Elsevier

Cancer Epidemiology

Volume 64, February 2020, 101629
Cancer Epidemiology

Adherence to the 2018 WCRF/AICR cancer prevention guidelines and chronic lymphocytic leukemia in the MCC-Spain study

https://doi.org/10.1016/j.canep.2019.101629Get rights and content

Highlights

  • The 2018 WCRF/AICR guidelines were examined in relation to chronic lymphocytic leukemia (CLL).

  • 318 CLL cases and 1293 controls from the MCC-Spain study were included.

  • Adherence to the 2018 WCRF/AICR recommendations was not associated with CLL.

Abstract

Introduction

Preventable risk factors for chronic lymphocytic leukemia (CLL) remain largely unknown. The aim of this study was to evaluate the association between adherence to nutrition-based guidelines for cancer prevention and CLL, in the MCC-Spain case–control study.

Methods

A total of 318 CLL cases and 1293 population-based controls were included in the present study. The World Cancer Research Fund/American Institute for Cancer Research (WCRC/AICR) score based on the 2018 recommendations for cancer prevention (on body fatness, physical activity, and diet) was constructed. We used logistic regression analysis adjusting for potential confounders.

Results

Individuals in the highest tertile of the WCRF/AICR score had an odds ratio for CLL of 1.25 (95 % CI 0.91; 1.73) compared with individuals with low adherence (p-trend = 0.172). Each point increment in the score was associated with an OR for CLL of 1.06 (95 % CI 0.91; 1.23). Analyses by severity of disease did not show significant heterogeneity of effects.

Conclusion

Overall, our results do not support an association between the WCRF/AICR score and CLL, yet we might have been limited by statistical power and study design to detect modest associations. Further research, ideally with a prospective design, long follow-up, and including additional lymphoma subtypes, is warranted to confirm the impact of composite healthy lifestyle behaviors on lymphoma risk.

Introduction

In 2018, the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) released a series of recommendations for cancer prevention, based on a comprehensive revision of the literature available at the time [1]. In line with the landmark report published in 2007 [2], the current guidelines aim to improve individuals' dietary and lifestyle patterns, including maintaining a lean body mass, participating in moderate physical activity, consuming a primarily plant-based diet, and minimizing the consumption of red and processed meats, fast food, energy-dense drinks, and alcohol. Adherence to such recommendations has been related to a lower risk of developing several solid neoplasms, namely breast cancer, in a number of studies [3,4]. However, to the date, no study has assessed its impact in hematological neoplasms.

Chronic lymphocytic leukemia (CLL) is the most common leukemia among the adult population, with an annual incidence rate of around 5 per 100,000 person-years in Europe [5]. Its etiology is poorly understood, with few well-established risk factors such as family history of hematological neoplasms and farming exposures, and several suggestive associations yet to be confirmed [6]. Among them, the role of modifiable lifestyle factors, including dietary habits, physical activity or body weight, remains uncertain. A population-based multicase–control study (MCC-Spain) was launched to evaluate the influence of lifestyle and environmental exposures and their interaction with genetic factors in CLL, among others [7]. In the present study, we assessed whether a composite measure of a healthy lifestyle, based on the 2018 WCRF/AICR recommendations for cancer prevention, is related to CLL.

Section snippets

Study population

MCC-Spain is a multicentric case–control study with population controls and cases with common tumors in Spain (prostate, breast, colorectal, gastroesophageal and CLL) [7]. Between 2010 and 2013, CLL cases aged 20–85 years were recruited in 11 Spanish hospitals from 5 Spanish provinces (Asturias, Barcelona, Cantabria, Girona and Granada). Simultaneously, population-based controls frequency-matched to cases, by age (5-year intervals), sex, and province of recruitment were randomly selected from

Results

Distribution of baseline characteristics between cases and controls are shown in the Appendix, Table A1 in Supplementary material. Compared with controls, cases were slightly older, showed a lower alcohol consumption, and were more likely to have a family history of hematological malignancy and to have ever worked in farming or agriculture. The distribution of key characteristics of controls according to adherence to the score is provided in the Appendix, Table A2 in Supplementary material.

Discussion

In this large population-based study, we did not find an association between greater adherence to the 2018 WCRF/AICR recommendations for cancer prevention and CLL. We cannot directly compare our results with other epidemiological studies since no previous study has researched the effect of the whole spectrum of nutrition, physical activity and body fatness on a hematological malignancy. However, our findings are in line with previous studies suggesting that lifestyle factors might have, at

Authorship contribution

Study conception and design: DC, MSo, DR

Acquisition of the data: YB, PA, EGL, RMG, LC, CR, EA, EB, EGB, JL, MMRS, M L-L, MA, EC, EGV, GCV, NA, MP, MK, SS, DC

Analysis of the data: MSo, EGL, AM

Interpretation of the data: DC, MSo, DR, MSa, RMG

Writing the article: MSo

Critical revision of the article: All authors approved the final manuscript and the decision to submit the manuscript.

Funding

This work was supported by Spanish Ministry of Economy and Competitiveness Juan de la Cierva de Incorporación grant IJCI-2014-20900. Spanish Ministry of Economy and Competitiveness - Carlos III Institute of Health cofunded by FEDER funds/European Regional Develpment Fund (ERDF) - a way to build Europe (grants PI17/01280, PI11/01810, PI14/01219, PI11/02213, PI09/1662, PI15/00966, RCESP C03/09, RTICESP C03/10, RTIC RD06/0020/0095, RD12/0036/0056, SV-09-CLINIC-1 and CIBERESP) and Agència de Gestió

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declaration of Competing Interest

None.

Acknowledgments

We thank all the subjects who participated in the study and all CLL MCC-Spain collaborators (the list can be found in Appendix).

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