Adherence to the 2018 WCRF/AICR cancer prevention guidelines and chronic lymphocytic leukemia in the MCC-Spain study
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).
References (28)
- et al.
Is concordance with World Cancer Research Fund/American Institute for Cancer research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study
Am. J. Clin. Nutr.
(2012) - et al.
Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project
Blood
(2010) - et al.
Population-based multicase-control study in common tumors in Spain (MCC-Spain): rationale and study design
Gac. Sanit.
(2015) - et al.
Food, nutrient and heterocyclic amine intake and the risk of bladder cancer
Eur. J. Cancer
(2007) - et al.
Body size and obesity during adulthood, and risk of lympho-haematopoietic cancers: an update of the WCRF-AICR systematic review of published prospective studies
Ann. Oncol. Off. J. Eur. Soc. Med. Oncol.
(2019) - et al.
Food of animal origin and risk of non-Hodgkin lymphoma and multiple myeloma: a review of the literature and meta-analysis
Crit. Rev. Oncol. Hematol.
(2016) Diet, Nutrition, Physical Activity, and Cancer: a Global Perspective. Continuous Update Project Expert Report
(2018)Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective
(2007)Operationalising the WCRF/AICR cancer prevention recommendations using an index score: recent meta-analysis in relation to cancer incidence and mortality
- et al.
Medical history, lifestyle, family history, and occupational risk factors for chronic lymphocytic leukemia/small lymphocytic lymphoma: the interlymph non-hodgkin lymphoma subtypes project
JNCI Monogr.
(2014)
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues
Using cross-check questions to address the problem of mis-reporting of specific food groups on Food Frequency Questionnaires. UKWCS Steering Group. United Kingdom Women’s Cohort Study Steering Group
Eur. J. Clin. Nutr.
Do cross-check questions improve food frequency questionnaire data?
IARC Sci. Publ.
Cited by (10)
Low to moderate adherence to 2018 diet and physical exercise recommendations of the World Cancer Research Fund/American Institute for Cancer Research is associated with prooxidant biochemical profile in women undergoing adjuvant breast cancer treatment
2023, Nutrition ResearchCitation Excerpt :Also, proper adherence to the recommendations of the WCRF/AICR can be directly associated with the modulation of oxidative stress and antioxidant capacity because it advocates consuming foods rich in compounds with antioxidant action and encourages physical exercise [4]. However, investigations are still quite limited regarding the association of adherence to WCRF/AICR recommendations and oxidative stress biomarkers, especially considering the updated guidelines of the 2018 report [4,25] and the assessment of women undergoing adjuvant treatment (AT) of breast cancer. Therefore, this study aims to investigate the influence of adherence to the updated recommendations of the WCRF/AICR on oxidative stress biomarkers in women with breast cancer.
Physical activity and the risk of non-Hodgkin lymphoma subtypes: A pooled analysis
2023, International Journal of CancerThe 2018 World Cancer Research Fund/American Institute for Cancer Research Score and Cancer Risk: A Longitudinal Analysis in the NIH-AARP Diet and Health Study
2022, Cancer Epidemiology Biomarkers and Prevention