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)

Author:

Shams-White Marissa M.,Tjaden Ashley H.,Edelstein Sharon L.,Bassiouni Sarah,Kahle Lisa L.,Kim Catherine,Pi-Sunyer Xavier,Temple Karla A.,Venditti Elizabeth M.,Reedy Jill,Heckman-Stoddard Brandy M.,Bray George A.,Gadde Kishore M.,Culbert Iris W.,Arceneaux Jennifer,Chatellier Annie,Dragg Amber,Champagne Catherine M.,Duncan Crystal,Eberhardt Barbara,Greenway Frank,Guillory Fonda G.,Herbert April A.,Jeffirs Michael L.,Kennedy Betty M.,Levy Erma,Lockett Monica,Lovejoy Jennifer C.,Morris Laura H.,Melancon Lee E.,Ryan Donna H.,Sanford Deborah A.,Smith Kenneth G.,Smith Lisa L.,St. Amant Julia A.,Tulley Richard T.,Vicknair Paula C.,Williamson Donald,Zachwieja Jeffery J.,Polonsky Kenneth S.,Tobian Janet,Ehrmann David A.,Matulik Margaret J.,Clark Bart,Czech Kirsten,DeSandre Catherine,Hilbrich Ruthanne,McNabb Wylie,Semenske Ann R.,Caro Jose F.,Furlong Kevin,Goldstein Barry J.,Watson Pamela G.,Smith Kellie A.,Mendoza Jewel,Wildman Wendi,Liberoni Renee,Spandorfer John,Pepe Constance,Donahue Richard P.,Goldberg Ronald B.,Prineas Ronald,Calles Jeanette,Ojito Juliet,Rowe Patricia,Cassanova-Romero Paul,Castillo-Florez Sumaya,Florez Hermes J.,Giannella Anna,Kirby Lascelles,Larreal Carmen,Lara Olga,McLymont Valerie,Mendez Jadell,Perry Arlette,Saab Patrice,Veciana Beth,Haffner Steven M.,Hazuda Helen P.,Montez Maria G.,Hattaway Kathy,Lorenzo Carlos,Martinez Arlene,Walker Tatiana,Dabelea Dana,Hamman Richard F.,Nash Patricia V.,Steinke Sheila C.,Testaverde Lisa,Anderson Denise R.,Ballonoff Larry B.,Bouffard Alexis,Bucca Brian,Calonge B. Ned,Delve Lynne,Farago Martha,Hill James O.,Hoyer Shelley R.,Jenkins Tonya,Jortberg Bonnie T.,Lenz Dione,Miller Marsha,Perreault Leigh,Price David W.,Regensteiner Judith G.,Seagle Helen,Smith Carissa M.,VanDorsten Brent,Horton Edward S.,Lawton Kathleen E.,Poirier Catherine S.,Swift Kati,Arky Ronald A.,Bryant Marybeth,Burke Jacqueline P.,Caballero Enrique,Callaphan Karen M.,Fargnoli Barbara,Franklin Therese,Ganda Om P.,Guidi Ashley,Guido Mathew,Jackson Sharon D.,Jacobsen Alan M.,Lambert Lori,Ledbury Sarah,Kocal Margaret,Kula Lyn M.,Malloy Maureen A.,Nicosia Maryanne,Oldmixon Cathryn F.,Pan Jocelyn,Quitingon Marizel,Rubtchinsky Stacy,Sansoucy Jessica,Schweizer Dana,Seely Ellen W.,Simonson Donald,Smith Fannie,Solomon Caren G.,Spellman Jeanne,Warram James,Kahn Steven E.,Montgomery Brenda K.,Fujimoto Wilfred,Knopp Robert H.,Lipkin Edward W.,Marr Michelle,Morgan-Taggart Ivy,Murillo Anne,Trence Dace,Taylor Lonnese,Thomas April,Tsai Elaine C.,Dagogo-Jack Samuel,Kitabchi Abbas E.,Murphy Mary E.,Taylor Laura,Dolgoff Jennifer,Applegate William B.,Bryer-Ash Michael,Clark Debra,Frieson Sandra L.,Ibebuogu Uzoma,Imseis Raed,Lambeth Helen,Lichtermann Lynne C.,Oktaei Hooman,Ricks Harriet,Rutledge Lily M. K.,Sherman Amy R.,Smith Clara M.,Soberman Judith E.,Williams-Cleaves Beverly,Metzger Boyd E.,Molitch Mark E.,Johnson Mariana K.,Adelman Daphne T.,Behrends Catherine,Cook Michelle,Fitzgibbon Marian,Giles Mimi M.,Heard Deloris,Johnson Cheryl K. H.,Larsen Diane,Lowe Anne,Lyman Megan,McPherson David,Penn Samsam C.,Pitts Thomas,Reinhart Renee,Roston Susan,Schinleber Pamela A.,Nathan David M.,McKitrick Charles,Turgeon Heather,Larkin Mary,Abbott Kathy,Anderson Ellen,Bissett Laurie,Bondi Kristy,Cagliero Enrico,Florez Jose C.,D’Anna Kali,Delahanty Linda,Goldman Valerie,Lou Peter,Poulos Alexandra,Raymond Elyse,Stevens Christine,Tseng Beverly,Olefsky Jerrold M.,Barrett-Connor Elizabeth,Carrion-Petersen Mary Lou,Beltran Madeline,Claravall Lauren N.,Dowden Jonalle M.,Edelman Steven V.,Henry Robert R.,Horne Javiva,Lamkin Marycie,Janesch Simona Szerdi,Leos Diana,Mudaliar Sunder,Polonsky William,Smith Jean,Torio-Hurley Jennifer,Vejvoda Karen,Pi-Sunyer F. Xavier,Lee Jane E.,Allison David B.,Agharanya Nnenna,Aronoff Nancy J.,Baldo Maria,Crandall Jill P.,Foo Sandra T.,Hagamen Susan,Luchsinger Jose A.,Pal Carmen,Parkes Kathy,Pena Mary Beth,Rooney Ellen S.,Van Wye Gretchen E. H.,Viscovich Kristine A.,Marrero David G.,Mather Kieren J.,Prince Melvin J.,Kelly Susie M.,Jackson Marcia A.,McAtee Gina,Putenney Paula,Ackermann Ronald T.,Cantrell Carolyn M.,Dotson Yolanda F.,Fineberg Edwin S.,Fultz Megan,Guare John C.,Hadden Angela,Ignaut James M.,Kirkman Marion S.,O’Kelly Phillips Erin,Porter Beverly D.,Roach Paris J.,Rowland Nancy D.,Wheeler Madelyn L.,Aroda Vanita,Ratner Robert E.,Youssef Gretchen,Shapiro Sue,Bavido-Arrage Catherine,Boggs Geraldine,Bronsord Marjorie,Brown Ernestine,Cheatham Wayman W.,Cola Susan,Evans Cindy,Gibbs Peggy,Kellum Tracy,Wiggins Renee,Lagarda Milvia,Leon Lilia,Levatan Claresa,Lindsay Milajurine,Nair Asha K.,Passaro Maureen,Silverman Angela,Uwaifo Gabriel,Wells-Thayer Debra,Saad Mohammed F.,Watson Karol,Budget Maria,Jinagouda Sujata,Botrous Medhat,Akbar Khan,Conzues Claudia,Magpuri Perpetua,Ngo Kathy,Rassam Amer,Waters Debra,Xapthalamous Kathy,Santiago Julio V.,Dagogo-Jack Samuel,White Neil H.,Brown Angela L.,Das Samia,Khare-Ranade Prajakta,Stich Tamara,Santiago Ana,Fisher Edwin,Hurt Emma,Jones Tracy,Kerr Michelle,Ryder Lucy,Wernimont Cormarie,Golden Sherita Hill,Saudek Christopher D.,Bradley Vanessa,Sullivan Emily,Whittington Tracy,Abbas Caroline,Allen Adrienne,Brancati Frederick L.,Cappelli Sharon,Clark Jeanne M.,Charleston Jeanne B.,Freel Janice,Horak Katherine,Greene Alicia,Jiggetts Dawn,Johnson Deloris,Joseph Hope,Loman Kimberly,Mosley Henry,Reusing John,Rubin Richard R.,Samuels Alafia,Shields Thomas,Stephens Shawne,Stewart Kerry J.,Thomas Lee Lana,Utsey Evonne,Williamson Paula,Schade David S.,Adams Karwyn S.,Canady Janene L.,Johannes Carolyn,Hemphill Claire,Hyde Penny,Atler Leslie F.,Boyle Patrick J.,Burge Mark R.,Chai Lisa,Colleran Kathleen,Gonzales Ysela,Hernandez-McGinnis Doris A.,Katz Patricia,King Carolyn,Rassam Amer,Rubinchik Sofya,Senter Willette,Waters Debra,Crandall Jill,Shamoon Harry,Brown Janet O.,Trandafirescu Gilda,Adorno Elsie,Cox Liane,Duffy Helena,Engel Samuel,Friedler Allison,Goldstein Angela,Howard-Century Crystal J.,Lukin Jennifer,Kloiber Stacey,Longchamp Nadege,Martinez Helen,Pompi Dorothy,Scheindlin Jonathan,Violino Elissa,Walker Elizabeth A.,Wylie-Rosett Judith,Zimmerman Elise,Zonszein Joel,Orchard Trevor,Wing Rena R.,Jeffries Susan,Koenning Gaye,Kramer M. Kaye,Smith Marie,Barr Susan,Benchoff Catherine,Boraz Miriam,Clifford Lisa,Culyba Rebecca,Frazier Marlene,Gilligan Ryan,Guimond Stephanie,Harrier Susan,Harris Louann,Kriska Andrea,Manjoo Qurashia,Mullen Monica,Noel Alicia,Otto Amy,Pettigrew Jessica,Rockette-Wagner Bonny,Rubinstein Debra,Semler Linda,Smith Cheryl F.,Venditti Elizabeth,Weinzierl Valarie,Williams Katherine V.,Wilson Tara,Arakaki Richard F.,Latimer Renee W.,Baker-Ladao Narleen K.,Isonaga Mae K.,Beddow Ralph,Bermudez Nina E.,Dias Lorna,Inouye Jillian,Mau Marjorie K.,Melish John S.,Mikami Kathy,Mohideen Pharis,Odom Sharon K.,Perry Raynette U.,Yamamoto Robin E.,Knowler William C.,Cooeyate Norman,Hoskin Mary A.,Percy Carol A.,Enote Alvera,Natewa Camille,Acton Kelly J.,Andre Vickie L.,Barber Rosalyn,Begay Shandiin,Bennett Peter H.,Benson Mary Beth,Bird Evelyn C.,Broussard Brenda A.,Bucca Brian C.,Chavez Marcella,Cook Sherron,Curtis Jeff,Dacawyma Tara,Doughty Matthew S.,Duncan Roberta,Dodge Charlotte,Edgerton Cyndy,Ghahate Jacqueline M.,Glass Justin,Glass Martia,Gohdes Dorothy,Grant Wendy,Hanson Robert L.,Horse Ellie,Ingraham Louise E.,Jackson Merry,Jay Priscilla,Kaskalla Roylen S.,Kessler David,Kobus Kathleen M.,Krakoff Jonathan,Kurland Jason,Manus Catherine,McCabe Cherie,Michaels Sara,Morgan Tina,Nashboo Yolanda,Nelson Julie A.,Poirier Steven,Polczynski Evette,Piromalli Christopher,Reidy Mike,Roumain Jeanine,Rowse Debra,Roy Robert J.,Sangster Sandra,Sewenemewa Janet,Smart Miranda,Tonemah Darryl,Williams Rachel,Wilson Charlton,Yazzie Michelle,Bain Raymond,Fowler Sarah,Temprosa Marinella,Larsen Michael D.,Brenneman Tina,Edelstein Sharon L.,Abebe Solome,Bamdad Julie,Barkalow Melanie,Bethepu Joel,Bezabeh Tsedenia,Butler Nicole,Callaghan Jackie,Carter Caitlin E.,Christophi Costas,Dwyer Gregory M.,Foulkes Mary,Gao Yuping,Gooding Robert,Gottlieb Adrienne,Grimes Kristina L.,Grover-Fairchild Nisha,Haffner Lori,Hoffman Heather,Jablonski Kathleen,Jones Steve,Jones Tara L.,Katz Richard,Kolinjivadi Preethy,Lachin John M.,Ma Yong,Mucik Pamela,Orlosky Robert,Pan Qing,Reamer Susan,Rochon James,Sapozhnikova Alla,Sherif Hanna,Stimpson Charlotte,Tjaden Ashley Hogan,Walker-Murray Fredricka,Venditti Elizabeth M.,Kriska Andrea M.,Semler Linda,Weinzierl Valerie,Marcovina Santica,Harting Jessica,Aldrich F. Alan,Albers John,Strylewicz Greg,Eastman R.,Fradkin Judith,Garfield Sanford,Lee Christine,Gregg Edward,Zhang Ping,O’Leary Dan,Evans Gregory,Budoff Matthew,Dailing Chris,Stamm Elizabeth,Schwartz Ann,Navy Caroline,Palermo Lisa,Rautaharju Pentti,Prineas Ronald J.,Alexander Teresa,Campbell Charles,Hall Sharon,Li Yabing,Mills Margaret,Pemberton Nancy,Rautaharju Farida,Zhang Zhuming,Soliman Elsayed Z.,Hu Julie,Hensley Susan,Keasler Lisa,Taylor Tonya,Danis Ronald,Davis Matthew,Hubbard Larry,Endres Ryan,Elsas Deborah,Johnson Samantha,Gama Vonnie,Goulding Anne,Luchsinger Jose A.,Manly Jennifer,Mayer-Davis Elizabeth,Moran Robert R.,Ganiats Ted,David Kristin,Sarkin Andrew J.,Groessl Erik,Katzir Naomi,Herman William H.,Brändle Michael,Brown Morton B.,Florez Jose C.,Altshuler David,Billings Liana K.,Chen Ling,Harden Maegan,Hanson Robert L.,Knowler William C.,Pollin Toni I.,Shuldiner Alan R.,Jablonski Kathleen,Franks Paul W.,

Abstract

AbstractBackgroundThe 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

Funder

National Institutes of Health

Publisher

Springer Science and Business Media LLC

Subject

Public Health, Environmental and Occupational Health,Nutrition and Dietetics,Endocrinology, Diabetes and Metabolism,Medicine (miscellaneous)

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