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Adherence to 2018 WCRF/AICR recommendations and colorectal cancer risk: A case-control and Mendelian randomization study.

Tiantian Wu,Yujing Fang,Qingjian Ou,Kexin Tu,Caixia Zhang

Published 2025 in Nutrition (Burbank, Los Angeles County, Calif.)

ABSTRACT

BACKGROUND The association between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations and colorectal cancer (CRC) risk remains inconsistent in epidemiological studies, with particularly sparse data from Chinese populations. This study aimed to evaluate this relationship comprehensively. METHODS We conducted a case-control study involving 3030 incident CRC cases and 3044 age- and sex-matched controls. Multivariable logistic regression models were used to examine the association between adherence to the seven-point 2018 WCRF/AICR score, the 2018 WCRF/AICR dietary score, and individual recommendations with CRC risk, with results presented as odds ratios (ORs) and 95% confidence intervals (95% CIs). Additionally, a two-sample Mendelian randomization (MR) study was performed to assess the causal relationship between individual recommendations and CRC risk. RESULTS Both a higher 2018 WCRF/AICR score (adjusted ORQ5 versus Q1: 0.52; 95% CI: 0.43, 0.64; Ptrend < 0.001) and a higher 2018 WCRF/AICR dietary score (adjusted ORQ5 versus Q1: 0.51; 95% CI: 0.42, 0.63; Ptrend < 0.001) were associated with a reduced CRC risk in Chinese populations. Adherence to individual recommendations on physical activity, plant-based food intake, red/processed meat intake limitation and alcohol intake limitation showed an inverse association with CRC risk. Of these, plant-based food intake and alcohol consumption limitation were further supported by MR analyses. CONCLUSIONS Greater adherence to the 2018 WCRF/AICR recommendations, particularly those related to plant-based food intake and alcohol intake limitation, was inversely associated with the risk of CRC.

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