Development and validation of a short screener to evaluate adherence to the World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations

Abstract

Background and aims: Adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations is associated with reduced risk for cancer and all-cause mortality. The aim of this study was to develop and validate a short screener to assess adherence to these guidelines.

Methods: The study was divided into two phases: Screener development (Phase I) and a validation study (Phase II). A subsample of participants from the PREDIMED-Plus study, an ongoing randomised lifestyle intervention trial which focuses on cardiovascular disease prevention, were invited from two recruiting centres in Spain for the pilot testing (n = 110) and validation (n = 148) of the tool. Participants completed the WCRF/AICR Screener, and dietary and lifestyle data were collected using validated methods (anthropometric measurements by trained staff, and validated diet and physical activity (PA) questionnaires). A score reflecting adherence to the recommendations was derived for each method (Screener and validated instruments), adapted from the 2018 WCRF/AICR Score. Relative agreement between the total scores was evaluated by Spearman correlation (r) and intraclass correlation coefficients (ICC). Cross-classification and Kappa coefficient (κ) were used for individual recommendations.

Results: The WCRF/AICR Screener has 13 questions covering seven recommendations (regarding body weight; PA; plant-based foods; fast and processed foods; red and processed meat; sugar-sweetened drinks; and alcoholic drinks) with a score range of 0-7 (higher scores indicated greater adherence). There was a significant correlation (r = 0.70) and a moderate agreement (ICC = 0.68) between the WCRF/AICR Screener (mean ± SD, 3.20 ± 0.92) and validated methods (3.05 ± 1.01) scores. The scores for individual recommendations showed very good agreement for body weight (κ = 0.84), substantial agreement for alcoholic drinks (κ = 0.71), moderate agreement for PA (κ = 0.58), red and processed meat (κ = 0.58) and sugar-sweetened drinks (κ = 0.56). Fair agreement was observed for plant-based foods (κ = 0.30) and fast and processed foods (κ = 0.27).

Conclusions: The WCRF/AICR Screener is a valid tool for assessing adherence to the WCRF/AICR Cancer Prevention Recommendations at an individual level, and could be useful for rapid assessment of diet and lifestyle in clinical settings for cancer prevention strategies.

Keywords: Cancer prevention; Diet; Lifestyle; Nutritional assessment; Screener; Validation.