Table 1.

WCRF/AICR cancer prevention recommendations, their operationalization in this study, and percent who met each recommendation

WCRF/AICR recommendation	Associated personal recommendations	Met/did not meet recommendation in this study if:	Colorectal cancer cases (N=546)		Non-cases (N=66,374)		VITAL cohort (N=66,920)
			N	%	N	%	N	%
1. Body fatness Be as lean as possible within the normal range of body weight	Ensure that weight through childhood and adolescent growth projects toward the lower end of the normal BMI range at age 21 Maintain body weight within the normal range from age 21 Avoid weight gain and increases in waist circumference throughout adulthood	Met: 18.5 kg/m2 ≤ BMI < 25 kg/m2	160	29.3	22,121	33.3	22,281	33.3
		Did not meet: BMI < 18.5 kg/m2 or BMI ≥ 25 kg/m2	386	70.7	44,253	66.7	44,639	66.7
2. Physical activity Be physically active as part of everyday life	Be moderately physically active, equivalent to brisk walking, for at least 30 minutes every day As fitness improves, aim for 60 minutes or more of moderate, or for 30 minutes or more of vigorous, physical activity every day Limit sedentary habits such as watching television	Met: ≥ 30 minutes per day of moderate or fast walking and/or moderate or strenuous activity on at least 5 days per week in at least 7 of the past 10 years	88	16.1	12,268	18.5	12,356	18.5
		Did not meet: < 30 minutes per day or < 5 days per week or < 7 of the previous 10 years of moderate or fast walking and/or moderate or strenuous activity	458	83.9	54,106	81.5	54,564	81.5
3. Energy density Limit consumption of energy dense foods; avoid sugary drinks	Consume energy-dense foods sparingly Avoid sugary drinks. (This principally refers to drinks with added sugars. Fruit juices should also be limited.) Consume ‘fast foods’ sparingly, if at all	Met: Energy density of diet < 125 kcal per 100 g and < 1 sugary drink and ≤ 3 servings of fruit juice per week	58	10.6	7,595	11.4	7,653	11.4
		Did not meet: Energy density of diet ≥ 125 kcal per 100 g or ≥ 1 sugary drink or > 3 servings of fruit juice per week	488	89.4	58,779	88.6	59,267	88.6
4. Plant foods Eat mostly foods of plant origin	Eat at least five portions/servings (at least 400 g or 14 oz) of a variety of non-starchy vegetables and of fruits every day Eat relatively unprocessed cereals (grains) and/or pulses (legumes) with every meal Limit refined starchy foods People who consume starchy roots or tubers as staples also to ensure intake of sufficient non-starchy vegetables, fruits, and pulses (legumes)	Met: ≥ 5 servings of fruits and vegetables and ≥ 1 serving of whole grains and/or legumes per day	57	10.4	7,606	11.5	7,663	11.5
		Did not meet: < 5 servings of fruits and vegetables and/or < 1 serving of whole grains and/or legumes per day	489	89.6	58,768	88.5	59,257	88.6
5. Red meat Limit intake of red meat and avoid processed meat	People who eat red meat to consume less than 500 g (18 oz) a week, very little if any to be processed	Met: < 18 oz total red and processed meat, including no more than 1 serving processed meat, per week	159	29.1	23,158	34.9	23,317	34.8
		Did not meet: ≥ 18 oz red and/or processed meat or > 1 serving processed meat per week	387	70.9	43,216	65.1	43,603	65.2
6. Alcohol Limit alcoholic drinks	If alcoholic drinks are consumed, limit consumption to no more than two drinks a day for men and one drink a day for women	Met: ≤ 1 drink per day for women, ≤ 2 drinks per day for men	441	80.8	56,767	85.5	57,208	85.5
		Did not meet: > 1 drink per day for women, > 2 drinks per day for men	105	19.2	9,607	14.5	9,712	14.5
7. Salt-preserved foods Limit consumption of salt; avoid moldy grains or legumes	Avoid salt-preserved, salted, or salty foods; preserve foods without using salt Limit consumption of processed foods with added salt to ensure an intake of less than 6 g (2.4 g sodium) a day Do not eat moldy cereals (grains) or pulses (legumes)	Not operationalized	--	--	--	--	--	--
8. Supplements Aim to meet nutritional needs through diet alone	Dietary supplements are not recommended for cancer prevention	Not operationalized	--	--	--	--	--	--

Italicized text indicates portions of the WCRF/AICR recommendations operationalized in this study. These represent the key components of the recommendations selected by an expert panel.