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Randomized Controlled Trial
. 2025 Sep;122(3):715-723.
doi: 10.1016/j.ajcnut.2025.07.011. Epub 2025 Jul 15.

The 2018 World Cancer Research Fund/American Institute for Cancer Research Score and Cancer Risk: results from the diabetes prevention program outcomes study

Ashley H Tjaden  1 , Audrey A Goldbaum  2 , Sharon L Edelstein  1 , Brandy M Heckman-Stoddard  3 , Jill Reedy  2 , William H Herman  4 , Mary Hoskin  5 , William C Knowler  1 , Mathias Schlögl  6 , Karla A Temple  7 , Elizabeth M Venditti  8 , Karol Watson  9 , Marinella Temprosa  1 , Marissa M Shams-White  10 ; DPP Research Group
Affiliations
Randomized Controlled Trial

The 2018 World Cancer Research Fund/American Institute for Cancer Research Score and Cancer Risk: results from the diabetes prevention program outcomes study

Ashley H Tjaden et al. Am J Clin Nutr. 2025 Sep.

Abstract

Background: Modifying lifestyle factors may reduce the incidence of obesity, diabetes, and cancer.

Objectives: We examined how alignment with the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations using the 2018 WCRF/AICR score was associated with incident lifestyle-related cancer in adults with prediabetes in the Diabetes Prevention Program (DPP, 1996-2001) and DPP Outcomes Study (DPPOS, 2002-2020), an observational follow-up of a randomized clinical trial.

Methods: Participants were randomly assigned to lifestyle, metformin, or placebo interventions (mean: 3 y) and followed for an additional 19 y. The 2018 WCRF/AICR score (0-7 points; higher score, better alignment) was calculated from body weight, physical activity, diet, and alcohol components at 0, 1, 5, 6, 9, and 15 y after randomization. Incident cancer was based on the 2018 WCRF/AICR 3rd Expert Report (18 cancers associated with lifestyle). Adjusted Cox proportional hazard models estimated associations between the score (baseline [0], change from 0 to 1 y, time dependent) and lifestyle-related cancer.

Results: Participants' (N = 3000) mean baseline WCRF/AICR score was 3.2 (SD: 1.1). There were 403 incident lifestyle-related cancer cases. Scores improved after 1 and 15 y (mean increase = 0.43 and 0.27 points, respectively, both P < 0.001). The baseline score was not associated with cancer risk. However, a 1-unit score improvement from 0 to 1 y and time-dependent scores were significantly associated with a 14% (hazard ratio [HR]: 0.86; 95% confidence interval [95% CI]: 0.76, 0.97) and 9% (HR: 0.91; 95% CI: 0.83, 0.997) lower risk, respectively, with no effect modification by intervention group or diabetes status. In exploratory by-component analyses, no single component was associated with risk.

Conclusions: Alignment with WCRF/AICR recommendations may lower cancer risk in adults with prediabetes and type 2 diabetes, highlighting the importance of considering lifestyle factors for cancer prevention.

Trial registration number: Diabetes Prevention Program, NCT00004992; Diabetes Prevention Program Outcomes Study, NCT00038727.

Keywords: alcohol; diet; disease prevention; obesity; physical activity; weight.

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Conflict of interest statement

Conflict of interest DPP Research Group reports financial support was provided by the National Institutes of Health. All other authors report no conflicts of interest.

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