title: Adherence to the WCRF/AICR cancer prevention recommendations and cancer-specific mortality: results from the Vitamins and Lifestyle (VITAL) Study.
abstract: OBJECTIVE
  In 2007, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) released eight recommendations related to body fatness, physical activity, and diet aimed at preventing the most common cancers worldwide. The purpose of this paper is to estimate the association between meeting these recommendations and cancer-specific mortality.
  
  
  METHODS
  We operationalized six recommendations (related to body fatness; physical activity; and consumption of foods that promote weight gain, plant foods, red and processed meat, and alcohol) and examined their association with cancer-specific mortality over 7.7 years of follow-up in the Vitamins and Lifestyle (VITAL) Study cohort. Participants included 57,841 men and women ages 50-76 in 2000-2002 who had not been diagnosed with cancer prior to baseline. Cancer-specific deaths (n = 1,595) were tracked through the Washington State death file.
  
  
  RESULTS
  Meeting the recommendations related to plant foods and foods that promote weight gain were most strongly associated with lower cancer-specific mortality [hazard ratio (HR) 0.82, 95 % confidence interval (CI) 0.67, 1.00 and HR 0.82, 95 % CI 0.70, 0.96, respectively]. Cancer-specific mortality was 61 % lower in respondents who met at least five recommendations compared to those who met none (HR 0.39, 95 % CI 0.24, 0.62). Cancer-specific mortality was 10 % lower on an average with each additional recommendation met (per-recommendation HR 0.90, 95 % CI 0.85, 0.94; p trend < 0.001). This association did not differ by sex or age but was stronger in non-smokers (HR 0.84, 95 % CI 0.76, 0.92) than in smokers (HR 0.93, 95 % CI 0.87, 0.98; p interaction = 0.086).
  
  
  CONCLUSIONS
  Adherence to the WCRF/AICR cancer prevention recommendations developed to reduce incidence of common cancers could substantially reduce cancer-specific mortality in older adults.
authors.affiliation: Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-262, Box 357236, Seattle, WA, 98195-7236, USA, thastert@umich.edu.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Hastert
authors.forename: Shirley A A
authors.initials: SA
authors.lastname: Beresford
authors.forename: Lianne
authors.initials: L
authors.lastname: Sheppard
authors.forename: Emily
authors.initials: E
authors.lastname: White
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D014815:Vitamins