eb_2015_le_final_topresent
TRANSCRIPT
Level of Dietary Adherence to WCRF/AICR
Recommendations among 75,131 Adventist
Health Study-2 Participants
Lap T. Le, DrPH(s)
Loma Linda University School of Public Health
Acknowledgements
» Karen Jaceldo, DrPH» Rawiwan Sirirat, MPH, RD
Objectives
» Rationales: WCRF/AIRC Index, AHS-2 cohort» Aims of study» Methods: Operationalization of WCRF/AIRC Index
» Results» Discussion» Conclusion
Rationale: WCRF/IACR » Most common chronic diseases, including cancers are preventable through modifiable risk factors.
Rationale: WCRF/AICR
» The relationship between modifiable risk factors and the major chronic diseases of lifestyle, including cancer is complex and intricate, and therefore requires a comprehensive approach to assess risk behaviors which encompass diets, physical activity, and other intermediate risk factors.
Rationale: Significance to Public Health
» The need to explore alternative measurements to assess and effectively prescribe overall dietary and lifestyle behavior recommendations to the public for cancer prevention is warranted.
WCRF / AICR» World Cancer Research Fund & American Institute of Cancer Research (WCRF/AICR) issued 8 recommendations (+2 special recommendations) for cancer prevention.~ Diet ~ Alcohol consumption~ Physical activity~ Weight management
WCRF/AICR Index-Based Recommendations1. Body fatness. Be as lean as possible without becoming underweight.
2. Physical activity. Be physically active as part of your everyday life.
3. Foods and drinks that promote weight gain. Limit consumption of energy-dense foods; avoid sugary drinks.
4. Plant foods. Eat mostly foods of plant origin.
5. Animal foods. Limit intake of red meat and avoid processed meat.
6. Alcoholic drinks. Limit alcoholic drinks.
7. Preservation, processing, preparation. Limit consumption of salt. Avoid moldy cereals (grains) or pulses (legumes).
8. Dietary Supplements. Aim to meet nutritional needs through diet alone.
9. Breastfeeding. Aim to breastfeed infants exclusively up to six months and continue with complementary feeding thereafter.
10. Cancer survivors.* All cancer survivors to receive nutritional care from an appropriately trained professional.
Rationale: WCRF/AICR» Popular dietary index scores only dietary components
» Characterized at the level of nutrients, individual foods, food groups, and 5 dietary patterns (non-veg, semi-, pesco-, lacto-ovo, and vegan)
» WCRF/AICR Index assesses both diets and lifestyle components (+ special recommendations)~ Allows AHS-2 to generate a composite index score to
assess both dietary and lifestyle behaviors.
Why focus on AHS-2 cohort?» Large cohort of ~96,000 Adventists in North America, with
unique & wide range of dietary patterns~35% male; 65% female~48% non-veg, 5% semi-, 10% pesco-, 29% lacto-ovo, and
8% vegan.
» Relatively small percentage of alcohol consumption and cigarette smoking.
» Dietary, lifestyle, and breastfeeding variables.
Aims of Study» To assess the degree of dietary adherence to the WCRF/AICR recommendations among the Adventist Health Study-2 (AHS-2) population.
» Compare the WCRF/AICR scores among vegetarians and non-vegetarians.
Methods» Constructed from the operationalization of multiple dietary and lifestyle components, using data from AHS-2 comprehensive questionnaires including: ~Quantitative FFQ ~Lifestyle assessment questionnaires
» SAS 9.4 was used.
EXAMPLE:WCRF/AICR
recommendationsPersonal
Recommendations Operationalization for
AHS-2 Cohort Score
3) Foods and drinks that promote weight gain. Limit consumption of energy-dense foods; avoid sugary drinks.
3a) Consume energy-dense foods sparingly
Consumed energy dense food less than 150 kcals per 100 grams per day
1
Consumed energy dense food more than 150 but less than 225 kcals per 100 grams per day
0.5
Consumed energy dense food more than 225 kcals per grams per day
0
3b) Avoid sugary drinks
Consumed sugary drinks equal to zero gram per day
1
Consumed sugary drinks greater than zero but less than 250 grams per day
0.5
Consumed sugary drinks greater than 250 grams per day
0
3c) Consume fast foods sparingly, if at all
Never or rarely consumed fast food or consumed 1-3 times per month
1
Consumed fast food 1-3 per month or once a week
0.5
Consumed fast food 4 times or more per week
0
Methods» Computed WCRF/AICR composite scores
~Total score = ∑ score of each individual recommendations
» Higher scores indicate greater concordance with recommendations.~ 0 = poor diet/lifestyle quality~16 = high diet/lifestyle quality (for AHS-2)
» Assumption of WCRF/AICR: Each major recommendation should contribute equally to the total composite score.
Results
WCRF/ AICR Mean Scores & Ranges » Results: Parameters Score Range Mean ±SD
Composite score 2–16 9.09 ±1.80 Gender* Male 2–15.5 8.66 ±1.73 Female 2–16 9.33 ±1.79
Race* Black 2–15.5 8.62 ±1.83 Non-Black 2–16 9.19 ±1.77Dietary Patterns* Non-vegetarian 2–15 8.49 ±1.78 Semi-vegetarian 4.5–14.5 9.23 ±1.57 Pesco- 3.4–15 9.63 ±1.63 Lacto-ovo- 3.5–16 9.54 ±1.58 Vegan 4–16 10.4 ±1.55* Statistically significant, p-value <0.05.
Average WCRF/AICR Score for Selected Characteristics among 75,131 AHS-2 Participants
Participant Characteristics Mean SD
Age, yrs
<50 8.97 1.86
50-64 9.14 1.82
>64 9.18 1.69
Educational level
High school or less 8.80 1.83 Trade school, associate degree, or some college 9.04 1.82 College graduates or higher 9.30 1.73
Smoking status
Never 9.22 1.75
Past 8.64 1.84
Current 7.13 1.88
Marital status
Never married 8.68 1.86 First marriage, remarried, Common Law marriage 9.12 1.78
Separated, divorced, widowed 9.14 1.82
Household income, $ per year
Less than 10,000 8.82 1.83
10,000 to 75,000 9.03 1.79
>75,000 to 200,000 9.18 1.77
More than 200,000 9.49 1.78
0
3
6
9
8.59.2
9.6 9.5
10.4
Average WCRF/AICR Scores According to Dietary Patterns among 75,131 Adventist Health Study-2 Participants
Non-veg Semi- Pesco- Lacto-ovo- Vegan
Av
era
ge
WC
RF
/AIC
R S
co
re
Non-black Black0
3
6
9
8.78.2
9.58.8
Average WCRF/AICR Scores According to Gender and Race/Ethnicity among 75,131 Adventist Health Study-2 Participants
Male Female
Race/Ethnicity
Av
era
ge
WC
RF
/AIC
R S
co
re
Black Non-blackMales
0
3
6
9
12
8.18.98.9 9.49.3
9.99.2
9.810.110.7
Average WCRF/AICR Scores by Dietary Patterns According to Race/Ethnicity among 26,510 Male Participants
Non-vegetarian Semi-vegetarian Pesco- Lacto-ovo- Vegan
Race/Ethnicity
Av
era
ge
WC
RF
/AIC
R S
co
re
Black Non-blackFemales
0
3
6
9
12
7.88.38.7
9.38.8
9.48.8
9.49.610.3
Average WCRF/AICR Scores by Dietary Patterns According to Race/Ethnicity among 48,597 Female Participants
Non-vegetarian Semi-vegetarian Pesco- Lacto-ovo- Vegan
Race/Ethnicity
Av
era
ge
WC
RF
/AIC
R S
co
re
Summary» The average composite score is 9.09, ranging from 2 to 16.
» There is a step-wise increase in the average WCRF/AICR score moving toward a plant-based diet.
» Overall, non-black female vegans have better dietary and lifestyle quality than their black non-vegetarian male counterparts, with the average score being higher with increased age, increased level of education, being married, higher household income, and those who never smoked cigarettes.
Discussion» EPIC cohort:
score range 0-6 for males; 0-7 for females~ Difference in operationalization for each
component among different studies~ Not all studies have available data to satisfy all
10 recommendations outlined by the WCRF/AICR.
» Further improvements to better operationalize individual components.
Conclusion
» Data collected from AHS-2 cohort were applicable to 9 out of 10 recommendations~ Applying WCRF/AICR index to this cohort is appropriate
in assessing overall dietary and lifestyle behaviors
» Vegan dietary pattern may be a good surrogate measure for healthy lifestyle
» WCRF/AICR scoring index could be used an exposure variable relating to other outcomes.
Disclosures
» Funding for AHS-2: National Cancer Institute grant 1U01CA152939
Q&A