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.

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. 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. 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. The Continuous Update Process

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. 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. One central database for cancer
prevention research
Database
Team
CUP Expert Panel
WCRF Secretariat

9. 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

10. Statistical methods
Dose-response meta-analysis using generalized least-squares for
trend estimation (command GLST in Stata)

11. Statistical methods
Publication bias
Exploratory analyses

12. Statistical methods
Stratified analyses, sensitivity analyses

13. The Continuous Update Project
Expert Panel

14. Breast cancer (premenopause)
Judgement of the Panel, 2007 and 2010
Second Expert Report 2007
CUP 2010

15. Colorectal cancer
Judgement of the Panel, 2007 and 2011
Second Expert Report 2007
Foods containing fibre ----- Convincing
CUP 2011

16. Colorectal cancer and dietary fibre
per 10 g increase
CUP Colorectal cancer report 2011 BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617

17. Colorectal cancer and dietary fibre (by food source)
CUP Colorectal cancer report 2011 BMJ 2011;343:d6617 doi: 10.1136/bmj.d6617

18. Pancreatic cancer
Judgement of the Panel, 2007 and 2012
Second Expert Report 2007
CUP 2012

19. 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

20. Endometrial cancer
Judgement of the Panel, 2007 and 2012
Second Expert Report 2007
CUP 2013

21. 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

22. The WCRF/AICR Continuous Update
Reports
http://www.wcrf.org/cancer_research/cup/key_findings/index.php

23. What next?
Ovarian cancer (December 2013)

24. What next?
Breast cancer survivors (early 2014)

25. What next?
Panel meetings:
June 2014:
June 2015:
April 2016:
Prostate
Stomach
Lung
Kidney
Oesophagus
Skin
Bladder
Mouth, pharynx, larynx
Cervix
Gallbladder
Nasopharynx

26. 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)