Unit of Medical Statistics and Biometry, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Venezian 1, 20133 Milan, Italy.
Department of Clinical Sciences and Community Health, Università degli studi di Milano, Via A. Vanzetti 5, 20133 Milan, Italy.
Nutrients. 2020 Feb 26;12(3):607. doi: 10.3390/nu12030607.
The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) introduced in 2007, and updated in 2018, nutrition-related recommendations for cancer prevention. Previous studies generally reported inverse associations of breast cancer with the 2007 recommendations, while no study has yet evaluated the association with the 2018 guidelines. We investigated the association between adherence to the 2018 WCRF/AICR recommendations and breast cancer risk in a case-control study from Italy and Switzerland (1991-2008) including 3034 incident histologically-confirmed breast cancer cases and 3392 hospital controls. Adherence to the 2018 guidelines was summarized through a score incorporating eight recommendations (body fatness, physical activity, consumption of wholegrains/vegetables/fruit/beans, "fast foods" and other processed foods high in fat, starches, or sugars, red/processed meat, sugar-sweetened drinks, alcohol, breastfeeding), with higher scores indicating higher adherence. Odds ratios (OR) were estimated using multiple logistic regression models. We also conducted a meta-analysis including 15 additional studies using random-effects models. In our case-control study, adherence to the 2018 WCRF/AICR guidelines was inversely associated with breast cancer, with ORs of 0.60 (95% confidence interval (CI), 0.51-0.70) for a score ≥5.5 vs. ≤4.25, and of 0.83 (95% CI, 0.79-0.88) for a 1-point increment. In our study, 25% of breast cancers were attributable to low-to-moderate guideline adherence. In the meta-analysis, the pooled relative risks (RRs) were 0.73 (95% CI, 0.65-0.82, p heterogeneity among studies< 0.001) for the highest vs. the lowest WCRF/AICR score category, and 0.91 (95% CI, 0.88-0.94, p heterogeneity < 0.001) for a 1-point increment. This work provides quantitative evidence that higher adherence to the WCRF/AICR recommendations reduces the risk of breast cancer, thus opening perspectives for prevention.
世界癌症研究基金会/美国癌症研究所（WCRF/AICR）于 2007 年首次提出，并于 2018 年更新了营养相关的癌症预防建议。先前的研究普遍报告乳腺癌与 2007 年建议呈负相关，而尚无研究评估与 2018 年指南的相关性。我们通过意大利和瑞士（1991-2008 年）的一项病例对照研究调查了 2018 年 WCRF/AICR 建议的依从性与乳腺癌风险之间的关联，该研究纳入了 3034 例确诊的乳腺癌病例和 3392 例医院对照。通过包含 8 条建议的评分（体脂肪、身体活动、全谷物/蔬菜/水果/豆类、“快餐”和其他高脂肪、高淀粉或高糖的加工食品、红色/加工肉类、含糖饮料、酒精、母乳喂养）来综合评估对 2018 年指南的依从性，得分越高表明依从性越高。采用多因素逻辑回归模型估计比值比（OR）。我们还进行了荟萃分析，纳入了使用随机效应模型的 15 项额外研究。在我们的病例对照研究中，2018 年 WCRF/AICR 指南的依从性与乳腺癌呈负相关，评分≥5.5 与≤4.25 相比，OR 为 0.60（95%置信区间（CI），0.51-0.70），评分每增加 1 分，OR 为 0.83（95% CI，0.79-0.88）。在我们的研究中，25%的乳腺癌归因于低至中度的指南依从性。荟萃分析中，最高与最低 WCRF/AICR 评分组别的汇总相对风险（RR）为 0.73（95%CI，0.65-0.82，p 异质性<0.001），评分每增加 1 分，RR 为 0.91（95%CI，0.88-0.94，p 异质性<0.001）。这项工作提供了定量证据，表明更高程度地遵循 WCRF/AICR 建议可降低乳腺癌风险，从而为预防乳腺癌提供了新的思路。
