Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: A cohort study

Dora Romaguera, Heather Ward, Petra A. Wark, Anne Claire Vergnaud, Petra H. Peeters, Carla H. van Gils, Pietro Ferrari, Veronika Fedirko, Mazda Jenab, Marie Christine Boutron-Ruault, Laure Dossus, Laureen Dartois, Camilla Plambeck Hansen, Christina Catherine Dahm, Genevieve Buckland, María José Sánchez, Miren Dorronsoro, Carmen Navarro, Aurelio Barricarte, Timothy J. KeyAntonia Trichopoulou, Christos Tsironis, Pagona Lagiou, Giovanna Masala, Valeria Pala, Rosario Tumino, Paolo Vineis, Salvatore Panico, H. Bas Bueno-de-Mesquita, Peter D. Siersema, Bodil Ohlsson, Karin Jirström, Maria Wennberg, Lena M. Nilsson, Elisabete Weiderpass, Tilman Kühn, Verena Katzke, Kay Tee Khaw, Nick J. Wareham, Anne Tjønneland, Heiner Boeing, José R. Quirós, Marc J. Gunter, Elio Riboli, Teresa Norat

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    Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients.


    The association between the WCRF/AICR score (score range 0–6 in men and 0–7 in women; higher scores indicate greater concordance) assessed on average 6.4 years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2 years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality.


    The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25–2.75/3.25–3.75), third (3–3.75/4–4.75), and fourth (4–6/5–7) categories of the score were 0.87 (0.72–1.06), 0.74 (0.61–0.90), and 0.70 (0.56–0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0–2/0–3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models.


    Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.

    Original languageEnglish
    Article number107
    JournalBMC Medicine
    Issue number1
    Publication statusPublished - 7 May 2015


    • Colorectal cancer
    • Diet
    • Healthy lifestyle
    • Physical activity
    • Survival
    • Weight

    ASJC Scopus subject areas

    • Medicine(all)


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