Abstract
Limited longitudinal studies have been conducted to evaluate colorectal cancer (CRC) incidence based on the updated 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations or other global lifestyle indices, and none in aged populations at high cardiovascular risk. We aimed to assess the association between CRC incidence and adherence to two emerging lifestyles indices (2018 WCRF/AICR score and another low-risk lifestyle (LRL) score comprising smoking status, alcohol consumption, physical activity, diet, and body mass index) in the Spanish PREvencion con DIeta MEDiterranea (PREDIMED) cohort. We studied 7216 elderly men and women at high cardiovascular risk. The 2018 WCRF/AICR and LRL scores were calculated. Multivariable Cox proportional regression models were fitted to estimate the HRs (hazard ratios) and 95% confidence intervals (CIs) for incident CRC events. During a median interquartile range (IQR) follow-up of 6.0 (4.4–7.3) years, 97 CRC events were considered. A significant linear association was observed between each 1-point increment in the WCRF/AICR score (score range from 0 to 7) and CRC risk (HR (95% CI) = 0.79 (0.63–0.99)). Similarly, each 1-point increment in the LRL score (score range from 0 to 5) was associated with a 22% reduction in CRC risk (0.78 (0.64–0.96)). Adhering to emergent lifestyle scores might substantially reduce CRC incidence in elderly individuals. Further longitudinal studies, which take different lifestyle indexes into account, are warranted in the future.
Highlights
Worldwide, colorectal cancer (CRC) is an important public health problem since it is the second most commonly occurring cancer in women and the third in men
In an attempt to know whether using scores based on overall lifestyle patterns may be useful to prevent CRC in aging individuals, we aimed to evaluate the associations between adherence to the 2018 WCRF/AICR and LRL scores with CRC incidence in elderly Spanish individuals at high cardiovascular disease (CVD) risk
confidence intervals (CIs)) = 0.71 (0.52-0.95; p for trend = 0.021) than in individuals with type 2 diabetes (T2D) at baseline (HR model 2 = 0.81 (0.62–1.06; P for trend = 0.443). This prospective cohort study showed that adherence to the most recent 2018 WCRF/AICR recommendations, as well as accomplishing a cluster of LRL factors, was inversely associated with CRC incidence in elderly Mediterranean individuals at high cardiovascular risk
Summary
Colorectal cancer (CRC) is an important public health problem since it is the second most commonly occurring cancer in women and the third in men. CRC is the second most common cause of cancer death in both sexes globally. There is convincing evidence that some dietary components (i.e., processed meat and alcohol intake) and body fatness are modifiable risk factors, contributing to the development of CRC, whereas physical activity decreases the risk [2]. Since foods are not consumed in isolation and have additive or synergistic health-related effects, the current literature focuses on examining diet as a multidimensional exposure [3]. Several a priori defined food groups and general index-based dietary patterns have been associated with lower CRC risk, supporting the hypothesis that high overall diet quality is associated with decreased CRC risk [4,5]
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