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 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

  1. 1. 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
  2. 2. The Continuous Update Project. Aims WCRF/AICR Recommendations for Cancer Prevention: Ensure everyone has access Based on the most up to date scientific evidence
  3. 3. 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
  4. 4. The Continuous Update Process
  5. 5. Continuous update epidemiologic evidence (SLR- Imperial College London) CUP people at Imperial College: http://www.dietandcancerreport.org/cancer_resource_center/continuous_update_project.php
  6. 6. 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)
  7. 7. One central database for cancer prevention research Database Team CUP Expert Panel WCRF Secretariat
  8. 8. 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
  9. 9. Statistical methods Dose-response meta-analysis using generalized least-squares for trend estimation (command GLST in Stata)
  10. 10. Statistical methods Publication bias Exploratory analyses
  11. 11. Statistical methods Stratified analyses, sensitivity analyses
  12. 12. The Continuous Update Project Expert Panel
  13. 13. Breast cancer (premenopause) Judgement of the Panel, 2007 and 2010 Second Expert Report 2007 CUP 2010
  14. 14. Colorectal cancer Judgement of the Panel, 2007 and 2011 Second Expert Report 2007 Foods containing fibre ----- Convincing CUP 2011
  15. 15. Colorectal cancer and dietary fibre per 10 g increase CUP Colorectal cancer report 2011 BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617
  16. 16. Colorectal cancer and dietary fibre (by food source) CUP Colorectal cancer report 2011 BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617
  17. 17. Pancreatic cancer Judgement of the Panel, 2007 and 2012 Second Expert Report 2007 CUP 2012
  18. 18. 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
  19. 19. Endometrial cancer Judgement of the Panel, 2007 and 2012 Second Expert Report 2007 CUP 2013
  20. 20. 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
  21. 21. The WCRF/AICR Continuous Update Reports http://www.wcrf.org/cancer_research/cup/key_findings/index.php
  22. 22. What next? Ovarian cancer (December 2013)
  23. 23. What next? Breast cancer survivors (early 2014)
  24. 24. What next? Panel meetings: June 2014: June 2015: April 2016: Prostate Stomach Lung Kidney Oesophagus Skin Bladder Mouth, pharynx, larynx Cervix Gallbladder Nasopharynx
  25. 25. 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)

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