Journal Article

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)

Pi-Sunyer, Xavier, Edelstein, Sharon L., Heckman-Stoddard, Brandy M., Venditti, Elizabeth M., Reedy, Jill, Kahle, Lisa L., Temple, Karla A., Shams-White, Marissa M., Tjaden, Ashley H., Kim, Catherine, Bassiouni, Sarah

2022

Overview

Background The 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). Methods The 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. Results Scores 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. Conclusions Score 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 registration Diabetes Prevention Program: NCT00004992 ; Diabetes Prevention Program Outcomes Study: NCT00038727

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Alcohol / alcohols / American Indians / Antidiabetics / Body mass index / body weight / breast feeding / Breastfeeding & lactation / Cancer / Cancer research / Clinical Nutrition / Curricula / Diabetes / Diet / Dietary fiber / Disease prevention / Exercise / Food / Fruits / Glucose / Health Promotion and Disease Prevention / Hispanic Americans / Insulin resistance / lifestyle / Lifestyles / Meat / Medical research / Medicine / Medicine & Public Health / metformin / Missing data / noninsulin-dependent diabetes mellitus / Nutrition research / Obesity / Oxidative stress / Physical activity / placebos / Prevention programs / processed meat / Public Health / Questionnaires / risk / Vegetables / Weight / Weight control