title: Adherence to the cancer prevention recommendations of the World Cancer Research Fund/American Institute for Cancer Research and mortality: a census-linked cohort.
abstract: BACKGROUND
  Modifiable lifestyle factors linked to cancer offer great potential for prevention. Previous studies suggest an association between adherence to recommendations on healthy lifestyle and cancer mortality.
  
  
  OBJECTIVE
  The aim of this study was to examine whether adherence to the cancer prevention recommendations of the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) is associated with reduced all-cause, total cancer, and specific cancer type mortality.
  
  
  METHODS
  We built a lifestyle score that included 3 categories, based on the recommendations of the WCRF/AICR. Applying Cox regression models, we investigated the association with all-cause, total cancer, and specific cancer type mortality; in addition, we included cardiovascular disease (CVD) mortality. We used census- and death registry-linked survey data allowing a mortality follow-up for ≤32 y. Our analysis included 16,722 participants. Information on lifestyle score components and confounders was collected at baseline.
  
  
  RESULTS
  Over a mean follow-up of 21.7 y, 3730 deaths were observed (1332 cancer deaths). Comparing best with poorest category of the lifestyle score showed an inverse association with all-cause (HR: 0.82; 95% CI: 0.75, 0.89) and total cancer (men only, HR: 0.69; 95% CI: 0.57, 0.84) mortality. We estimated that ∼13% of premature cancer deaths in men would have been preventable if lifestyle score levels had been high. Inverse associations were observed for lung, upper aerodigestive tract, stomach, and prostate cancer mortality [men and women combined, HR: 0.72; 95% CI: 0.51, 0.99; HR: 0.49; 95% CI: 0.26, 0.92; HR: 0.34; 95% CI: 0.14, 0.83; HR: 0.48; 95% CI: 0.28, 0.82 (men only), respectively]. CVD mortality was not associated with the lifestyle score (men and women combined, HR: 0.96; 95% CI: 0.82, 1.13).
  
  
  CONCLUSIONS
  Our results support the importance of adhering to recommendations for a healthy lifestyle with regard to all-cause and cancer mortality. To reduce the burden of cancer in the population, preventive measures should stress the potential of low-risk health behavior patterns rather than of specific risk factors only.
authors.affiliation: Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and tina.lohse@uzh.ch.
authors.forename: Tina
authors.initials: T
authors.lastname: Lohse
authors.affiliation: Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and Health Division-Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Faeh
authors.affiliation: Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bopp
authors.affiliation: Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and.
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control; D019352:Censuses; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006293:Health Promotion; D006306:Health Surveys; D000070497:Healthy Lifestyle; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality / Q000517:prevention & control*; D010349:Patient Compliance; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D014837:Voluntary Health Agencies; D014944:World Health Organization
keywords: WCRF/AICR recommendations; cancer; lifestyle; mortality; prevention