Association between the 2018 WCRF/AICR and the Low-Risk Lifestyle Scores with Colorectal Cancer Risk in the Predimed Study

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The Centro de Investigacion Biomedica en Red Fisiopatologia de la Obesidad y Nutricion (CIBEROBN) is an initiative of the Spanish Instituto de Salud Carlos III (ISCIII) which is funded by FEDER A way to make Europe/Investing in your future (CB06/03). It is supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through grants provided to research networks specifically developed for the trial (RTIC G03/140 and RD 06/0045) through CIBEROBN, and by grants from the Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigacion Sanitaria-Fondo Europeo de Desarrollo Regional (PI04-2239, PI05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI07/0473, PI10/01407, PI10/02658, PI11/01647, and PI11/02505; PI13/00462), Ministerio de Ciencia e Innovacion (AGL-2009-13906-C02 and AGL2010-22319-C03), Fundacion Mapfre 2010, Consejeria de Salud de la Junta de Andalucia (PI0105/2007), Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (PROMETEO17/2017), and the Navarra Regional Government (27/2011). The Fundacion Patrimonio Comunal Olivarero andHojiblanca SA (Malaga, Spain), CaliforniaWalnut Commission (Sacramento, CA), Borges SA (Reus, Spain), and Morella Nuts SA (Reus, Spain) donated the olive oil, walnuts, almonds, and hazelnuts, respectively, used in the study. J. Salas-Salvado, the senior author/gratefully acknowledges the financial support by ICREA under the ICREA Academia program. Dr. P.H.-A. is supported by a postdoctoral fellowship (Juan de la Cierva-Formacion, FJCI-2017-32205). L. Barrubes has been awarded a grant by the Spanish Ministry of Education, Culture, and Sports (FPU 16/00165). M.M.-G. was the recipient of the Nicolas Monardes Programme from the Servicio Andaluz de Salud, Junta de Andalucia, Spain (RC-0001-2018 and C-0029-2023). None of the funding sources played a role in the design, collection, analysis or interpretation of the data or in the decision to submit the manuscript for publication.

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Ramírez Sabio JbAuthorEstruch RAuthorRos EAuthor

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Article

Publicated to:Journal Of Clinical Medicine. 9 (4): E1215- - 2020-04-01 9(4), DOI: 10.3390/jcm9041215

Authors: Barrubés, L; Babio, N; Hernández-Alonso, P; Salas-Salvadó, J; Toledo, E; Estruch, R; Ros, E; Fitó, M; Alonso-Gómez, AM; Fiol, M; Lapetra, J; Serra-Majem, L; Pintó, X; Ruiz-Canela, M; Corella, D; Castañer, O; Macías-González, M; Sabio, JBR

Affiliations

August Pi & Sunyer Biomed Res Inst IDIBAPS, Barcelona 08036, Spain - Author

Balear Isl Hlth Res Inst IdISBa, Palma de Mallorca 07120, Spain - Author

Ctr Salud Univ San Pablo, Dept Family Med, Res Unit, Dist Sanitario Atenc Primaria Sevilla, Seville 41013, Spain - Author

Hosp Univ Bellvitge, Internal Med, Lipids & Vasc Risk Unit, Lhospitalet De Llobregat 08907, Spain - Author

Inst Hosp del Mar Invest Mediques IMIM, Cardiovasc Risk & Nutr Res REGICOR Grp, Barcelona 08003, Spain - Author

Inst Salud Carlos III ISCIII, Consorcio CIBER, MP Fisiopatol Obesidad & Nutr CIBERObn, Madrid 28029, Spain - Author

Sagunto Hosp, Oncol Serv, Valencia 46520, Spain - Author

Son Espases Hosp, Palma De Mallorca 07120, Spain - Author

Univ Barcelona, Hosp Clin, Dept Internal Med, Barcelona 08036, Spain - Author

Univ Barcelona, Hosp Clin, Lipid Clin, Endocrinol & Nutr Serv, Barcelona 08036, Spain - Author

Univ Basque Country UPV EHU, Bioaraba Hlth Res Inst, Osakidetza Basque Hlth Serv, Araba Univ Hosp, Vitoria 01007, Spain - Author

Univ Las Palmas Gran Canaria, Res Inst Biomed & Hlth Sci, Las Palmas Gran Canaria 35017, Spain - Author

Univ Malaga IBIMA, Virgen de la Victoria Univ Hosp, Dept Endocrinol & Nutr, Malaga 29071, Spain - Author

Univ Navarra, Dept Prevent Med & Publ Hlth, Navarra Inst Hlth Res, Pamplona 31009, Spain - Author

Univ Rovira & Virgili, Dept Bioquim & Biotecnol, Unitat Nutr Humana, Hosp Univ San Joan de Reus,Inst Invest Pere Virgi, Reus 43201, Spain - Author

Univ Valencia, Dept Prevent Med, Valencia 46010, Spain - Author

‎ August Pi & Sunyer Biomed Res Inst IDIBAPS, Barcelona 08036, Spain - Author

‎ Balear Isl Hlth Res Inst IdISBa, Palma De Mallorca 07120, Spain - Author

‎ Ctr Salud Univ San Pablo, Dept Family Med, Res Unit, Dist Sanitario Atenc Primaria Sevilla, Seville 41013, Spain - Author

‎ Hosp Univ Bellvitge, Internal Med, Lipids & Vasc Risk Unit, Lhospitalet De Llobregat 08907, Spain - Author

‎ Inst Hosp del Mar Invest Mediques IMIM, Cardiovasc Risk & Nutr Res REGICOR Grp, Barcelona 08003, Spain - Author

‎ Inst Salud Carlos III ISCIII, Consorcio CIBER, MP Fisiopatol Obesidad & Nutr CIBERObn, Madrid 28029, Spain - Author

‎ Sagunto Hosp, Oncol Serv, Valencia 46520, Spain - Author

‎ Son Espases Hosp, Palma De Mallorca 07120, Spain - Author

‎ Univ Barcelona, Hosp Clin, Dept Internal Med, Barcelona 08036, Spain - Author

‎ Univ Barcelona, Hosp Clin, Lipid Clin, Endocrinol & Nutr Serv, Barcelona 08036, Spain - Author

‎ Univ Basque Country UPV EHU, Bioaraba Hlth Res Inst, Osakidetza Basque Hlth Serv, Araba Univ Hosp, Vitoria 01007, Spain - Author

‎ Univ Las Palmas Gran Canaria, Res Inst Biomed & Hlth Sci, Las Palmas Gran Canaria 35017, Spain - Author

‎ Univ Malaga IBIMA, Virgen de la Victoria Univ Hosp, Dept Endocrinol & Nutr, Malaga 29071, Spain - Author

‎ Univ Navarra, Dept Prevent Med & Publ Hlth, Navarra Inst Hlth Res, Pamplona 31009, Spain - Author

‎ Univ Rovira & Virgili, Dept Bioquim & Biotecnol, Unitat Nutr Humana, Hosp Univ San Joan de Reus,Inst Invest Pere Virgi, Reus 43201, Spain - Author

‎ Univ Valencia, Dept Prevent Med, Valencia 46010, Spain - Author

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.

Keywords

adherenceaicr scorecolorectal cancerconcordancedietary patternsindexinsulinlifestyle patternslow-risk lifestyle indexmetaanalysisphysical-activity questionnairepredimedprevention guidelinesrecommendationswcrf/aicr scoreAdherenceAdultAgedAicr scoreAlcohol consumptionArticleCaloric intakeCancer colorectalCancer mortalityCancer preventionCancer riskCardiovascular riskCohort analysisColorectal cancerConcordanceDietary intakeDietary patternsEstils de vidaFemaleFollow upFood compositionFood frequency questionnaireFood intakeHealthy lifestyleHormone substitutionHumanIndexInsulinLifestyle patternsLifestylesLongitudinal studyLow risk lifestyle scoreLow-risk lifestyle indexMajor clinical studyMaleMediterranean dietMetaanalysisMetabolic equivalentMiddle agedNutritional assessmentObservational studyPhysical activityPhysical-activity questionnairePredimedPrevention guidelinesQuestionnaireRecommendationsResearch fund/american instituteRisk factorScoring systemSensitivity analysisSmokingVery elderlyWaist circumferenceWcrfWcrf/aicr scoreWestern dietWhole grain

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Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Clinical Medicine due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2020, it was in position 39/167, thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine, General & Internal.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations from Scopus Elsevier, it yields a value for the Field-Weighted Citation Impact from the Scopus agency: 1.35, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-22, the following number of citations: