Development and validation of a short screener to evaluate adherence to the World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations

Background and aims: Adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations is associated with reduced risk for cancer and all-cause mortality. The aim of this study was to develop and validate a short screener to assess adherence to these guidelines. Methods: The study was divided into two phases: Screener development (Phase I) and a validation study (Phase II). A subsample of participants from the PREDIMED-Plus study, an ongoing randomised lifestyle intervention trial which focuses on cardiovascular disease prevention, were invited from two recruiting centres in Spain for the pilot testing (n = 110) and validation (n = 148) of the tool. Participants completed the WCRF/AICR Screener, and dietary and lifestyle data were collected using validated methods (anthropometric measurements by trained staff, and validated diet and physical activity (PA) questionnaires). A score reflecting adherence to the recommendations was derived for each method (Screener and validated instruments), adapted from the 2018 WCRF/AICR Score. Relative agreement between the total scores was evaluated by Spearman correlation (r) and intraclass correlation coefficients (ICC). Crossclassification and Kappa coefficient (K) were used for individual recommendations. Results: The WCRF/AICR Screener has 13 questions covering seven recommendations (regarding body weight; PA; plant-based foods; fast and processed foods; red and processed meat; sugar-sweetened drinks; and alcoholic drinks) with a score range of 0-7 (higher scores indicated greater adherence). There was a significant correlation (r = 0.70) and a moderate agreement (ICC = 0.68) between the WCRF/ AICR Screener (mean +/- SD, 3.20 +/- 0.92) and validated methods (3.05 +/- 1.01) scores. The scores for individual recommendations showed very good agreement for body weight (K = 0.84), substantial agreement for alcoholic drinks (K = 0.71), moderate agreement for PA (K = 0.58), red and processed meat (K = 0.58) and sugar-sweetened drinks (K = 0.56). Fair agreement was observed for plant-based foods (K = 0.30) and fast and processed foods (K = 0.27). Conclusions: The WCRF/AICR Screener is a valid tool for assessing adherence to the WCRF/AICR Cancer Prevention Recommendations at an individual level, and could be useful for rapid assessment of diet and lifestyle in clinical settings for cancer prevention strategies. (c) 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).