Abstract 5248: Adherence to the WCRF/AICR cancer prevention guidelines and colorectal cancer incidence and mortality in the biracial cohort–the Atherosclerosis Risk in Communities (ARIC) study
Authors: Lintelmann Anna K. , Onyeaghala Guillaume , Joshu Corinne E. , Lutsey Pamela L. , Folsom Aaron R. , Robien Kimberly , Platz Elizabeth A. , Prizment Anna E. 
Published: August 2018

Abstract
Introduction: Greater adherence to the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) cancer prevention recommendations has been linked to decreased risk of colorectal cancer (CRC). However, it is unknown whether this association differs by race. We compared the adherence to the WCRF/AICR guidelines between African-Americans and Whites and assessed the association between adherence and CRC incidence and mortality in the Atherosclerosis Risk in Communities (ARIC) prospective analytic cohort (1987-2012).
Methods: Baseline information from 13,822 participants (54.6% women, 26.5% African-American) was used to develop an 8-component adherence score based on the WCRF/AICR guidelines. The adherence score included body mass index (BMI), physical activity, and dietary intake recommendations, including intake of alcohol, fruits and vegetables, dietary fiber, sugar-sweetened beverages, sodium, and red and processed meats. Each recommendation contributed 0, 0.5, or 1 points, with higher scores corresponding to greater adherence. Adherence scores were categorized as tertiles (0.5-4.0, 4.5-5.0, and 5.5-8.0). Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals (HR, 95% CI) for the CRC incidence and mortality associated with the adherence score for the total cohort and stratified by race.
Results: Mean adherence score was 4.31 (range 0.5-8.0) in African-Americans (N=3,668; 101 CRC cases; 31 CRC deaths) and 4.85 (range 1.0-8.0) in Whites (N=10,154; 268 CRC cases; 87 CRC deaths). African-Americans were less likely to follow most of the cancer prevention guidelines than Whites (except alcohol and sodium intake). After adjustment for age, gender, race, center, smoking, education, intake of aspirin, calcium, total calories, and, in women, hormone-replacement therapy, greater adherence was associated with a 28% lower CRC risk (0.55-0.96) for the highest versus lowest adherence score tertile (ptrend=0.03), and were similar in men (HR=0.76, 95% CI: 0.51-1.12) and women (HR=0.69, 95% CI: 0.46-1.03; pinteraction with gender=0.66). When stratified by race, HRs were 0.74 (0.41-1.34) in African-Americans and 0.74 (0.53-1.02) in Whites (pinteraction with race=0.72) for the highest versus lowest tertile, but power was limited in African-Americans. Associations between adherence score and fully-adjusted mortality from CRC showed a similar inverse trend, but were not significant.
Conclusions: Greater adherence to the WCRF/AICR cancer prevention recommendations was associated with decreased CRC risk in the ARIC cohort. The associations between adherence score and CRC risk were similar in African-Americans and Whites.
Citation Format: Anna K. Lintelmann, Guillaume Onyeaghala, Corinne E. Joshu, Pamela L. Lutsey, Aaron R. Folsom, Kimberly Robien, Elizabeth A. Platz, Anna E. Prizment. Adherence to the WCRF/AICR cancer prevention guidelines and colorectal cancer incidence and mortality in the biracial cohort–the Atherosclerosis Risk in Communities (ARIC) study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5248.