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)

DPP Research Group

doi:10.1186/s40795-022-00596-7

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)

DPP Research Group

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Article number	105
Journal	BMC Nutrition
Volume	8
Issue number	1
DOIs	https://doi.org/10.1186/s40795-022-00596-7
State	Published - Dec 2022

Keywords

Alcohol
Diet
Disease prevention
Obesity
Physical activity
Weight

Access to Document

10.1186/s40795-022-00596-7

Cite this

@article{91263a0726c04c98b6d626cdfab701c8,

title = "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)",

abstract = "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.",

keywords = "Alcohol, Diet, Disease prevention, Obesity, Physical activity, Weight",

author = "{DPP Research Group} and Shams-White, {Marissa M.} and Tjaden, {Ashley H.} and Edelstein, {Sharon L.} and Sarah Bassiouni and Kahle, {Lisa L.} and Catherine Kim and Xavier Pi-Sunyer and Temple, {Karla A.} and Venditti, {Elizabeth M.} and Jill Reedy and Heckman-Stoddard, {Brandy M.} and Bray, {George A.} and Gadde, {Kishore M.} and Culbert, {Iris W.} and Jennifer Arceneaux and Annie Chatellier and Amber Dragg and Champagne, {Catherine M.} and Crystal Duncan and Barbara Eberhardt and Frank Greenway and Guillory, {Fonda G.} and Herbert, {April A.} and Jeffirs, {Michael L.} and Kennedy, {Betty M.} and Erma Levy and Monica Lockett and Lovejoy, {Jennifer C.} and Morris, {Laura H.} and Melancon, {Lee E.} and Ryan, {Donna H.} and Sanford, {Deborah A.} and Smith, {Kenneth G.} and Smith, {Lisa L.} and {St. Amant}, {Julia A.} and Tulley, {Richard T.} and Vicknair, {Paula C.} and Donald Williamson and Zachwieja, {Jeffery J.} and Polonsky, {Kenneth S.} and Janet Tobian and Ehrmann, {David A.} and Matulik, {Margaret J.} and Bart Clark and Kirsten Czech and Catherine DeSandre and Ruthanne Hilbrich and Wylie McNabb and Semenske, {Ann R.} and Caro, {Jose F.} and Kevin Furlong and Goldstein, {Barry J.} and Watson, {Pamela G.} and Smith, {Kellie A.} and Jewel Mendoza and Wendi Wildman and Renee Liberoni and John Spandorfer and Constance Pepe and Donahue, {Richard P.} and Goldberg, {Ronald B.} and Ronald Prineas and Jeanette Calles and Juliet Ojito and Patricia Rowe and Paul Cassanova-Romero and Sumaya Castillo-Florez and Florez, {Hermes J.} and Anna Giannella and Lascelles Kirby and Carmen Larreal and Olga Lara and Valerie McLymont and Jadell Mendez and Arlette Perry and Patrice Saab and Beth Veciana and Haffner, {Steven M.} and Hazuda, {Helen P.} and Montez, {Maria G.} and Kathy Hattaway and Carlos Lorenzo and Arlene Martinez and Tatiana Walker and Dana Dabelea and Hamman, {Richard F.} and Nash, {Patricia V.} and Steinke, {Sheila C.} and Lisa Testaverde and Anderson, {Denise R.} and Ballonoff, {Larry B.} and Alexis Bouffard and Brian Bucca and Calonge, {B. Ned} and Lynne Delve and Martha Farago and Hill, {James O.} and Hoyer, {Shelley R.} and Tonya Jenkins and Jortberg, {Bonnie T.} and Dione Lenz and Marsha Miller and Leigh Perreault and Price, {David W.} and Regensteiner, {Judith G.} and Helen Seagle and Smith, {Carissa M.} and Brent VanDorsten and Horton, {Edward S.} and Lawton, {Kathleen E.} and Poirier, {Catherine S.} and Kati Swift and Arky, {Ronald A.} and Marybeth Bryant and Burke, {Jacqueline P.} and Enrique Caballero and Callaphan, {Karen M.} and Barbara Fargnoli and Therese Franklin and Ganda, {Om P.} and Ashley Guidi and Mathew Guido and Jackson, {Sharon D.} and Jacobsen, {Alan M.} and Lori Lambert and Sarah Ledbury and Margaret Kocal and Kula, {Lyn M.} and Malloy, {Maureen A.} and Maryanne Nicosia and Oldmixon, {Cathryn F.} and Jocelyn Pan and Marizel Quitingon and Stacy Rubtchinsky and Jessica Sansoucy and Dana Schweizer and Seely, {Ellen W.} and Donald Simonson and Fannie Smith and Solomon, {Caren G.} and Jeanne Spellman and James Warram and Kahn, {Steven E.} and Montgomery, {Brenda K.} and Wilfred Fujimoto and Knopp, {Robert H.} and Lipkin, {Edward W.} and Michelle Marr and Ivy Morgan-Taggart and Anne Murillo and Dace Trence and Lonnese Taylor and April Thomas and Tsai, {Elaine C.} and Samuel Dagogo-Jack and Kitabchi, {Abbas E.} and Murphy, {Mary E.} and Laura Taylor and Jennifer Dolgoff and Applegate, {William B.} and Michael Bryer-Ash and Debra Clark and Frieson, {Sandra L.} and Uzoma Ibebuogu and Raed Imseis and Helen Lambeth and Lichtermann, {Lynne C.} and Hooman Oktaei and Harriet Ricks and Rutledge, {Lily M.K.} and Sherman, {Amy R.} and Smith, {Clara M.} and Soberman, {Judith E.} and Beverly Williams-Cleaves and Metzger, {Boyd E.} and Molitch, {Mark E.} and Johnson, {Mariana K.} and Adelman, {Daphne T.} and Catherine Behrends and Michelle Cook and Marian Fitzgibbon and Giles, {Mimi M.} and Deloris Heard and Johnson, {Cheryl K.H.} and Diane Larsen and Anne Lowe and Megan Lyman and David McPherson and Penn, {Samsam C.} and Thomas Pitts and Renee Reinhart and Susan Roston and Schinleber, {Pamela A.} and Nathan, {David M.} and Charles McKitrick and Heather Turgeon and Mary Larkin and White, {Neil H.} and Brown, {Angela L.} and Ling Chen",

note = "Funding Information: The DPP Research Group gratefully acknowledges the commitment and dedication of the participants of the DPP and DPPOS. Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) under award numbers U01 DK048489, U01 DK048339, U01 DK048377, U01 DK048349, U01 DK048381, U01 DK048468, U01 DK048434, U01 DK048485, U01 DK048375, U01 DK048514, U01 DK048437, U01 DK048413, U01 DK048411, U01 DK048406, U01 DK048380, U01 DK048397, U01 DK048412, U01 DK048404, U01 DK048387, U01 DK048407, U01 DK048443, and U01 DK048400, by providing funding during DPP and DPPOS to the clinical centers and the Coordinating Center for the design and conduct of the study, and collection, management, analysis, and interpretation of the data. Funding was also provided by the National Institute of Child Health and Human Development, the National Institute on Aging, the National Eye Institute, the National Heart Lung and Blood Institute, the National Cancer Institute, the Office of Research on Women{\textquoteright}s Health, the National Institute on Minority Health and Health Disparities, the Centers for Disease Control and Prevention, and the American Diabetes Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Southwestern American Indian Centers were supported directly by the NIDDK, including its Intramural Research Program, and the Indian Health Service. The General Clinical Research Center Program, National Center for Research Resources, and the Department of Veterans Affairs supported data collection at many of the clinical centers. Merck KGaA provided medication for DPPOS. DPP/DPPOS have also received donated materials, equipment, or medicines for concomitant conditions from Bristol-Myers Squibb, Parke-Davis, and LifeScan Inc., Health O Meter, Hoechst Marion Roussel, Inc., Merck-Medco Managed Care, Inc., Merck and Co., Nike Sports Marketing, Slim Fast Foods Co., and Quaker Oats Co. McKesson BioServices Corp., Matthews Media Group, Inc., and the Henry M. Jackson Foundation provided support services under subcontract with the Coordinating Center. The sponsor of this study was represented on the Steering Committee and played a part in study design, how the study was done, and publication. All authors in the writing group had access to all data. The opinions expressed are those of the study group and do not necessarily reflect the views of the funding agencies. A complete list of the DPP Research group, Centers, investigators, and staff can be found in the supplementary material. AHT and SLE are the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: The DPP Research Group gratefully acknowledges the commitment and dedication of the participants of the DPP and DPPOS. Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) under award numbers U01 DK048489, U01 DK048339, U01 DK048377, U01 DK048349, U01 DK048381, U01 DK048468, U01 DK048434, U01 DK048485, U01 DK048375, U01 DK048514, U01 DK048437, U01 DK048413, U01 DK048411, U01 DK048406, U01 DK048380, U01 DK048397, U01 DK048412, U01 DK048404, U01 DK048387, U01 DK048407, U01 DK048443, and U01 DK048400, by providing funding during DPP and DPPOS to the clinical centers and the Coordinating Center for the design and conduct of the study, and collection, management, analysis, and interpretation of the data. Funding was also provided by the National Institute of Child Health and Human Development, the National Institute on Aging, the National Eye Institute, the National Heart Lung and Blood Institute, the National Cancer Institute, the Office of Research on Women{\textquoteright}s Health, the National Institute on Minority Health and Health Disparities, the Centers for Disease Control and Prevention, and the American Diabetes Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Southwestern American Indian Centers were supported directly by the NIDDK, including its Intramural Research Program, and the Indian Health Service. The General Clinical Research Center Program, National Center for Research Resources, and the Department of Veterans Affairs supported data collection at many of the clinical centers. Merck KGaA provided medication for DPPOS. DPP/DPPOS have also received donated materials, equipment, or medicines for concomitant conditions from Bristol-Myers Squibb, Parke-Davis, and LifeScan Inc., Health O Meter, Hoechst Marion Roussel, Inc., Merck-Medco Managed Care, Inc., Merck and Co., Nike Sports Marketing, Slim Fast Foods Co., and Quaker Oats Co. McKesson BioServices Corp., Matthews Media Group, Inc., and the Henry M. Jackson Foundation provided support services under subcontract with the Coordinating Center. The sponsor of this study was represented on the Steering Committee and played a part in study design, how the study was done, and publication. All authors in the writing group had access to all data. The opinions expressed are those of the study group and do not necessarily reflect the views of the funding agencies. A complete list of the DPP Research group, Centers, investigators, and staff can be found in the supplementary material. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = dec,

doi = "10.1186/s40795-022-00596-7",

language = "English",

volume = "8",

journal = "BMC Nutrition",

issn = "2055-0928",

number = "1",

}

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 - DeSandre, Catherine

AU - Hilbrich, Ruthanne

AU - McNabb, Wylie

AU - Semenske, Ann R.

AU - Caro, Jose F.

AU - Furlong, Kevin

AU - Goldstein, Barry J.

AU - Watson, Pamela G.

AU - Smith, Kellie A.

AU - Mendoza, Jewel

AU - Wildman, Wendi

AU - Liberoni, Renee

AU - Spandorfer, John

AU - Pepe, Constance

AU - Donahue, Richard P.

AU - Goldberg, Ronald B.

AU - Prineas, Ronald

AU - Calles, Jeanette

AU - Ojito, Juliet

AU - Rowe, Patricia

AU - Cassanova-Romero, Paul

AU - Castillo-Florez, Sumaya

AU - Florez, Hermes J.

AU - Giannella, Anna

AU - Kirby, Lascelles

AU - Larreal, Carmen

AU - Lara, Olga

AU - McLymont, Valerie

AU - Mendez, Jadell

AU - Perry, Arlette

AU - Saab, Patrice

AU - Veciana, Beth

AU - Haffner, Steven M.

AU - Hazuda, Helen P.

AU - Montez, Maria G.

AU - Hattaway, Kathy

AU - Lorenzo, Carlos

AU - Martinez, Arlene

AU - Walker, Tatiana

AU - Dabelea, Dana

AU - Hamman, Richard F.

AU - Nash, Patricia V.

AU - Steinke, Sheila C.

AU - Testaverde, Lisa

AU - Anderson, Denise R.

AU - Ballonoff, Larry B.

AU - Bouffard, Alexis

AU - Bucca, Brian

AU - Calonge, B. Ned

AU - Delve, Lynne

AU - Farago, Martha

AU - Hill, James O.

AU - Hoyer, Shelley R.

AU - Jenkins, Tonya

AU - Jortberg, Bonnie T.

AU - Lenz, Dione

AU - Miller, Marsha

AU - Perreault, Leigh

AU - Price, David W.

AU - Regensteiner, Judith G.

AU - Seagle, Helen

AU - Smith, Carissa M.

AU - VanDorsten, Brent

AU - Horton, Edward S.

AU - Lawton, Kathleen E.

AU - Poirier, Catherine S.

AU - Swift, Kati

AU - Arky, Ronald A.

AU - Bryant, Marybeth

AU - Burke, Jacqueline P.

AU - Caballero, Enrique

AU - Callaphan, Karen M.

AU - Fargnoli, Barbara

AU - Franklin, Therese

AU - Ganda, Om P.

AU - Guidi, Ashley

AU - Guido, Mathew

AU - Jackson, Sharon D.

AU - Jacobsen, Alan M.

AU - Lambert, Lori

AU - Ledbury, Sarah

AU - Kocal, Margaret

AU - Kula, Lyn M.

AU - Malloy, Maureen A.

AU - Nicosia, Maryanne

AU - Oldmixon, Cathryn F.

AU - Pan, Jocelyn

AU - Quitingon, Marizel

AU - Rubtchinsky, Stacy

AU - Sansoucy, Jessica

AU - Schweizer, Dana

AU - Seely, Ellen W.

AU - Simonson, Donald

AU - Smith, Fannie

AU - Solomon, Caren G.

AU - Spellman, Jeanne

AU - Warram, James

AU - Kahn, Steven E.

AU - Montgomery, Brenda K.

AU - Fujimoto, Wilfred

AU - Knopp, Robert H.

AU - Lipkin, Edward W.

AU - Marr, Michelle

AU - Morgan-Taggart, Ivy

AU - Murillo, Anne

AU - Trence, Dace

AU - Taylor, Lonnese

AU - Thomas, April

AU - Tsai, Elaine C.

AU - Dagogo-Jack, Samuel

AU - Kitabchi, Abbas E.

AU - Murphy, Mary E.

AU - Taylor, Laura

AU - Dolgoff, Jennifer

AU - Applegate, William B.

AU - Bryer-Ash, Michael

AU - Clark, Debra

AU - Frieson, Sandra L.

AU - Ibebuogu, Uzoma

AU - Imseis, Raed

AU - Lambeth, Helen

AU - Lichtermann, Lynne C.

AU - Oktaei, Hooman

AU - Ricks, Harriet

AU - Rutledge, Lily M.K.

AU - Sherman, Amy R.

AU - Smith, Clara M.

AU - Soberman, Judith E.

AU - Williams-Cleaves, Beverly

AU - Metzger, Boyd E.

AU - Molitch, Mark E.

AU - Johnson, Mariana K.

AU - Adelman, Daphne T.

AU - Behrends, Catherine

AU - Cook, Michelle

AU - Fitzgibbon, Marian

AU - Giles, Mimi M.

AU - Heard, Deloris

AU - Johnson, Cheryl K.H.

AU - Larsen, Diane

AU - Lowe, Anne

AU - Lyman, Megan

AU - McPherson, David

AU - Penn, Samsam C.

AU - Pitts, Thomas

AU - Reinhart, Renee

AU - Roston, Susan

AU - Schinleber, Pamela A.

AU - Nathan, David M.

AU - McKitrick, Charles

AU - Turgeon, Heather

AU - Larkin, Mary

AU - White, Neil H.

AU - Brown, Angela L.

AU - Chen, Ling

N1 - Funding Information: The DPP Research Group gratefully acknowledges the commitment and dedication of the participants of the DPP and DPPOS. Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) under award numbers U01 DK048489, U01 DK048339, U01 DK048377, U01 DK048349, U01 DK048381, U01 DK048468, U01 DK048434, U01 DK048485, U01 DK048375, U01 DK048514, U01 DK048437, U01 DK048413, U01 DK048411, U01 DK048406, U01 DK048380, U01 DK048397, U01 DK048412, U01 DK048404, U01 DK048387, U01 DK048407, U01 DK048443, and U01 DK048400, by providing funding during DPP and DPPOS to the clinical centers and the Coordinating Center for the design and conduct of the study, and collection, management, analysis, and interpretation of the data. Funding was also provided by the National Institute of Child Health and Human Development, the National Institute on Aging, the National Eye Institute, the National Heart Lung and Blood Institute, the National Cancer Institute, the Office of Research on Women’s Health, the National Institute on Minority Health and Health Disparities, the Centers for Disease Control and Prevention, and the American Diabetes Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Southwestern American Indian Centers were supported directly by the NIDDK, including its Intramural Research Program, and the Indian Health Service. The General Clinical Research Center Program, National Center for Research Resources, and the Department of Veterans Affairs supported data collection at many of the clinical centers. Merck KGaA provided medication for DPPOS. DPP/DPPOS have also received donated materials, equipment, or medicines for concomitant conditions from Bristol-Myers Squibb, Parke-Davis, and LifeScan Inc., Health O Meter, Hoechst Marion Roussel, Inc., Merck-Medco Managed Care, Inc., Merck and Co., Nike Sports Marketing, Slim Fast Foods Co., and Quaker Oats Co. McKesson BioServices Corp., Matthews Media Group, Inc., and the Henry M. Jackson Foundation provided support services under subcontract with the Coordinating Center. The sponsor of this study was represented on the Steering Committee and played a part in study design, how the study was done, and publication. All authors in the writing group had access to all data. The opinions expressed are those of the study group and do not necessarily reflect the views of the funding agencies. A complete list of the DPP Research group, Centers, investigators, and staff can be found in the supplementary material. AHT and SLE are the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: The DPP Research Group gratefully acknowledges the commitment and dedication of the participants of the DPP and DPPOS. Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) under award numbers U01 DK048489, U01 DK048339, U01 DK048377, U01 DK048349, U01 DK048381, U01 DK048468, U01 DK048434, U01 DK048485, U01 DK048375, U01 DK048514, U01 DK048437, U01 DK048413, U01 DK048411, U01 DK048406, U01 DK048380, U01 DK048397, U01 DK048412, U01 DK048404, U01 DK048387, U01 DK048407, U01 DK048443, and U01 DK048400, by providing funding during DPP and DPPOS to the clinical centers and the Coordinating Center for the design and conduct of the study, and collection, management, analysis, and interpretation of the data. Funding was also provided by the National Institute of Child Health and Human Development, the National Institute on Aging, the National Eye Institute, the National Heart Lung and Blood Institute, the National Cancer Institute, the Office of Research on Women’s Health, the National Institute on Minority Health and Health Disparities, the Centers for Disease Control and Prevention, and the American Diabetes Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Southwestern American Indian Centers were supported directly by the NIDDK, including its Intramural Research Program, and the Indian Health Service. The General Clinical Research Center Program, National Center for Research Resources, and the Department of Veterans Affairs supported data collection at many of the clinical centers. Merck KGaA provided medication for DPPOS. DPP/DPPOS have also received donated materials, equipment, or medicines for concomitant conditions from Bristol-Myers Squibb, Parke-Davis, and LifeScan Inc., Health O Meter, Hoechst Marion Roussel, Inc., Merck-Medco Managed Care, Inc., Merck and Co., Nike Sports Marketing, Slim Fast Foods Co., and Quaker Oats Co. McKesson BioServices Corp., Matthews Media Group, Inc., and the Henry M. Jackson Foundation provided support services under subcontract with the Coordinating Center. The sponsor of this study was represented on the Steering Committee and played a part in study design, how the study was done, and publication. All authors in the writing group had access to all data. The opinions expressed are those of the study group and do not necessarily reflect the views of the funding agencies. A complete list of the DPP Research group, Centers, investigators, and staff can be found in the supplementary material. 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

UR - http://www.scopus.com/inward/record.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 -

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)

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