Table 2.

The associations between adherence to components of the ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention and Nonsmokinga with cancer incidence by baseline health status

Total analytic populationParticipants without chronic disease at baseline
GuidelinesCohortCasesHR (95%CI)bCohortCasesHR (95%CI)b
Achieve and maintain a healthy weight throughout life
 Body mass index (kg/m2) at baseline
  <18.5718541.78 (1.35–2.35)394231.75 (1.14–2.68)
  18.5–24.915,0286311 (Ref.)9,1863061 (Ref.)
  25.0–29.918,2596460.86 (0.77–0.96)8,4522691.02 (0.87–1.21)
  30.0–34.913,1554450.87 (0.77–0.99)4,4291301.05 (0.85–1.30)
  35.0–39.97,2102520.95 (0.81–1.10)1,742440.96 (0.69–1.33)
  ≥40.06,7282120.99 (0.84–1.17)1,306381.26 (0.89–1.79)
Adopt a physically active lifestyle
 Physical activity guidelinec
  Meets12,5713891 (Ref.)6,7651821 (Ref.)
  Does not meet48,5271,8511.05 (0.94–1.18)18,7446281.08 (0.91–1.29)
   Somewhat active24,1798111.01 (0.89–1.14)10,3502980.99 (0.82–1.19)
   Inactive24,3481,0401.10 (0.97–1.24)8,3943301.20 (1.00–1.46)
Consume a healthy diet, with an emphasis on plant foods
 Diet quality score (number of recommendation met)d
  34,5831651 (Ref.)1,786491 (Ref.)
  211,8974541.10 (0.92–1.32)4,5281521.28 (0.93–1.78)
  134,0281,2561.17 (0.99–1.39)14,6404741.33 (0.97–1.81)
  010,5903651.16 (0.96–1.40)4,5551351.27 (0.90–1.78)
If you drink alcoholic beverages, limit consumption
 Alcohol consumptione
  Non and moderate49,5881,7631 (Ref.)19,4055701 (Ref.)
  Heavy11,5104771.17 (1.05–1.32)6,1042401.35 (1.14–1.60)
‘Stay away from tobacco’
 Smoking statusf
  Never22,8026471 (Ref.)8,7062251 (Ref.)
  Ever38,2961,5931.49 (1.35–1.64)16,8035851.30 (1.11–1.54)
   Former12,6675081.25 (1.11–1.40)4,2981341.04 (0.83–1.29)
   Current – Light17,2376861.64 (1.45–1.85)8,5852851.38 (1.14–1.69)
   Current – Heavy8,3923992.00 (1.74–2.30)3,9201661.81 (1.44–2.27)
  • NOTE: Participants without chronic disease at baseline include participants without a diagnosis of diabetes, hypertension, or chronic obstructive pulmonary disease.

  • Abbreviations: ACS, American Cancer Society; CI, confidence interval; Ref., reference.

  • aAmerican Cancer Society recommendations found at: and in Kushi et al. (2).

  • bAdjusted for enrolment source, race, family history of cancer, insurance coverage, education, income, marital status, neighborhood deprivation index, total energy intake, postmenopausal hormone use (women only), and the individual exposures included in the table.

  • cParticipants met current aerobic physical activity recommendations via sports and exercise if they reported ≥150 minutes/week of moderate activity, ≥75 minutes/week of vigorous activity, or ≥150 minutes/week of moderate and vigorous activity combined. Participants who did not meet the physical activity guideline were classified into two groups of ‘somewhat active’ and ‘inactive’ based on whether they were above or below the median for total activity (in MET-hrs).

  • dDiet quality score created by summing number of nutrition-related ACS sub-guidelines met (0–3) related to consumption of grains, red and processed meats, and fruits and vegetables.

  • eModerate alcohol consumption is defined as >0 but ≤1 drink/day for women or ≤2 drinks/day for men.

  • fLight current smoking is defined as smoking for <20 years or <20 cigarettes/day. Heavy current smoking is defined as smoking ≥20 cigarettes/day and for ≥20 years.