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. Key & 25 others Antonia 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

    Research output: Contribution to journalArticle

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    Abstract

    Background

    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.

    Methods

    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.

    Results

    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.

    Conclusions

    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
    Volume13
    Issue number1
    DOIs
    Publication statusPublished - 7 May 2015

    Fingerprint

    Colorectal Neoplasms
    Cohort Studies
    Guidelines
    Survival
    Research
    Neoplasms
    Mortality
    Confidence Intervals
    Exercise
    Diet
    Edible Plants
    Proportional Hazards Models
    Survivors
    Life Style
    Incidence

    Keywords

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

    ASJC Scopus subject areas

    • Medicine(all)

    Cite this

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

    In: BMC Medicine, Vol. 13, No. 1, 107, 07.05.2015.

    Research output: Contribution to journalArticle

    Romaguera, D, Ward, H, Wark, PA, Vergnaud, AC, Peeters, PH, van Gils, CH, Ferrari, P, Fedirko, V, Jenab, M, Boutron-Ruault, MC, Dossus, L, Dartois, L, Hansen, CP, Dahm, CC, Buckland, G, Sánchez, MJ, Dorronsoro, M, Navarro, C, Barricarte, A, Key, TJ, Trichopoulou, A, Tsironis, C, Lagiou, P, Masala, G, Pala, V, Tumino, R, Vineis, P, Panico, S, Bueno-de-Mesquita, HB, Siersema, PD, Ohlsson, B, Jirström, K, Wennberg, M, Nilsson, LM, Weiderpass, E, Kühn, T, Katzke, V, Khaw, KT, Wareham, NJ, Tjønneland, A, Boeing, H, Quirós, JR, Gunter, MJ, Riboli, E & Norat, T 2015, 'Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: A cohort study' BMC Medicine, vol. 13, no. 1, 107. https://doi.org/10.1186/s12916-015-0332-5
    Romaguera, Dora ; Ward, Heather ; Wark, Petra A. ; Vergnaud, Anne Claire ; Peeters, Petra H. ; van Gils, Carla H. ; Ferrari, Pietro ; Fedirko, Veronika ; Jenab, Mazda ; Boutron-Ruault, Marie Christine ; Dossus, Laure ; Dartois, Laureen ; Hansen, Camilla Plambeck ; Dahm, Christina Catherine ; Buckland, Genevieve ; Sánchez, María José ; Dorronsoro, Miren ; Navarro, Carmen ; Barricarte, Aurelio ; Key, Timothy J. ; Trichopoulou, Antonia ; Tsironis, Christos ; Lagiou, Pagona ; Masala, Giovanna ; Pala, Valeria ; Tumino, Rosario ; Vineis, Paolo ; Panico, Salvatore ; Bueno-de-Mesquita, H. Bas ; Siersema, Peter D. ; Ohlsson, Bodil ; Jirström, Karin ; Wennberg, Maria ; Nilsson, Lena M. ; Weiderpass, Elisabete ; Kühn, Tilman ; Katzke, Verena ; Khaw, Kay Tee ; Wareham, Nick J. ; Tjønneland, Anne ; Boeing, Heiner ; Quirós, José R. ; Gunter, Marc J. ; Riboli, Elio ; Norat, Teresa. / Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients : A cohort study. In: BMC Medicine. 2015 ; Vol. 13, No. 1.
    @article{7041a39354f34a8888b4ba70ba4b02b1,
    title = "Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: A cohort study",
    abstract = "BackgroundCancer 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.MethodsThe 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.ResultsThe 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.ConclusionsGreater 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.",
    keywords = "Colorectal cancer, Diet, Healthy lifestyle, Physical activity, Survival, Weight",
    author = "Dora Romaguera and Heather Ward and Wark, {Petra A.} and Vergnaud, {Anne Claire} and Peeters, {Petra H.} and {van Gils}, {Carla H.} and Pietro Ferrari and Veronika Fedirko and Mazda Jenab and Boutron-Ruault, {Marie Christine} and Laure Dossus and Laureen Dartois and Hansen, {Camilla Plambeck} and Dahm, {Christina Catherine} and Genevieve Buckland and S{\'a}nchez, {Mar{\'i}a Jos{\'e}} and Miren Dorronsoro and Carmen Navarro and Aurelio Barricarte and Key, {Timothy J.} and Antonia Trichopoulou and Christos Tsironis and Pagona Lagiou and Giovanna Masala and Valeria Pala and Rosario Tumino and Paolo Vineis and Salvatore Panico and Bueno-de-Mesquita, {H. Bas} and Siersema, {Peter D.} and Bodil Ohlsson and Karin Jirstr{\"o}m and Maria Wennberg and Nilsson, {Lena M.} and Elisabete Weiderpass and Tilman K{\"u}hn and Verena Katzke and Khaw, {Kay Tee} and Wareham, {Nick J.} and Anne Tj{\o}nneland and Heiner Boeing and Quir{\'o}s, {Jos{\'e} R.} and Gunter, {Marc J.} and Elio Riboli and Teresa Norat",
    year = "2015",
    month = "5",
    day = "7",
    doi = "10.1186/s12916-015-0332-5",
    language = "English",
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    journal = "BMC Medicine",
    issn = "1464-2662",
    publisher = "BioMed Central",
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    TY - JOUR

    T1 - Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients

    T2 - A cohort study

    AU - Romaguera, Dora

    AU - Ward, Heather

    AU - Wark, Petra A.

    AU - Vergnaud, Anne Claire

    AU - Peeters, Petra H.

    AU - van Gils, Carla H.

    AU - Ferrari, Pietro

    AU - Fedirko, Veronika

    AU - Jenab, Mazda

    AU - Boutron-Ruault, Marie Christine

    AU - Dossus, Laure

    AU - Dartois, Laureen

    AU - Hansen, Camilla Plambeck

    AU - Dahm, Christina Catherine

    AU - Buckland, Genevieve

    AU - Sánchez, María José

    AU - Dorronsoro, Miren

    AU - Navarro, Carmen

    AU - Barricarte, Aurelio

    AU - Key, Timothy J.

    AU - Trichopoulou, Antonia

    AU - Tsironis, Christos

    AU - Lagiou, Pagona

    AU - Masala, Giovanna

    AU - Pala, Valeria

    AU - Tumino, Rosario

    AU - Vineis, Paolo

    AU - Panico, Salvatore

    AU - Bueno-de-Mesquita, H. Bas

    AU - Siersema, Peter D.

    AU - Ohlsson, Bodil

    AU - Jirström, Karin

    AU - Wennberg, Maria

    AU - Nilsson, Lena M.

    AU - Weiderpass, Elisabete

    AU - Kühn, Tilman

    AU - Katzke, Verena

    AU - Khaw, Kay Tee

    AU - Wareham, Nick J.

    AU - Tjønneland, Anne

    AU - Boeing, Heiner

    AU - Quirós, José R.

    AU - Gunter, Marc J.

    AU - Riboli, Elio

    AU - Norat, Teresa

    PY - 2015/5/7

    Y1 - 2015/5/7

    N2 - BackgroundCancer 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.MethodsThe 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.ResultsThe 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.ConclusionsGreater 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.

    AB - BackgroundCancer 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.MethodsThe 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.ResultsThe 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.ConclusionsGreater 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.

    KW - Colorectal cancer

    KW - Diet

    KW - Healthy lifestyle

    KW - Physical activity

    KW - Survival

    KW - Weight

    U2 - 10.1186/s12916-015-0332-5

    DO - 10.1186/s12916-015-0332-5

    M3 - Article

    VL - 13

    JO - BMC Medicine

    JF - BMC Medicine

    SN - 1464-2662

    IS - 1

    M1 - 107

    ER -