Norat Teresa - 20th International Nutrition Congress 2013
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Norat Teresa - 20th International Nutrition Congress 2013

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The 20th International Congress of Nutrition (ICN) hosted by the International Union of Nutritional Science (IUNS) took place on the 15th-20th September 2013, Granada, Spain. WCRF International held a ...

The 20th International Congress of Nutrition (ICN) hosted by the International Union of Nutritional Science (IUNS) took place on the 15th-20th September 2013, Granada, Spain. WCRF International held a 2-hour symposium on the Continuous Update Project (CUP) entitled ‘Food, Nutrition, Physical Activity and Cancer – Keeping the Evidence Current: WCRF/AICR Continuous Update Project (CUP).’ It included four presentations exploring the latest updates from the CUP.

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Norat Teresa - 20th International Nutrition Congress 2013 Norat Teresa - 20th International Nutrition Congress 2013 Presentation Transcript

  • The WCRF/AICR Continuous Update Aims and Process Teresa Norat Continuous Update Project School of Public Health, Imperial College London, UK ICN 17 September 2013
  • The Continuous Update Project. Aims WCRF/AICR Recommendations for Cancer Prevention: Ensure everyone has access Based on the most up to date scientific evidence
  • What is the Continuous Update Project? Continuous update epidemiologic evidence (SLR- Imperial College London) Up-to-date database Mechanistic evidence (University of Bristol) Evaluation of evidence (Independent panel of experts) Recommendations Education and research priorities
  • The Continuous Update Process
  • Continuous update epidemiologic evidence (SLR- Imperial College London) CUP people at Imperial College: http://www.dietandcancerreport.org/cancer_resource_center/continuous_update_project.php
  • CUP Search Literature Review PROTOCOL (SLR- Imperial College London) Research topic : The associations between food, nutrition and physical activity and  Cancer risk  Mortality and second cancers in breast cancer survivors. Main objective : Summarize the evidence from prospective studies and randomised controlled trials (case-control studies if requested by the Panel). Search strategy: Medline, Central, ClinialTrials.gov Hand search of references (reviews, meta-analysis, recent relevant papers) (http://www.dietandcancerreport.org/cancer_resource_center/downloads/SLR_Manual.pdf)
  • One central database for cancer prevention research Database Team CUP Expert Panel WCRF Secretariat
  • Number of articles from cohort studies in the WCRF database (updated August 2013) * Update of cancers of mouth, pharynx and larynx to start on October 2013
  • Statistical methods Dose-response meta-analysis using generalized least-squares for trend estimation (command GLST in Stata)
  • Statistical methods Publication bias Exploratory analyses
  • Statistical methods Stratified analyses, sensitivity analyses
  • The Continuous Update Project Expert Panel
  • Breast cancer (premenopause) Judgement of the Panel, 2007 and 2010 Second Expert Report 2007 CUP 2010
  • Colorectal cancer Judgement of the Panel, 2007 and 2011 Second Expert Report 2007 Foods containing fibre ----- Convincing CUP 2011
  • Colorectal cancer and dietary fibre per 10 g increase CUP Colorectal cancer report 2011 BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617
  • Colorectal cancer and dietary fibre (by food source) CUP Colorectal cancer report 2011 BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617
  • Pancreatic cancer Judgement of the Panel, 2007 and 2012 Second Expert Report 2007 CUP 2012
  • Pancreatic cancer SLR 2012 Alcoholic drinks Nonlinear dose-response analysis of total alcoholic drinks and pancreatic cancer 2 3 Linear dose-response meta-analysis Study Weight 1.5 RR (95% CI) Per 1 drink/week Gender 1 Year RR % Author 1.01 (1.00, 1.01) 32.83 M/F 1.01 (1.00, 1.01) 31.69 F 0.99 (0.98, 0.99) 32.43 MWS F 1.36 (0.98, 1.89) 0.13 IWHS 1994 M/F 1.00 (0.93, 1.07) 2.82 1993 M 1.65 (1.11, 2.47) 0.09 1.00 (0.99, 1.01) 100.00 Jiao 2009 Stevens 2009 Harnack 1997 Shibata Zheng M/F CPS II .8 2011 NIH-AARP 0 Leisure World 20 30 Total alcoholic drinks (drinks/week) 40 Scatter plot of risk estimates of total alcoholic drinks and pancreatic cancer .85 1 2 3 1 Estimated RR 2 Overall I-squared = 93.0%, p = 0.000 LBS 10 Best fitting fractional polynomial 95% confidence interval 4 Gapstur 0 10 20 30 Total alcoholic drinks (drinks/week) Reference categories RR for alcohol exposure http://www.dietandcancerreport.org/cancer_resource_center/downloads/cu/Pancreatic-Cancer-SLR-2011.pdf 40
  • Endometrial cancer Judgement of the Panel, 2007 and 2012 Second Expert Report 2007 CUP 2013
  • Endometrial cancer Forest plots. Highest vs lowest Sitting time Physical activity High vs low High vs low Author Year RR (95% CI) Study Contrast Conroy 2009 0.87 (0.60, 1.27) WHS >=20.4  vs <2.7 METh/week Gierach 2009 0.56 (0.46, 0.68) NIH-AARP >=5 times/week vs Never/rarely Patel 2008 0.67 (0.44, 1.03) CPS II 0.94 (0.75, 1.18) EPIC >=41.26 vs <12.01 METh/week Frieberg 2006 0.90 (0.67, 1.21) SMC >=20 min/d vs <20 min/d Schouten 2004 0.54 (0.34, 0.85) NLCS >=90 vs <30 min/d Folsom 2003 1.05 (0.84, 1.33) IWHS High vs Low Furberg 2003 0.71 (0.34, 1.49) NNHSS Active vs sedentary Terry 1999 0.10 (0.04, 0.60) STR Hard activity vs None RR (95% CI) Study >=31.5 vs 0-<7 METh/week  Friedenreich 2007 Author Year Moore 2009 1.45 (1.10, 1.92) Patel 2008 1.40 (1.03, 1.89) Friberg 2006 1.66 (1.05, 2.61)     .5 .1   .25 .5 1 1.5   .75 1 1.5 2   3   Contrast NIH-AARP 9+h/day vs <3 h CPS-II 6+ vs <3 hour/day SMC High vs low
  • The WCRF/AICR Continuous Update Reports http://www.wcrf.org/cancer_research/cup/key_findings/index.php
  • What next? Ovarian cancer (December 2013)
  • What next? Breast cancer survivors (early 2014)
  • What next? Panel meetings: June 2014: June 2015: April 2016: Prostate Stomach Lung Kidney Oesophagus Skin Bladder Mouth, pharynx, larynx Cervix Gallbladder Nasopharynx
  • Thanks! CUP Team Dagfinn Aune; Snieguole Vingeliene; Deborah Navarro Rosenblatt; Teresa Norat; Doris Chan; Ana Rita Vieira, Leila Abar and Christophe Stevens (not in photo) Darren Greenwood, University of Leeds, Statistical Advisor (not in photo)