Table 3.
The associations between the ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention and Nonsmoking with Colorectal Cancer Incidence.
| Total Analytic Cohort | Black participants | |||||
|---|---|---|---|---|---|---|
| Guideline | Cohort (N) | Cases (N) | HR (95%CI) a | Cohort (N) | Cases (N) | HR (95%CI) a |
| Achieve and maintain a healthy weight throughout life. | ||||||
| Body mass index at baseline (kg/m2) | ||||||
| <18.5 | 867 | 14 | 1.95 (1.13 to 3.38) | 549 | 9 | 1.80 (0.91 to 3.56) |
| 18.5–24.9 | 17897 | 160 | 1 (Ref.) | 11790 | 114 | 1 (Ref.) |
| 25.0–29.9 | 22859 | 239 | 1.10 (0.89 to 1.34) | 14940 | 173 | 1.10 (0.87 to 1.40) |
| ≥30.0 | 33559 | 329 | 1.06 (0.87 to 1.30) | 23408 | 253 | 1.05 (0.82 to 1.33) |
| Be physically active. | ||||||
| Physical activity guideline b | ||||||
| Meets | 14681 | 123 | 1 (Ref.) | 9774 | 90 | 1 (Ref.) |
| Does not meet | 60501 | 619 | 1.07 (0.88 to 1.31) | 40913 | 459 | 1.06 (0.84 to 1.33) |
| Somewhat active | 30245 | 303 | 1.09 (0.88 to 1.35) | 20398 | 225 | 1.08 (0.84 to 1.39) |
| Inactive | 30256 | 316 | 1.05 (0.85 to 1.31) | 20515 | 234 | 1.03 (0.80 to 1.33) |
| Limit sedentary behavior (quartiles of sitting time, hours) | ||||||
| <5.8 | 18707 | 210 | 1 (Ref.) | 12510 | 147 | 1 (Ref.) |
| 5.9–8.5 | 19625 | 210 | 0.98 (0.87 to 1.19) | 12845 | 159 | 1.08 (0.86 to 1.35) |
| 8.6–12.0 | 19430 | 159 | 0.80 (0.65 to 0.98) | 12827 | 123 | 0.88 (0.67 to 1.12) |
| ≥12.1 | 17420 | 163 | 0.97 (0.79 to 1.20) | 12505 | 120 | 0.96 (0.75 to 1.23) |
| Follow a healthy eating pattern. | ||||||
| Diet quality score (number of recommendations met)c | ||||||
| 2–3 | 9008 | 105 | 1 (Ref.) | 6347 | 84 | 1 (Ref.) |
| 1 | 40087 | 396 | 0.90 (0.72 to 1.12) | 27403 | 300 | 0.89 (0.70 to 1.14) |
| 0 | 26087 | 241 | 0.91 (0.71 to 1.15) | 16937 | 165 | 0.86 (0.66 to 1.13) |
| It is best not to drink alcohol. | ||||||
| Alcohol consumption d | ||||||
| None | 34962 | 382 | 1 (Ref.) | 22774 | 278 | 1 (Ref.) |
| Moderate | 26932 | 241 | 0.93 (0.78 to 1.10) | 17722 | 177 | 0.95 (0.78 to 1.16) |
| Heavy | 13288 | 119 | 0.95 (0.76 to 1.20) | 10191 | 94 | 0.97 (0.74 to 1.26) |
| Smoking status | ||||||
| Never | 26997 | 259 | 1 (Ref.) | 18819 | 198 | 1 (Ref.) |
| Ever | 48185 | 483 | 1.14 (0.97 to 1.34) | 31868 | 351 | 1.17 (0.97 to 1.41) |
| Former | 17310 | 211 | 1.21 (1.01 to 1.46) | 10140 | 146 | 1.28 (1.03 to 1.59) |
| Current | 30875 | 272 | 1.07 (0.88 to 1.30) | 21728 | 205 | 1.07 (0.85 to 1.33) |
Abbreviations: ACS, American Cancer Society; HR, hazard ratio; CI, confidence interval; Ref., reference.
Adjusted for sex, race, enrollment source, household income, education, family history of colorectal cancer, insurance coverage, neighborhood deprivation, colorectal cancer screening participation, and the variables presented in the table.
Participants met aerobic physical activity recommendations if they reported ≥ 150 min/week of moderate activity, ≥ 75 min/week of vigorous activity or ≥ 150 min/week of moderate and vigorous activity combined. Participants who did not meet the physical activity guideline were classified into two groups of “somewhat active” and “inactive” based on whether they were above or below the median for total activity (in MET-hrs).
Diet quality variable is created by summing the nutrition-related ACS sub-guidelines met (0–3) related to consumption of grains, red and processed meats, and fruits and vegetables.
Moderate alcohol consumption is defined as 0< drinks/day ≤1 drink/day for women and as 0< drinks/day ≤2 for men.