda Jenab, Anne K. Illner, Hermann Brenner, José M. Ordóñez-Mena, Jessica C. Kiefte de Jong, Oscar H. Franco, Philippos Orfanos, Antonia Trichopoulou, Paolo Boffetta, Antonio Agudo, Petra H. Peeters, Anne Tjønneland, Göran Hallmans, H. Bas Bueno-de-Mesquita, Yikyung Park, Edith J. Feskens, Lisette C. de Groot and Ellen Kampman on behalf of the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES)
Cancer Epidemiol Biomarkers Prev January 1 2017 (26) (1) 136-144; DOI: 10.1158/1055-9965.EPI-16-0428
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