TY - JOUR
T1 - 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)
AU - DPP Research Group
AU - Shams-White, Marissa M.
AU - Tjaden, Ashley H.
AU - Edelstein, Sharon L.
AU - Bassiouni, Sarah
AU - Kahle, Lisa L.
AU - Kim, Catherine
AU - Pi-Sunyer, Xavier
AU - Temple, Karla A.
AU - Venditti, Elizabeth M.
AU - Reedy, Jill
AU - Heckman-Stoddard, Brandy M.
AU - Bray, George A.
AU - Gadde, Kishore M.
AU - Culbert, Iris W.
AU - Arceneaux, Jennifer
AU - Chatellier, Annie
AU - Dragg, Amber
AU - Champagne, Catherine M.
AU - Duncan, Crystal
AU - Eberhardt, Barbara
AU - Greenway, Frank
AU - Guillory, Fonda G.
AU - Herbert, April A.
AU - Jeffirs, Michael L.
AU - Kennedy, Betty M.
AU - Levy, Erma
AU - Lockett, Monica
AU - Lovejoy, Jennifer C.
AU - Morris, Laura H.
AU - Melancon, Lee E.
AU - Ryan, Donna H.
AU - Sanford, Deborah A.
AU - Smith, Kenneth G.
AU - Smith, Lisa L.
AU - St. Amant, Julia A.
AU - Tulley, Richard T.
AU - Vicknair, Paula C.
AU - Williamson, Donald
AU - Zachwieja, Jeffery J.
AU - Polonsky, Kenneth S.
AU - Tobian, Janet
AU - Ehrmann, David A.
AU - Matulik, Margaret J.
AU - Clark, Bart
AU - Czech, Kirsten
AU - Golden, Sherita Hill
AU - Clark, Jeanne M.
AU - Charleston, Jeanne B.
AU - Mosley, Henry
AU - Stewart, Kerry J.
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - Alcohol
KW - Diet
KW - Disease prevention
KW - Obesity
KW - Physical activity
KW - Weight
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UR - http://www.scopus.com/inward/citedby.url?scp=85138611143&partnerID=8YFLogxK
U2 - 10.1186/s40795-022-00596-7
DO - 10.1186/s40795-022-00596-7
M3 - Article
C2 - 36131333
AN - SCOPUS:85138611143
SN - 2055-0928
VL - 8
JO - BMC Nutrition
JF - BMC Nutrition
IS - 1
M1 - 105
ER -