American Institute For Cancer Research Research Articles

Abstract B058: Positive changes in diet quality among African American breast cancer survivors from Moving Forward, a weight loss intervention program

Abstract Background: African American breast cancer survivors (AABCS) experience higher rates of all-cause mortality and recurrence risk compared to survivors of other races/ethnicities. Although disparities are multi-factorial, lifestyle is a key factor in cancer survivorship, comorbidity burden and quality of life. The American Cancer Society (ACS) and American Institute for Cancer Research (AICR) have set nutrition and physical activity guidelines for cancer survivors. This study examines the between and with-in group differences of diet quality and related outcomes among AABCS enrolled in Moving Forward (MF).  Methods:  MF was a 6-month, community-based, weight-loss intervention trial for AABCS. Participants were randomized to either an Interventionist-Guided (IG) or Self-Guided (SG) group. Both groups received educational materials to promote lifestyle changes. The IG group also received twice weekly group sessions with supervised exercise and group support. Participants completed surveys on diet quality (Block 2005 Food Frequency Questionnaires (FFQ)) and related outcomes, and fitness assessments at baseline, post-intervention and at a 12-month follow-up. Diet quality was scored using the Healthy Eating Index (HEI-2010) range 0-100, Alternative Healthy Eating Index (AHEI-2010) range 0-110, and ACS/AICR guidelines range 0-21 to measure adherence pre- and post-intervention. Results: 180 AABCS completed the FFQ at all 3 timepoints and were included in these analyses. Participants had a mean age of 57.6 ± 10.6, 40.2% were married/living with a partner, and had varied income and education levels. Participants were an average of 7.2 years from diagnosis (range 0.8-35.1 years), 99% had surgery, 78% had radiation and 74% had chemotherapy. At baseline, mean diet scores were 65.3 for HEI-2010, 56.7 for AHEI-2010, and 12.7 for ACS/AICR guidelines. Although results varied among the 3 diet indices, participants in the IG group saw significant improvements in fruit, vegetable, and whole grain consumption with decreased sugar, empty calorie, and trans fat consumption from baseline to 6 and 12 months. Both groups saw improvements in total scores for all 3 diet indices from baseline to 6 and 12 months. The SG group improved in limiting sugars and empty calories from baseline to follow-up timepoints. The IG group saw greater improvements in fruit and vegetable consumption compared to SG group in all 3 diet indices. Body Mass Index and physical activity were significantly improved in both groups but social support, self-efficacy, and perceived barriers to healthy eating were significantly improved in the IG group only. Conclusion: Overall diet quality scores were suboptimal at baseline showing a need for positive dietary change among AABCS, and a need for more evidence considering diet quality and social predictors of dietary intake in this community. Data from culturally tailored and community-based interventions like MF can be used to develop effective, sustainable strategies to improve diet quality and related outcomes in AABCS even after an intervention ends. Citation Format: Margaret Y. Tovar, Sparkle Springfield, Melinda Stolley. Positive changes in diet quality among African American breast cancer survivors from Moving Forward, a weight loss intervention program [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B058.

Abstract A089: Examining the role of Social Determinants of Health (SDoH) on adherence to cancer prevention recommendations: Evidence from a national representative sample

Abstract The role of Social Determinants of Health (SDoH)  on adherence to cancer prevention recommendations has not been systematically examined among adults in the United States adults despite  the influential role of SDoH in shaping individuals' health behaviors and outcomes. Our purpose was to  explore the effects of SDoH on adherence to cancer prevention recommendations among  adults in the United States Methods: We used data from the Health Information National Trends Survey (HINTS), 6 cycle (2022).  Adults aged 18 years and above were included. Adherence to cancer prevention recommendations was measured with the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations Score.  SDoH was measured based on the American Cancer society's five core SDOH domains (economic stability, social and community context, neighborhood and built environment, education access, and healthcare access). Weighted hierarchical multiple regression models were conducted using each domain of SDOH as a block, controlling for age, gender, race, selfcare efficacy, cormorbidity, cancer risk perception and  belief about cancer,  Jackknife replicate weights were incorporated into the analyses. Results: The sample consisted of 6252 respondents with a mean age of 55.6 (SD, 17.4) years,  The  estimated mean adherence rate  to cancer prevention recommendations among adults in the United States was  40.4% (SD 21.8) .Adherence to  cancer prevention recommendations was positively associated with  having a college education compare to less than high school education (Odd Ratio [OR], 6.29, P = .019),  combined household income of $75,000 and above compare to combined household income of less than $20,000 ( OR, 5.11 , P= .014) , retired compared to full-time employement ( OR, 4.87, P < .001), access to health insurance compared to lack of health insurance  (OR, 4.01, P= .020). These findings suggest that  interventions targeting  the effects of SDoH on cancer on adherence to cancer prevention recommendations may consider the  socioeconomic context of targeted individuals. Such interventions should focus on addressing barriers related to education access, income stability, employment status  and healthcare access.   Citation Format: Adaeze Aroh, Ifeanyi N. Madujibeya. Examining the role of Social Determinants of Health (SDoH) on adherence to cancer prevention recommendations: Evidence from a national representative sample [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A089.

Adherence to the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations and risk of 14 lifestyle-related cancers in the UK Biobank prospective cohort study

BackgroundThe World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations are lifestyle-based recommendations which aim to reduce cancer risk. This study investigated associations between adherence, assessed using a standardised scoring system, and the risk of all cancers combined and of 14 cancers for which there is strong evidence for links with aspects of lifestyle in the UK.MethodsWe used data from 94,778 participants (53% female, mean age 56 years) from the UK Biobank. Total adherence scores (range 0–7 points) were derived from dietary, physical activity, and anthropometric data. Associations between total score and cancer risk (all cancers combined; and prostate, breast, colorectal, lung, uterine, liver, pancreatic, stomach, oesophageal, head and neck, ovarian, kidney, bladder, and gallbladder cancer) were investigated using Cox proportional hazard models, adjusting for age, sex, deprivation index, ethnicity, and smoking status.ResultsMean total score was 3.8 (SD 1.0) points. During a median follow-up of 8 years, 7296 individuals developed cancer. Total score was inversely associated with risk of all cancers combined (HR: 0.93; 95%CI: 0.90–0.95 per 1-point increment), as well as breast (HR: 0.90; 95%CI: 0.86–0.95), colorectal (HR: 0.90; 95%CI: 0.84–0.97), kidney (HR: 0.82; 95%CI: 0.72–0.94), oesophageal (HR: 0.84; 95%CI: 0.71–0.98), ovarian (HR: 0.76; 95%CI: 0.65–0.90), liver (HR: 0.78; 95%CI: 0.63–0.97), and gallbladder (HR: 0.70; 95%CI: 0.53–0.93) cancers.ConclusionsGreater adherence to lifestyle-based recommendations was associated with reduced risk of all cancers combined and of breast, colorectal, kidney, oesophageal, ovarian, liver, and gallbladder cancers. Our findings support compliance with the Cancer Prevention Recommendations for cancer prevention in the UK.

Socio-demographic variation in adherence to the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations within the UK Biobank prospective cohort study.

The 2018 (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations are evidence-based lifestyle recommendations which aim to reduce the risk of cancer worldwide. Sociodemographic factors modulate lifestyle behaviours, and both cancer incidence and survival are socio-economically patterned. We investigated adherence to these recommendations and examined patterns of adherence across sociodemographic subgroups in the UK Biobank cohort. We included 158 415 UK Biobank participants (mean age 56years, 53% female). Total adherence scores were derived from dietary, physical activity and anthropometric data using the 2018 WCRF/AICR standardized scoring system. One-Way analysis of variance (ANOVA) was used to test for differences in total scores and in values for individual score components according to sociodemographic factors and Pearson's Χ2 test to investigate associations between sociodemographic factors according to tertiles of adherence score. Mean total adherence score was 3.85 points (SD 1.05, range 0-7 points). Higher total scores were observed in females, and older (>57years), Chinese or South Asian, and more educated participants. We found significant variations in adherence to individual recommendations by sociodemographic factors including education, Townsend deprivation index and ethnicity. Identifying and understanding lifestyle and dietary patterns according to sociodemographic factors could help to guide public health strategies for the prevention of cancers and other non-communicable diseases.

Abbreviated Score to Assess Adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations and Risk of Cancer in the UK Biobank.

The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations are lifestyle-based guidelines which aim to reduce cancer risk. This study investigated, in the UK Biobank, associations between an abbreviated score to assess adherence to these Recommendations and the risk of all cancers combined and of 14 cancers for which there is strong evidence for links with diet, adiposity, and physical activity. We used data from 288,802 UK Biobank participants (mean age 56.2 years), cancer-free at baseline. An abbreviated version of the 2018 WCRF/AICR Score was calculated to assess adherence to five Recommendations on (i) body weight, (ii) physical activity, (iii) fruits, vegetables, and dietary fiber, (iv) red and processed meat, and (v) alcohol. Multivariable Cox proportional hazards models were used to analyze associations between the abbreviated score (range, 0-5 points) and cancer incidence, adjusting for confounders. During a median follow-up of 8.2 years (interquartile range, 7.4-8.9), 23,448 participants were diagnosed with cancer. The abbreviated score was inversely associated with risk of cancer overall [HR: 0.93; 95% confidence interval (CI): 0.92-0.95 per 1-point increment], and breast (HR: 0.90; 95% CI: 0.87-0.94), colorectal (HR: 0.86; 95% CI: 0.83-0.90), lung (HR: 0.89; 95% CI: 0.84-0.94), kidney (HR: 0.83; 95% CI: 0.76-0.90), pancreatic (HR: 0.86; 95% CI: 0.79-0.94), uterine (HR: 0.79; 95% CI: 0.73-0.86), esophageal (HR: 0.82; 95% CI: 0.75-0.90), stomach (HR: 0.89; 95% CI: 0.79-0.99), and liver (HR: 0.80; 95% CI: 0.72-0.90) cancers. Greater adherence to the Cancer Prevention Recommendations, assessed using an abbreviated score, was associated with reduced risk of all cancers combined and of nine site-specific cancers. Our findings support compliance to these Recommendations for cancer prevention.

Associations of Adherence to the 2018 World Cancer Research Fund and the American Institute for Cancer Research Dietary Recommendations with Gut Microbiota and Inflammation Levels.

Whether the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) dietary recommendations affect the gut microbiota and inflammatory status remains unclear. We examined the association of dietary adherence scores to the WCRF/AICR with gut microbiota and inflammation in a cross-sectional setting. The WCRF/AICR diet adherence scores were calculated for 151 participants (adenoma 97, non-adenoma 54) from 7-day dietary records. The gut microbiota was analyzed by 16S rRNA gene sequencing of fecal samples. The levels of inflammatory biomarkers in both blood (i.e., IL-6, IL-8, IgA, IgM, and IgG) and fecal samples (i.e., FCP) were evaluated in 97 colorectal adenoma patients who had blood samples available. Multivariable linear regression analyses were conducted to examine the association of individual and total dietary adherence scores with gut microbiota and inflammatory biomarker levels. Participants with higher adherence had lower relative abundance of Proteobacteria (β = -0.041, 95%CI: -0.073, -0.009), Enterobacteriaceae (β = -0.035, 95%CI: -0.067, -0.003), and unidentified Enterobacteriaceae at the genus level (β = -0.029, 95%CI: -0.055, -0.003) compared to those with lower adherence. Plant-based food intake was positively correlated with increased abundance of Phascolarctobacterium (β = 0.013, 95%CI: 0.001, 0.026). Restricting fast food was linked to high abundance of Bacteroidaceae (β = 0.149, 95%CI: 0.040, 0.257) and Bacteroides (β = 0.149, 95%CI: 0.040, 0.257). Limiting sugary drinks was associated with reduced abundance of Lachnospiraceae (β = -0.155, 95%CI: -0.292, -0.018). Plant-based food intake (β = -0.251, 95%CI: -0.450, -0.052) and restriction of fast food (β = -0.226, 95%CI: -0.443, -0.008) were associated with reduced IGG levels in men. Alcohol restriction was linked to lower IL-6 (β = -7.095, 95%CI: -11.286, -2.903) and IL-8 (β = -7.965, 95%CI: -14.700, -1.230) levels in women, but with higher IL-6 (β = 0.918, 95%CI: 0.161, 1.675) levels in men. Our findings support the association of adherence to the WCRF/AICR diet with gut microbiota and inflammation. These results need to be validated in additional prospective or interventional studies.

Different operationalizations of the 2018 WCRF/AICR cancer prevention recommendations and risk of cancer.

The standardized scoring system assessing adherence to the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) cancer prevention recommendations assigns equal weight for each recommendation, thereby giving higher weight to dietary factors collectively (5 points) than adiposity (1 point) and physical activity (1 point). An alternative score assigning equal weights to the adiposity, physical activity, alcohol, and other dietary (composite) recommendations may better predict cancer associations. We examined associations between standardized and alternative scores with cancer risk in two US prospective cohorts. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression. During 28 years of follow-up, 16,342 incident cancer cases in women and 8729 cases in men occurred. Individuals in the highest versus lowest quintile of the standardized score had a reduced overall cancer risk (women: HR = 0.89, 95% CI: 0.85, 0.94; men: HR = 0.87, 95% CI: 0.81, 0.94). Results were slightly stronger for the alternative score (women: HR = 0.83, 95% CI: 0.79, 0.87; men: HR = 0.81, 95% CI: 0.75, 0.86). Similar patterns were observed for obesity-related, alcohol-related, smoking-related, and digestive system cancers. Greater adherence to the WCRF/AICR cancer prevention recommendations was associated with lower cancer risk. A score assigning equal weights to the adiposity, physical activity, alcohol, and all remaining diet components yielded stronger associations than the standardized score.

Determinants and changes in adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer-prevention recommendations over the past 25 years in Switzerland.

The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) established 10 lifestyle recommendations for cancer prevention. The current study examines the proportion and changes over 25 years of adherence to these recommendations and their determinants in Switzerland. On the basis of six Swiss Health Surveys (1992-2017, N = 110 478), an index reflecting adherence to the 2018 WCRF/AICR cancer-prevention recommendations was created. Multinomial logistic regression models were fitted to investigate changes over time and determinants of a cancer-protective lifestyle. Adherence to cancer-prevention recommendations was moderate and higher in the years 1997-2017 compared to 1992. Higher adherence was observed among women (odds ratio [OR]high vs. low adherence ranging from 3.31 to 3.74) and participants with a tertiary education level (ORhigh vs. low adherence ranging from 1.71 to 2.18), and lower adherence among participants of the oldest age group (ORhigh vs. low adherence ranging from 0.28 to 0.44) and participants of the Switzerland (lat.: Confoederatio helvetica)-French language regions (ORhigh vs. low adherence ranging from 0.53 to 0.73). Our results showed that cancer-prevention recommendations are not well followed by the general Swiss population, as the adherence to a cancer-protective lifestyle was generally moderate; however, adherence to cancer-prevention recommendations improved over the past 25 years. Sex, age group, education level, and language regions were significant determinants of adherence to a cancer-protective lifestyle. Further actions at the governmental and individual levels promoting the adoption of a cancer-protective lifestyle are needed.

Does adherence to cancer prevention guidelines before diagnosis associate with improved cancer survival?

10582 Background: The American Institute for Cancer Research and American Cancer Society regularly publish cancer prevention recommendations for decreasing cancer risk. Which lifestyles, or whether they work together to impact cancer survival is not well established. We examined associations of adherence to cancer prevention recommendations with mortality in 5,766 patients enrolled in the Data Bank and BioRepository at Roswell Park. Methods: Patients were newly diagnosed between 2003 and 2016 with a variety of pathologically confirmed invasive malignancies. Detailed epidemiological data including lifestyles one year prior to diagnosis were linked with Tumor Registry data. The primary analytic exposure was a composite Lifestyle Index Score (LIS) created in accordance with previously published standardization guidance; the primary analytic outcome was all-cause mortality. The LIS comprised seven lifestyles including: physical activity (PA); body mass index (BMI); fruit and vegetable (FV) intake; red and processed meat (RPM) intake; sugar sweetened beverage (SSB) consumption; alcohol consumption; and smoking status. Kaplan Meier analyses were used to compare survival experience according to LIS tertiles. Multivariable Cox proportional hazard models adjusted for age, tumor type, stage, and sex were used to estimate the associations of the LIS and each lifestyle factor with mortality in the overall study population and according to tumor stage. Results: During follow-up through April 2022, we observed 2,316 deaths (median follow-up 6.9 years). Patients reporting strongest adherence to prevention recommendations (highest LIS tertile) had significantly improved survival compared to patients with the lowest LIS (93.0 vs. 75.0 months, respectively; log-rank p < 0.0001). In multivariable analyses, the highest versus lowest LIS tertile was associated with a 17% reduction in mortality in the overall study population (HR = 0.83, 95% CI: 0.74-0.93). Significant mortality reductions were observed in patients diagnosed with both early- and late-stage disease (HR = 0.73, 95% CI: 0.59-0.90 and HR = 0.85, 95% CI: 0.73-0.99, respectively). Being a never smoker (HR = 0.54, 95% CI: 0.47-0.62), meeting the PA Guidelines (HR = 0.74, 95% CI: 0.66-0.83), and highest FV intake (HR = 0.82, 95% CI: 0.73-0.91) were the only independent factors associated with significant reductions in mortality. Conclusions: Strongest adherence to the cancer prevention recommendations before diagnosis was associated with significant reductions in mortality. These findings provide additional evidence that modifiable lifestyle factors can impact cancer survival, even among patients diagnosed with advanced-stage disease. Confirmatory studies examining post-diagnosis lifestyles are needed so that lifestyle assessment tools, education, and intervention can be clinically leveraged to improve patient outcomes.

Adherence to Cancer Prevention Lifestyle Recommendations Before, During, and 2 Years After Treatment for High-risk Breast Cancer

The American Institute for Cancer Research and American Cancer Society regularly publish modifiable lifestyle recommendations for cancer prevention. Whether these recommendations have an impact on high-risk breast cancer survival remains unknown. To investigate whether adherence to cancer prevention recommendations before, during, and 1 and 2 years after breast cancer treatment was associated with disease recurrence or mortality. The Diet, Exercise, Lifestyles, and Cancer Prognosis Study (DELCaP) was a prospective, observational cohort study designed to assess lifestyles before diagnosis, during treatment, and at 1 and 2 years after treatment completion, implemented ancillary to the Southwest Oncology Group (SWOG) S0221 trial, a multicenter trial that compared chemotherapy regimens in breast cancer. Participants were chemotherapy-naive patients with pathologic stage I to III high-risk breast cancer, defined as node-positive disease with hormone receptor-negative tumors larger than 1 cm or any tumor larger than 2 cm. Patients with poor performance status and comorbidities were excluded from S0221. The study was conducted from January 1, 2005, to December 31, 2010; mean (SD) follow-up time for those not experiencing an event was 7.7 (2.1) years through December 31, 2018. The analyses reported herein were performed from March 2022 to January 2023. An aggregated lifestyle index score comprising data from 4 time points and 7 lifestyles, including (1) physical activity, (2) body mass index, (3) fruit and vegetable consumption, (4) red and processed meat intake, (5) sugar-sweetened beverage consumption, (6) alcohol consumption, and (7) smoking. Higher scores indicated healthier lifestyle. Disease recurrence and all-cause mortality. A total of 1340 women (mean [SD] age, 51.3 [9.9] years) completed the baseline questionnaire. Most patients were diagnosed with hormone-receptor positive breast cancer (873 [65.3%]) and completed some education beyond high school (954 [71.2%]). In time-dependent multivariable analyses, patients with highest vs lowest lifestyle index scores experienced a 37.0% reduction in disease recurrence (hazard ratio, 0.63; 95% CI, 0.48-0.82) and a 58.0% reduction in mortality (hazard ratio, 0.42; 95% CI, 0.30-0.59). In this observational study of patients with high-risk breast cancer, strongest collective adherence to cancer prevention lifestyle recommendations was associated with significant reductions in disease recurrence and mortality. Education and implementation strategies to help patients adhere to cancer prevention recommendations throughout the cancer care continuum may be warranted in breast cancer.

Role of walnut-derived urolithins in reducing colonic inflammation in a patient cohort elucidated by an integrated omics analysis.

Abstract Diet can directly affect colon health and cancer risk. For example, the polyphenolic ellagitannins (punicigalin) that are present in walnuts are converted by the microbiome to a panel of bioactive urolithin metabolites. In particular, urolithin A has been studied for its anti-inflammatory and anti-cancer properties. In this pilot clinical trial, we evaluate the effects of walnut consumption (2-oz per day) on urinary urolithins and blood serum inflammatory markers, as well as on the transcriptome of normal colon and polyp tissue in 38 healthy obese and non-obese subjects. Our in-depth computational analysis of metabolomics and proteomics data suggests that subjects with higher urolithin A formation show significantly lower levels of several key serological markers of inflammation, including C-Peptide, sICAM-1, sIL6-R, Ghrelin, TRAIL, sVEGFR2, MCP2, and Haptoglobin. Furthermore, RNA-Seq transcriptomic analysis of colon tissue taken from proximal and distal colon shows reduced inflammatory programs and activation of the KICSTOR complex in subjects with higher urolithin A formation. These studies indicate that higher urolithin A formation is linked to an anti-inflammatory response, warranting further studies to better understand the role of urolithins in the inflammatory process. Supported by grants from American Institute for Cancer Research, California Walnut Commission, and National Cancer Institute (R01 CA252045).

Nodular Regenerative Hyperplasia of the Liver Associated With Vascular Endothelial Growth Factor Tyrosine Kinase Inhibitor in a Patient With Metastatic Renal Cell Carcinoma.

Article Tools CASE REPORTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/PO.22.00625 JCO Precision Oncology no. 7 (2023) e2200625. Published online April 13, 2023. PMID: 37053537 Nodular Regenerative Hyperplasia of the Liver Associated With Vascular Endothelial Growth Factor Tyrosine Kinase Inhibitor in a Patient With Metastatic Renal Cell Carcinoma Shannon Rudolph, BS1xShannon RudolphSearch for articles by this author; Mingjia Li , MD2xMingjia LiSearch for articles by this author; Jinesh Gheeya , MD, PhD2xJinesh GheeyaSearch for articles by this author; Danielle Zimmerman , MD2xDanielle ZimmermanSearch for articles by this author; Ming Yin, MD2xMing YinSearch for articles by this author; Steven K. Clinton, MD, PhD2xSteven K. ClintonSearch for articles by this author; Anil V. Parwani, MD, PhD, MBA3xAnil V. ParwaniSearch for articles by this author; and Yuanquan Yang , MD, PhD2xYuanquan YangSearch for articles by this author Show More 1The College of Medicine, The Ohio State University, Columbus, OH2Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH3Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH https://doi.org/10.1200/PO.22.00625 First Page Full Text PDF Figures and Tables © 2023 by American Society of Clinical OncologySUPPORTNational Cancer Institute grant K12CA133250 to Y. Y.AUTHOR CONTRIBUTIONSConception and design: Ming Yin, Yuanquan YangAdministrative support: Steven K. ClintonCollection and assembly of data: Shannon Rudolph, Mingjia Li, Jinesh Gheeya, Danielle Zimmerman, Anil V. ParwaniData analysis and interpretation: Shannon Rudolph, Mingjia Li, Jinesh Gheeya, Steven K. ClintonManuscript writing: All authorsFinal approval of manuscript: All authorsAccountable for all aspects of the work: All authorsAUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTERESTThe following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/po/author-center.Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).Ming YinStock and Other Ownership Interests: NovavaxSteven K. ClintonResearch Funding: NIH, American Institute for Cancer Research, American Cancer Society, Department of Defense-Prostate Cancer Research Program, United States Department of Agriculture, The National Cattleman's Beef AssociationYuanquan YangStock and Other Ownership Interests: PfizerConsulting or Advisory Role: The whiteoak groupSpeakers' Bureau: AstraZenecaResearch Funding: Incyte (Inst), Novartis (Inst), Amgen (Inst)No other potential conflicts of interest were reported.

Abstract P5-08-07: Dietary patterns among women with early-stage breast cancer from the Healthy Living Program

Abstract Background: Diet is a modifiable risk factor for breast cancer risk and mortality. Current guidelines recommend a diet that provides a diverse array of nutrients, comprised predominantly of fruits/vegetables and whole grains, with limited added sugar. The Healthy Living Program (HLP) is a clinical program at Memorial Sloan Kettering Cancer Center for patients with early-stage breast cancer that offers longitudinal, personalized lifestyle management starting at the time of diagnosis. Here, we report dietary patterns among the HLP cohort and association with baseline body mass index (BMI). Methods: We included all patients enrolled in the HLP from September 2020-February 2022. At the time of enrollment, participants complete a survey containing the National Cancer Institute (NCI) Dietary Screener Questionnaire (DSQ), which consists of consumption frequency questions for 26 food items over the past month. Total daily intake equivalents are calculated for foods from every diet factor group according to standard NCI DSQ scoring as follows: 1) Total daily cup equivalents of fruits/vegetables, which includes fruit, fruit juice, salad, potatoes, beans, other vegetables, tomato sauce, salsa, and pizza; 2) Total daily ounce equivalents of whole grains, which includes cereal, whole grain bread, whole grain rice, and popcorn; 3) Total teaspoon (tsp) equivalents of added sugars from candy, doughnuts, cookies/cake/pie, cereal, ice cream, and sugar-sweetened beverages including soda, fruit drinks, and sugar/honey in coffee/tea. Adherence to recommended daily intake of fruits/vegetables, whole grains, and added sugars was assessed as per the 2020-2025 Dietary Guidelines, the American Institute for Cancer Research, and the World Health Organization guidelines. Patient and tumor characteristics were abstracted from medical records. Results: Among the 399 patients included, the median age at diagnosis was 58 and median baseline BMI was 26.1 kg/m2. 45 patients had carcinoma in situ (11.3%), 296 had stage I disease (74.2%), 51 had stage II disease (12.8%), and 7 had stage III disease (1.8%). 316 had hormone-receptor positive disease (89.3%), 24 had HER2-positive disease (6.8%), and 26 had triple-negative disease (7.3%). 106 participants (27%) met the guideline recommendation of ≥4-5 cup equivalents of fruits/vegetables daily and 3 participants (0.8%) met the guideline recommendation of ≥3 ounces equivalents of whole grains daily. All patients in the cohort met the guideline recommendation of < 6 tsp equivalents of added sugars daily. Only 2 patients (0.5%) met guidelines for all three diet factors. Baseline BMI was significantly higher among patients who did not meet the recommended fruit/vegetable intake than among those who did (26.9 kg/m2 vs. 24.5 kg/m2, p=0.016). There were no significant differences in BMI between those who did and did not adhere to the other diet factor guidelines and no significant association between tumor stage or histology and dietary guideline adherence. Conclusion: Most patients with early-stage breast cancer did not meet the recommended daily intake of fruits/vegetables or whole grains. Participants who did not meet the fruit and vegetable intake guideline had significantly higher BMI at diagnosis. These findings indicate that lifestyle assessment near the time of breast cancer diagnosis identifies patients that could benefit from personalized dietary interventions to optimize prognostic factors such as BMI. Citation Format: Bethina Liu, Sherry Shen, Erica Salehi, Yuan Chen, Nicolas Toumbacaris, Johnny Allsop, Cara Anselmo, Stacie Corcoran, Bridget Kelly, Rocco Magnoli, Andrea Smith, Melissa Emerzian, Julia Brockway-Marchello, Doreen Bacotti, Mark E. Robson, Neil M. Iyengar. Dietary patterns among women with early-stage breast cancer from the Healthy Living Program [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-08-07.

Is Following a Cancer-Protective Lifestyle Linked to Reduced Cancer Mortality Risk?

Objectives: This study investigates the association between a cancer protective lifestyle (defined based on the revised World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) cancer prevention recommendations) and mortality in Switzerland. Methods: Based on the cross-sectional, population-based National Nutrition Survey, menuCH (n = 2057), adherence to the WCRF/AICR recommendations was assessed via a score. Quasipoisson regression models were fitted to examine the association of adherence to the WCRF/AICR recommendations with mortality at the Swiss district-level. Spatial autocorrelation was tested with global Moran's I. Integrated nested Laplace approximation models were fitted when significant spatial autocorrelation was detected. Results: Participants with higher cancer prevention scores had a significant decrease in all-cause (relative risk 0.95; 95% confidence interval 0.92, 0.99), all-cancer (0.93; 0.89, 0.97), upper aero-digestive tract cancer (0.87; 0.78, 0.97), and prostate cancer (0.81; 0.68, 0.94) mortality, compared to those with lower scores. Conclusion: The inverse association between adherence to the WCRF/AICR recommendations and mortality points out the potential of the lifestyle recommendations to decrease mortality and especially the burden of cancer in Switzerland.

Operationalisation of a standardised scoring system to assess adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations in the UK biobank.

In 2018, The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) published ten evidence-based Cancer Prevention Recommendations designed to reduce the risk of cancer via improved lifestyle behaviours. In 2019, Shams-White and colleagues created the "2018 WCRF/AICR Score" which aimed to standardise how adherence to these recommendations is assessed. The standardised scoring system includes seven of the recommendations concerning weight, physical activity and diet, with an optional eighth recommendation on breastfeeding. To promote transparency and reproducibility, the present paper describes the methodology for operationalisation of the standardised scoring system in the UK Biobank. UK Biobank recruited >500,000 individuals aged 37-73 years, between 2006 and 2010. In 2021, we held a workshop with experts which aimed to reach consensus on how to operationalise the scoring system using data available within UK Biobank. We used data on anthropometric measurements, physical activity and diet to calculate adherence scores. 24 h dietary assessment data were used to measure adherence to the following recommendations: "Eat a diet rich in wholegrains, vegetables, fruit, and beans", "Limit consumption of "fast foods" and other processed foods high in fat, starches or sugars" and "Limit consumption of sugar-sweetened drinks"; food frequency questionnaire data were used to assess adherence to "Limit consumption of red and processed meat" and "Limit alcohol consumption". Participants were allocated points for meeting, partially meeting or not meeting each recommendation, using cut-offs defined in the standardised scoring system. At our workshop, discussions included the use of national guidelines to assess adherence to the recommendation on alcohol consumption, as well as challenges faced including defining the adapted ultra-processed food variables. A total score was calculated for 158,415 participants (mean 3.9 points, range 0-7 points). We also describe the methodology to derive a partial 5-point adherence score using data from the food frequency questionnaire in 314,616 participants. We describe the methodology used to estimate adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations for participants in the UK Biobank, including some of the challenges faced operationalising the standardised scoring system.

Cancers Attributable to Smoking and Obesity in Turkey: a population-based study

Objective: Cancers are the second most common cause of mortality following cardiovascular diseases in Turkey. Tobacco and obesity are the two major etiological factors for cancer progression, which are highly prevalent in Turkey. This study aimed to evaluate the new cancer cases in Turkey attributable to these two main risk factors. Material and methods: The tobacco-related cancers based on the International Agency for Research on Cancer (IARC) monographs were esophagus, oral cavity, gastric, pancreatic, larynx, lung, renal, and bladder cancers, and the obesity-related cancers based on the IARC's and World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Continuous Update Project's reports were esophagus, colon, rectum, gallbladder, pancreas, kidney, ovary, endometrium, and breast cancers. The cancer incidences were obtained from the national cancer statistics. A lag time of at least 10 years was regarded adequate to observe the effects of past exposures on the new cancer cases. Prevalence of tobacco smoking was based on Peto-Lopez approach, and the obesity prevalence was obtained from the National Burden of Disease and Cost-Effectiveness Project Household Survey, 2003 Report in Turkey. Using these incidence and prevalence data, we estimated the population-attributable fractions (PAF) of cancers attributable to smoking and obesity in Turkey. Results: For tobacco-related cancers, the highest PAFs were found in lung cancer (89.8%), larynx cancer (86%), oral cavity and pharynx cancer (77.2%) in males, and larynx cancer (46.5%), lung cancer (43%), and esophagus cancer (31.4%) in females. For obesity-related cancers, the highest PAFs were found in esophagus adenocarcinoma (31.4%), kidney cancer (19.8%), gallbladder cancer (15.1%) in males, and esophagus adenocarcinoma (33.9%), endometrium cancer (32.8%), and postmenopausal breast cancer (22.8%) in females. When all tobacco-related cancers were considered, 41283 cases in males and 3853 cases in females were attributable to tobacco smoking, and when all obesity-related cancer types were considered, the number of attributable cancer cases to obesity was 2653 in men and 7387 in women Conclusion: The current situation of avoidable cancer burden in Turkey shows that eliminating the tobacco smoking and obesity may result with preventing more than 50000 cancer cases in Turkey.

Diet Intervention: Choice for Cancer Prevention and Patients Survival

Cancer remains a second leading cause of death in the world, despite significant advances in treatment. It is well known that diet has a significant impact on overall health, calorie restriction may be beneficial for treating a number of diseases and even lengthening patients survival. Obesity and cancer have been shown to have strong epidemiological links, and healthy diets have been shown to lower the risk of developing cancer. There is also evidence that obese patients have a worse outcome and a higher mortality rate after being diagnosed with breast, colon, prostate, pancreatic, ovarian, and hematologic cancers. However, little is known about how nutrition may affect cancer once it has been detected, particularly how diet may influence cancer therapy [1].
 The American Institute for Cancer Research (AICR) developed lifestyle recommendations based on the most recent evidence. Following these suggestions may increase overall survival after cancer diagnosis: preserving a healthy body weight; engaging in physical activity; eating a diet high in fiber and soy; and limiting the consumption of fats, particularly saturated fatty acids. Previous study also supports the clinical utility of diet interventions in cancer patients. These interventions aim to ensure adequate energy and nutrient intake during chemotherapy, which may also improve patient response to and alleviate the toxicity of pharmacological anti-cancer therapies. Furthermore, by reducing cancer comorbidities, modifications in lifestyle, like as diet and exercise, might lessen the long-term negative effects of treatment regimens and improve general health over the long term [2].
 Consumption of lignans, raw vegetables, dietary fiber, the Mediterranean diet, various dietary sources, low meat consumption, vegetarianism, or veganism, dietary intake (or biomarkers) of specific vitamins, like vitamin D, vitamin K2, or vitamin C, were all linked to a lower risk of developing cancer. An increased risk of cancer mortality was associated with poor food quality, alcohol usage, the intake of soft beverages like juice, and to a lesser extent, the consumption of certain fatty acids. The risk of dying from cancer was significantly enhanced by obesity [3].
 The diet play important role in the lifestyle, disease prevention and may act as an immune booster but diet intervention is not surprising topic of discussion in the therapy of cancer. If the dietary intervention found beneficial in cancer treatment and prevention with therapeutic efficacy, it may have little or no toxicity. At this point, it is impossible to be sure which dietary strategy is best, and diet efficacies are likely to vary depending on patient, therapeutic regimen and cancer type. When implementing these strategies in the clinic, some personalization may be required because physician who treat overweight and obese patients are aware that sometimes the best diet is the one the patient is willing and able to follow. Further studies are needed on better diet intervention to cancer patients in order to improve cancer prognosis and patients survival

Longitudinal Associations of Adherence to the Dietary World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and Dutch Healthy Diet (DHD) Recommendations with Plasma Kynurenines in Colorectal Cancer Survivors after Treatment

The tryptophan-kynurenine pathway has been linked to cancer aetiology and survivorship, and diet potentially affects metabolites of this pathway, but evidence to date is scarce. Among 247 stage I-III CRC survivors, repeated measurements were performed at 6 weeks, 6 months, and 1 year post-treatment. Adherence to the World Cancer Research Fund/ American Institute for Cancer Research (WCRF) and Dutch Healthy Diet (DHD) recommendations was operationalized using seven-day dietary records. Plasma kynurenines of nine metabolites were analysed. Longitudinal associations of adherence to these dietary patterns and plasma kynurenines were analysed using confounder-adjusted linear mixed-models. In general, higher adherence to the dietary WCRF/AICR and DHD recommendations was associated with lower concentrations of kynurenines with pro-oxidative, pro-inflammatory, and neurotoxic properties (3-hydroxykynurenine (HK) and quinolinic acid (QA)), and higher concentrations of kynurenines with anti-oxidative, anti-inflammatory, and neuroprotective properties (kynurenic acid (KA) and picolinic acid (Pic)), but associations were weak and not statistically significant. Statistically significant positive associations between individual recommendations and kynurenines were observed for: nuts with kynurenic-acid-to-quinolinic-acid ratio (KA/QA); alcohol with KA/QA, KA, and xanthurenic acid (XA); red meat with XA; and cheese with XA. Statistically significant inverse associations were observed for: nuts with kynurenine-to-tryptophan ratio (KTR) and hydroxykynurenine ratio; alcohol with KTR; red meat with 3-hydroxyanthranilic-to-3-hydroxykynurenine ratio; ultra-processed foods with XA and KA/QA; and sweetened beverages with KA/QA. Our findings suggest that CRC survivors might benefit from adhering to the dietary WCRF and DHD recommendations in the first year after treatment, as higher adherence to these dietary patterns is generally, but weakly associated with more favourable concentrations of kynurenines and their ratios. These results need to be validated in other studies.

Socioeconomic differences in adherence to the World Cancer Research Fund Cancer Prevention Recommendations in the UK Biobank cohort

BackgroundThe combined incidence rate of all cancers is higher in deprived population groups than in least-deprived groups. Approximately 40% of cancers in the UK are attributable to lifestyle risk factors, such as smoking and obesity, which are also socioeconomically patterned, and which suggests that public health strategies for primary cancer prevention might need to be tailored according to socioeconomic status. The World Cancer Research Fund and American Institute for Cancer Research's Cancer Prevention Recommendations aim to reduce cancer risk. We investigated socioeconomic status differences in adherence to these recommendations within the cohort of the UK Biobank prospective study. MethodsWe used data from participants in the UK Biobank prospective cohort study recruited between 2006 and 2010. Socioeconomic status was assessed by means of the Townsend deprivation index and participants were categorised according to deprivation quartiles. Scores for adherence to the Cancer Prevention Recommendations were calculated from dietary, physical activity, and body composition data via the recommended standardised scoring system, ranging from 0 (unhealthier lifestyle) to 7 (healthier lifestyle) points. Regression models were run to investigate associations between socioeconomic status and total score, adjusting for age, sex, ethnicity, and smoking status. Associations between adherence to individual recommendations and socioeconomic status were investigated using chi-square tests. FindingsData from 150 649 participants (median age 57 years [IQR 50–63]; 79 322 [53%] women and 71 327 [47%] men) were included. The mean total adherence score was 3·58 points (SD 1·04). Adherence score was not associated with socioeconomic status (p=0·13), but was significantly related to age, sex, ethnicity, and smoking status (p<0·0001). Adherence to the recommendations for bodyweight, physical activity, and intake of fruit, vegetables, and dietary fibre was lower for the most deprived group (p<0·0001). In contrast, less deprived participants were less likely to meet the recommendations for the intake of alcohol, red and processed meat, ultra-processed foods, and sugary drinks (p<0·0001) InterpretationOur findings provide evidence on which specific recommendations for cancer prevention could be tailored, or targeted, towards those in different socioeconomic status groups. FundingWereld Kanker Onderzoek Fonds (grant number IIG_FULL_2020_032), as part of the World Cancer Research Fund International Grant Programme.

The 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) score and diabetes risk in the Diabetes Prevention Program Outcomes Study (DPPOS)

BackgroundThe 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 3rd expert report highlights up-to-date Cancer Prevention Recommendations that may reduce burdens of many chronic diseases, including diabetes. This study examined if following a lifestyle that aligns with the recommendations – assessed via the 2018 WCRF/AICR Score – was associated with lower risk of type 2 diabetes in high-risk adults participating in the Diabetes Prevention Program Outcomes Study (DPPOS).MethodsThe Diabetes Prevention Program (DPP) randomized adults at high risk for diabetes to receive a lifestyle intervention (ILS), metformin (MET) or a placebo (PLB) (mean: 3.2 years), with additional follow-up in DPPOS for 11 years (mean: 15 years total). 2018 WCRF/AICR Scores included seven components: body weight, physical activity, plant-based foods, fast foods, red and processed meat, sugar-sweetened beverages, and alcohol; the optional breastfeeding component was excluded. Scores ranged 0-7 points (with greater scores indicating greater alignment with the recommendations) and were estimated at years 0, 1, 5, 6, 9, and 15 (N=3,147). Fasting glucose and HbA1c were measured every six months and oral glucose tolerance tests were performed annually. Adjusted Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were used to examine the association of both Score changes from years 0-1 and time-dependent Score changes on diabetes risk through DPP and year 15.ResultsScores improved within all groups over 15 years (p<0.001); ILS Scores improved more than MET or PLB Scores after 1 year (p<0.001). For every 1-unit improvement from years 0-1, there was a 31% and 15% lower diabetes risk in ILS (95% CI: 0.56-0.84) and PLB (95% CI: 0.72-0.97) through DPP, and no significant association in MET. Associations were greatest among American Indian participants, followed by non-Hispanic White and Hispanic participants. Score changes from years 0-1 and time-dependent Score changes in ILS and PLB remained associated with lower risk through year 15.ConclusionsScore improvements were associated with long-term, lower diabetes risk among high-risk adults randomized to ILS and PLB, but not MET. Future research should explore impact of the Score on cancer risk.Trial registrationDiabetes Prevention Program: NCT00004992; Diabetes Prevention Program Outcomes Study: NCT00038727