Cancer Latinoamerica

Cancer Epidemiology 86 (2023) 102436
Contents lists available at ScienceDirect
Cancer Epidemiology
journal homepage: www.elsevier.com/locate/canep
Latin American and the Caribbean Code Against Cancer 1st edition: Weight,
physical activity, diet, breastfeeding, and cancer☆
Tania C. Aburto a, Isabelle Romieu b, Mariana C. Stern c, Simón Barquera a, Camila Corvalán d,
Pedro C. Hallal e, Luz M. Reynales-Shigematsu b, Joaquín Barnoya f, g, Tania M. Cavalcante h,
Carlos Canelo-Aybar i, Marilina Santero i, Ariadna Feliu j, Carolina Espina j, Juan A. Rivera b, *
a
Center for Research on Nutrition and Health, National Institute of Public Health, 62100 Cuernavaca, Mexico
b
Center for Population Health Research, National Institute of Public Health, 62100 Cuernavaca, Mexico
c
Department of Preventive Medicine and Urology, Keck School of Medicine of USC, 90033 Los Angeles, United States
d
Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
e
Department of Kinesiology and Community Health, University of Illinois Champaign-Urbana, Illinois, United States
f
Research Department, Integra Cancer Institute, Guatemala City, Guatemala
g
Department of Environmental and Occupational Health, Colorado School of Public Health, CU Anschutz, United States
h
Instituto Nacional de Câncer José de Alencar Gomes da Silva, Secretaria Executiva da Comissão Nacional para a Implementação da Convenção-Quadro para o Controle
do Tabaco, Rio de Janeiro, RJ, Brasil
i
Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
j
International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 Lyon CEDEX
07 France
A R T I C L E I N F O A B S T R A C T
Keywords: In Latin America and the Caribbean a considerable proportion of the population have excess body weight, do not
Body weight meet the recommendations of physical activity and healthy diet, and have suboptimal rates of breastfeeding.
Physical activity Excess body weight is associated with at least 15 cancer sites, physical activity protects against three cancers,
Diet
with some evidence suggesting a protective effect for eight more cancer sites, and sedentary behavior probably
Breast feeding
Primary prevention
increases the risk of five cancer sites. Fiber and wholegrains protect against colorectal cancer, high intake of
Latin America and the Caribbean Code Against fruits and vegetables could reduce the risk of aerodigestive cancers; processed and red meat increase the risk of
Cancer colorectal cancer; and very hot beverages are associated with esophageal cancer. Moreover, sugar-sweetened
beverages and ultra-processed foods are a convincing cause for excess body weight, increasing cancer risk
through this pathway, with some emerging evidence suggesting also direct pathways. Breastfeeding protects
against breast cancer, and could protect against ovarian cancer. Taking this evidence into account, the Latin
America and the Caribbean Code Against Cancer recommends the general public to maintain a healthy body
weight, be physically active and limit sedentary behavior, eat a healthy diet (eat plenty of vegetables, fruits,
wholegrains and legumes; avoid sugar-sweetened beverages and processed meat; and limit ultra-processed foods,
red meat and very hot beverages), and breastfeed. Moreover, the Latin America and the Caribbean Code Against
Cancer also includes a set of public policy recommendations for cancer prevention to inform policy makers and
civil society about the need of policies to shape healthy environments and create opportunities to facilitate the
adoption of the recommendations directed to the public.
☆
This article is published as part of a supplement supported by the International Agency for Research on Cancer/World Health Organization. The authors alone are
responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the Institutions with which they are
affiliated.
* Correspondence to: Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico.
E-mail address: [email protected] (J.A. Rivera).
https://doi.org/10.1016/j.canep.2023.102436
Received in revised form 6 July 2023; Accepted 13 July 2023
Available online 16 October 2023
1877-7821/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY IGO license
(http://creativecommons.org/licenses/by/3.0/igo/).
T.C. Aburto et al. Cancer Epidemiology 86 (2023) 102436
1. Introduction population for cancer risk reduction and mortality through screening
programs [1,2]. The recommendations intended to be suitable for the
In 2014, the 4th edition of the European Code Against Cancer general public and referred to actions that individuals could take.
(hereafter, European Code) was published, providing 12 recommenda Under the overall umbrella of the World Code Against Cancer
tions based on solid scientific evidence to the European Union Framework [1,3], using the methodology established by the
Fig. 1. Latin America and the Caribbean Code Against Cancer 1st edition: Recommendations for the general public.
2
International Agency for Research on Cancer (IARC, cancer research 1.1.2. Cancer in Latin America and the Caribbean
agency of the World Health Organization, WHO) and the experience of In 2019, 1.5 million new cases and 700,000 cancer deaths occurred
developing and promoting the European Code Against Cancer, 4th edi in LAC; accounting for 7.6% of all new cases and 7% of all cancer deaths
tion [2], the 1st edition of the Latin America and the Caribbean (LAC) worldwide [5,7]. Furthermore, the burden is expected to reach 2.4
Code Against Cancer has been developed by experts of LAC, in collab million new cases annually by 2040, an increase of 67%, 20 percentage
oration with the Pan-American Health Organization (PAHO/WHO). points above the worldwide average [7,8]. These estimates are conser
The LAC Code Against Cancer consists of a set of evidence-based vative since they do not consider potential increases in risk factors [6].
cancer prevention recommendations targeted to the general popula In 2020, the age-standardized cancer incidence and mortality rates in
tion, suited to the epidemiological, socioeconomic, and cultural condi LAC were 186 and 86.6 per 100,000 person-years, respectively [7]. The
tions of LAC, along with new scientific evidence reviewed in the context highest incidence rates were in Uruguay and Guadeloupe, and the
of LAC, and tailored to the availability and accessibility of health-care highest mortality rates in Uruguay and Barbados (Figure 2). Cancers
systems, provided by a supplementary set of recommendations to poli with the highest incidence were prostate, breast, colorectal, lung, and
cymakers [4] (Fig. 1) (Supplementary material), considering the social stomach; and the ones with the highest mortality were lung, colorectal,
determinants on individual choice. This is particularly relevant in LAC breast, prostate, and stomach, with some differences across LAC sub
given the inequities in access to goods, services, and education across regions (Fig. 3) [7].
the region. Here, we present the scientific evidence for the association of
excess body weight, physical activity, diet and breastfeeding with cancer 1.2. Risk factors prevalence
risk.
1.2.1. Excess body weight
1.1. Cancer burden In 2016, 55% of adult women and 50% of adult men were over
weight or obese globally [9]. In LAC, 61% of adult women and 53% of
1.1.1. Cancer in the world adult men were overweight or obese. The countries with the highest
Cancer is among the top leading causes of death worldwide [5]. In prevalence of overweight and obesity were Chile (79.5% of women and
2019, cancer was the first or second leading cause of premature death in 75% men) and Mexico (76% of women and 72% of men), whereas the
112 of 183 countries [6]. In 2020, 19.3 million new cases and 10 million lowest were Paraguay and Trinidad and Tobago among women (<55%),
cancer deaths occurred worldwide [6]. Ageing, along with the expected and Saint Lucia and Trinidad and Tobago among men (<40%) [10]. The
population growth, results in a projected increase in annual new cancer proportion of adolescents with excess body weight in LAC is also sig
cases of 47%, or 28.4 million by 2040 [6]. nificant, with over 38% of both male and female adolescents presenting
overweight or obesity. Among male adolescents, Argentina and Chile
had the highest prevalence (>50%), while Colombia and Saint Lucia had
Fig. 2. Age-standardized incidence and mortality rates (per 100,000), and M:I ratio in LAC countries among A) men and B) women, 2020.
Source: GLOBOCAN. M:I ratio, mortality incidence ratio. LAC: Latin America and The Caribbean. Central America: Belize, Costa Rica, El Salvador, Guatemala,
Honduras, Mexico, Nicaragua, and Panama. The Caribbean: Bahamas, Barbados, Cuba, Dominican Republic, Guadeloupe, Martinique, Haiti, Jamaica, Puerto Rico,
Saint Lucia, and Trinidad and Tobago. South America: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname,
Uruguay, and Venezuela.
3
Fig. 3. Most frequent cancers in LAC subregions, 2020. Excluding non-melanoma skin cancer.
Source: GLOBOCAN. LAC: Latin America and the Caribbean. Central America: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama.
The Caribbean: Bahamas, Barbados, Cuba, Dominican Republic, Guadeloupe, Martinique, Haiti, Jamaica, Puerto Rico, Saint Lucia, and Trinidad and Tobago. South
America: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela.
the lowest ones (<29%). Among female adolescents, Bahamas, Mexico higher average intakes in LAC compared to other regions of the world
and Venezuela had the highest prevalence (>45%), whereas Haiti the [18,19]. However, pulses intake in LAC is highly variable. The ELANS
lowest (<30%) [10]. study estimated an average intake of 42 g/day, ranging from 4 g/day in
Argentina to 100 g/day in Costa Rica [16].
1.2.2. Physical activity Ultra-processed foods (UPF) are edible products that undergo mul
Worldwide in 2016, 27.5% of the adult population was not meeting tiple industrial processes and are made from processed substances
the physical activity recommendations of 150 min per week, in LAC this extracted or refined from whole food (e.g. oils, and fats, flours and
proportion was even higher at 39% [11]. Within the region, Brazil had starches, variants of sugar, and cheap parts or remnants of animal food).
the highest prevalence of physical inactivity (47%), while Dominica had Most are very durable, palatable and ready to consume and contain a
the lowest (22%) [11]. Among adolescents, 81% of the global popula number of additives. Examples are instant meals, candies, chocolates,
tion was not meeting the physical activity recommendation of 300 min ice cream, sweet breads, packaged cookies, sugary breakfast cereals and
per week [12]. In LAC, this proportion was similar, with 84% of ado processed salty snacks, such as chips and crackers [20]. National data
lescents being physically inactive; having the highest proportion in showed a sustained rise in UPF sales in the last decades in LAC [21].
Venezuela (88.8%), and the lowest in Antigua and Barbuda (79.2%) Contribution of UPF to total energy intake in the adult population ranges
[12]. from 15.8% in Colombia to 30% in Mexico [22]. In preschool children,
the contribution is even higher, with percentages that go from 18% in
1.2.3. Diet Colombia to 44% in Chile [23]. Alongside, in the last decade, LAC has
In 2010, global fruit intake was estimated at 81 g/day and vegetable become the largest consumer of sugar-sweetened beverages (SSBs)
intake (including legumes) at 209 g/day [13], falling below the World worldwide. Four countries in LAC: Chile (166 kcal/day), Mexico
Health Organization (WHO) recommended intake of 400 g/day [14]. A (158 kcal/day), Argentina (135 kcal/day), and Brazil (90 kcal/day) are
study with data from 28 American countries estimated a vegetable among the 10 countries with the highest consumption of SSBs globally
intake of 56 g/day in Central America, 156 g/day in South America and [24].
104 g/day in the Caribbean [15]. Likewise, the Latin American Study of Several South American countries, such as Argentina, Brazil, and
Nutrition and Health (ELANS, for its Spanish acronym), which has in Chile, are among the countries with the highest consumption of red meat
formation from eight countries (Argentina, Brazil, Chile, Peru, worldwide, especially beef. In the ELANS study, the average red meat
Colombia, Costa Rica, Ecuador and Venezuela), estimated 75 g/day of consumption was 61 g/day, with the highest consumption in Argentina
fruit and 87 g/day of vegetable intake; with all countries falling below (79 g/day) and the lowest in Peru (26 g/day) [16]. Similar to red meat,
the recommendation [16]. To reduce cancer risk, most grains in the diet processed meat intake varied widely in the ELANS study, averaging
should be wholegrains; however, only 4.6% of total grains consumed 18.5 g/day with the highest consumption in Chile (25 g/day) and the
were wholegrains according to the ELANS study [17]. Global estimates lowest in Peru (6.2 g/day) [16].
of pulses intake vary widely, ranging from 3.9 g/day to 21 g/day with Coffee, tea, herbal infusions, and yerba mate are commonly
4
consumed as hot or very hot beverages. Hot beverages are usually served Barbados) [37]. A meta-analysis from 239 studies estimated that each
at temperatures between 50 and 65 ◦ C, and very hot beverages above increase of 5 kg/m2 in BMI was associated with a rise of 19% in the risk
65 ◦ C, and are generally drunk after cooling slightly. But the tempera of cancer mortality [38].
ture of hot and very hot beverages varies in the region according to Recent evidence suggests that excess body weight in childhood and
preferences. In general, coffee and tea are consumed at ’hot’ tempera adolescence is associated with increased obesity-related cancer risk and
tures while yerba mate is usually consumed at ’very hot’ temperatures. mortality in adulthood [39–42], highlighting the importance of pre
Mate is consumed mainly in Argentina, Brazil, Paraguay and Uruguay venting overweight in all life stages. However, there is no clear
[25]. consensus on whether the risk persists if body weight is reduced later in
life, with some studies observing increased risk independent of adult
1.2.4. Breastfeeding BMI [39,40], while others reporting increased risk only if overweight
In LAC, 54% of children initiate breastfeeding within the first hour of prevailed in later stages of life [43–45]. Yet, the existing evidence shows
life, 38% are exclusively breastfed until six months of age, and 32% that obesity during childhood and adolescence tends to persist into
continue to breastfeed for two years. The proportion of infants exclu adulthood [46], reiterating the importance of obesity prevention during
sively breastfed until six months of age and who continue to breastfeed early life stages.
for two year is lower in LAC than the global average of 44% and 65%, Breast cancers are the exception. Evidence suggests that body fatness
respectively. However, the proportion of children who initiate breast in young adulthood (18–30 years) as well as adult body fatness have
feeding within the first hour of life is slightly higher (global 48% vs. LAC both a protective effect on premenopausal breast cancer. For post
54%). Exclusive breastfeeding for six months varies between 2.8% menopausal breast cancer, body fatness in young adulthood also has a
(Surinam) and 68.4% (Peru) [26]. probable protective effect, while adult body fatness and adult weight
gain are associated with increased risk [29,47,48].
2. Association with cancer Mechanisms linking excess body weight to cancer include hyper
insulinemia and insulin resistance, increased levels of insulin-like
2.1. Excess body weight growth factor-I (IGF-I), increased estrogen and other sex hormones,
chronic inflammation, oxidative stress and alterations in adipokines
The European Code concluded that excess body fat was associated [49].
with nine cancer sites [27]. In 2016, a report from the IARC Working The effect of excess body weight on cancer survival is poorly un
Group on Body Fatness concluded that there is sufficient evidence be derstood. While some evidence suggests a positive association of post-
tween excess body fatness and 13 cancers: esophagus (adenocarcinoma), diagnosis weight gain, waist circumference and BMI with all-cause
colorectal, gallbladder, pancreas, postmenopausal breast, endometrium, and breast-cancer specific mortality [50]; another recent meta-analysis
ovary, kidney, stomach (gastric cardia), liver, thyroid, meningioma and found null association between adiposity (visceral and total) and
multiple myeloma [28]. The World Cancer Research Fund and American all-cause mortality, cancer mortality, and cancer progression among
Institute for Cancer Research (WCRF/AICR) Third Expert Report of 2018 patients diagnosed with 10 cancer sites, including breast cancer [51].
(hereafter, WCRF/AICR Report) also included in the list, with strong Although mechanisms of excess body weight that are associated with
evidence, advanced prostate cancer and cancers of the mouth, pharynx, increased cancer risk could also affect cancer survivorship and response
and larynx [29] (Table 1). Recent systematic reviews and meta-analyses to treatment, research for post-diagnosis weight-loss interventions and
consistently support these conclusions [30–36]. cancer survival is limited [52].
Worldwide, it was estimated that 3.6% of all new cancer cases in
adults in 2012 were attributable to high body mass index (BMI) [37].
The attributable fraction was higher in women than men (5.4% vs. 2.2. Physical activity
1.9%). In LAC women, these attributable fractions were higher (6.4%),
with high heterogeneity among countries (1.6% in Haiti to 12.7% in The European Code and the WCRF/AIRC Report concluded that
there was strong evidence that physical activity protects against colon,
Table 1
Estimated associations from meta-analyses of excess weight with cancer incidence and mortality.
Cancer type Number of studies Relative risk Comparison unit Reference
Esophagus (adenocarcinoma) 9 1.48 (1.35,1.62) Per 5 kg/m2 increment [29], 2018

Colorectal 38 1.05 (1.03,1.07) Per 5 kg/m2 increment [29], 2018
Gall bladder 8 1.25 (1.15,1.37) Per 5 kg/m2 increment [29], 2018
Pancreas 23 1.10 (1.07,1.40) Per 5 kg/m2 increment [29], 2018
Post-menopausal breast 56 1.12 (1.09,1.15) Per 5 kg/m2 increment [29], 2018
Endometrium 26 1.50 (1.42,1.59) Per 5 kg/m2 increment [29], 2018
20 prospective 2.54 (2.27,2.81) Obesity vs. Normal weight [30], 2015
20 case-control 3.33 (2.87,3.79)* Obesity vs. Normal weight [30], 2015
Ovary 25 1.06 (1.02,1.11) Per 5 kg/m2 increment [29], 2018
Kidney 23 1.30 (1.35,1.35) Per 5 kg/m2 increment [29], 2018
24 1.76 (1.61,1.91) Obesity vs. Normal weight [31], 2018
Stomach (gastric cardia) 7 1.23 (1.07,1.40) Per 5 kg/m2 increment [29], 2018
Liver 12 1.30 (1.16,1.46) Per 5 kg/m2 increment [29], 2018
22 1.77 (1.56,2.01) Obesity vs. Normal weight [32], 2021
Thyroid 31 1.50 (1.45–1.55) Obesity vs. Normal weight [33], 2021
Meningioma 11 1.19 (1.14,1.25) Per 5 kg/m2 increment [34], 2016
Multiple Myeloma 23 1.06 (1.03,1.10) Per 5 kg/m2 increment [35], 2019
Postate (advanced) 23 1.08 (1.04,1.12) Per 5 kg/m2 increment [29], 2018
Mouth, pharynx and larynx 20 1.15 (1.06,1.24) Per 5 kg/m2 increment [29], 2018
Bladder 19 Men: 1.14 (1.06,1.22) Obesity vs. Normal weight [36], 2021
Women: 1.19 (1.02,1.38)
Cancer mortality 160 1.19 (1.18,1.20) Per 5 kg/m2 increment [38], 2016
*
Odds Ratio instead of Relative Risk
5
Table 2 recurrence and survival of patients living with cancer [62].

Estimated associations from meta-analyses of physical activity and sedentarism Evidence also suggests that sedentary behavior, independently of
with cancer incidence and mortality. physical activity, might increase cancer risk. Even though the WCRF/
Cancer type Number of Relative risk Comparison unit Reference AICR Report classified sedentary behavior as having limited evidence
studies for increased risk of endometrial cancer [63], a recent meta-analysis
Physical Activity suggested a positive association between sedentary behavior and
Colon 12 0.80 Highest vs lowest [54], increased risk of ovarian, breast, colon, rectum, and endometrial can
(0.72,0.88) level of total PA 2018 cers, as well as with all-cancer mortality [64]. Still, some of the esti
20 0.84 Highest vs lowest [54],
mated effect could be residual confounding by BMI or physical activity.
(0.78,0.91) level of 2018
recreational PA The mechanisms linking physical activity and sedentary behavior
20 0.67 Highest vs lowest [55], with cancer are similar to those for excess body weight. Physical activity
(0.59,0.77) level of PA 2018 decreases insulin resistance, influence sex hormones levels, and reduce
Post- 8 0.87 Highest vs lowest [54], oxidative stress and chronic inflammation [65]. Additionally, physical
menopausal (0.79,0.96) level of total PA 2018
breast
activity benefits weight loss and maintenance, contributing to cancer
22 0.87 Highest vs lowest [54], prevention through this pathway [66], whereas sedentary behaviors
(0.81,0.94) level of 2018 might increase the risk for weight gain [67].
recreational PA
(0.84,0.89) level of PA 2019
Endometrium 9 0.73 Highest vs lowest [54], 2.3. Diet
(0.58,0.93) level of 2018
recreational PA 2.3.1. Very hot beverages
The WCRF/AICR Report concluded that there was strong evidence
(0.75,0.85) level of PA 2015
Cancer 71 0.83 Highest vs lowest [60],
that regular consumption of mate, as drunk in the traditional South
mortality (0.79,0.87) level of PA 2016 American style as a scalding hot beverage, increases the risk of esoph
Sedentarism ageal squamous cell carcinoma [68] (Table 3). In 2016, an IARC
Endometrium 3 1.46 Highest vs lowest [54], Working Group concluded that drinking very hot beverages at temper
(1.21,1.76) 2018
atures above 65 ◦ C is probably carcinogenic to humans (type 2 A),
11 1.29 High vs low [64],
(1.16,1.45) 2022 whereas drinking mate that is not very hot is not classifiable as to its
Ovarian 8 1.29 High vs low [64], carcinogenicity [25].
(1.08,1.56) 2022 For the LAC Code Against Cancer, 1st edition, following the IARC
Breast 29 1.08 High vs low [64], methodology applied to the European Code [69], when evaluating
(1.04,1.12) 2022
Colon 34 1.25 High vs low [64],
agents classified as Group 2 A, a systematic review of the most recent
(1.16,1.33) 2022 evidence had to be performed to evaluate if there is sufficient evidence
Rectum 28 1.07 High vs low [64], of association with cancer. Following this methodology, we conducted a
(1.01,1.12) 2022 systematic review on the effect of drinking very hot beverages on the
Cancer 17 1.18 High vs low [64],
risk of esophageal cancer on June, 2022. The review consisted of two
mortality (1.09,1.26) 2022
separate phases: a) an overview of systematic reviews of related research
questions and, b) a systematic review of individual studies (comparative
breast and endometrial cancers [53,54] (Table 2). This association was cohorts and case-control studies) to update the evidence identified from
independent of body weight. Recent meta-analyses assessing the asso previous reviews.
ciation between physical activity and colon [55], breast [56] and For the first phase, 14 systematic reviews with moderate overlap and
endometrial [57] cancers support these conclusions. Different domains of varying quality were identified. Among those, the most recent
(total, recreational, occupational, walking/biking for transportation) included a meta-analysis, estimating that drinking hot tea was positively
and intensities (light, moderate and vigorous) of physical activity were associated with esophageal cancer, particularly with esophageal squa
associated with reduced risks [55–57]. Moreover, physical activity had a mous cell carcinoma [70]. However, a limitation of most individual
stronger protective association for colon and endometrial risk among studies included is that they rely on self-report of temperature, and thus,
overweight compared to normal-weight individuals [55,57], suggesting temperature of beverage intake becomes subjective. The second phase
that individuals at higher risk benefit more from physical activity. Being identified two additional individual studies that assessed the association
physically active during childhood, adolescence, and early adulthood between hot beverages and esophageal cancer. In a hospital-based
(<30 years) decreased the risk for breast (RR=0.81; 95%CI=0.76,0.87) case-control study, authors found no association between oolong tea
and colon cancer (RR=0.67; 95%CI=0.50,0.88) [58], highlighting once and esophageal squamous cell carcinoma, except when it was drunk hot
again the importance of healthy lifestyles in all stages of life. (OR=1.60; 95%CI=1.06,2.41) [71]. Noteworthy, in a population-based
In a pooled analysis from 12 prospective cohorts and 1.44 million case-control from China, researchers addressed a limitation of previous
participants, high levels of leisure physical activity were associated with studies, by assessing the usual temperature at which participants drunk
lower risk of 13 cancer sites. Most of these associations were slightly their tea by inviting them to sip water at 65 ◦ C and asking whether they
attenuated after being adjusted by BMI, with 10 remaining statistically usually drank their tea hotter than that or not. Authors estimated that
significant (esophageal adenocarcinoma, lung, kidney, myeloid leuke drinking very hot tea was associated with increased risk of esophageal
mia, myeloma, colon, head and neck, rectal, bladder, and breast) [59]. A squamous cell carcinoma (OR=1.67; 95%CI=1.25,2.24) compared to
meta-analysis from 71 prospective cohort studies found that the highest non-drinkers [72].
levels of physical activity reduced cancer mortality by 17% compared Contrariwise, mate per se does not seem to be associated with
with inactivity in the general population [60]. esophageal cancer. A pooled analysis, that reported estimates of asso
Physical activity seems to also have benefits following a cancer ciation between mate drinking and esophageal cancer stratified esti
diagnosis. Interventions that increase physical activity among cancer mates by temperature and showed little evidence of association when
patients improve their quality of life [61]. Moreover, evidence shows mate was consumed warm [73]; suggesting that the increased risk is
that physical activity could have potential beneficial effects on cancer most likely due to the temperature of the beverage itself, rather than to
the type of infusion.
6
Table 3
Estimated associations from meta-analyses and pooled analyses of dietary factors and breastfeeding with cancer incidence and mortality.
Dietary factor Cancer type Number of Relative risk Comparison unit Reference
studies
Very Hot beverages Esophagus (squamous cell 5 1.16 (1.07,1.25) Per one cup per day of mate, drunk scalding hot [68], 2018
carcinoma)
Esophagus 23 1.77 Hot tea vs no consumption [70], 2022
(1.46,2.16)*
Esophagus (squamous cell 12 2.33 Hot tea vs no consumption [70], 2022
carcinoma) (1.51,3.61)*
Esophagus (squamous cell 2 2.15 (1.5–3.1) Very hot mate vs no consumption [73], 2014
carcinoma)
Sugar-sweetened beverages Breast 7 1.14 (1.01,1.30) High vs low intake [86], 2021
Prostate 5 1.18 (1.10,1.27) High vs low intake [86], 2021
Ultra-processed foods Colorectal 3 1.29 (1.08,1.53) Highest vs lowest intake [87], 2022
Wholegrains Colorectal 6 0.83 (0.78,0.89) Per 90 g/day increment [90], 2018
Cancer mortality 5 0.84 (0.76,0.92) High vs low intake [91], 2019
6 0.85 (0.80–0.91) Per 90 g/day increment [92], 2016
Dietary fiber Colorectal 21 0.93 (0.87,1.00) Per 10 g/day increment [90], 2018
Cancer mortality 5 0.87 (0.79,0.95) High vs low intake [91], 2019
Fruits and non-starchy Esophagus (adenocarcinoma) 3 0.89 (0.80,0.99) Per 100 g/day increment of vegetables [90], 2018
vegetables
Lung (people who smoke tobacco) 6 0.88 (0.79,0.99) Per 100 g/day increment of vegetables [90], 2018
Bladder 8 0.97 (0.95,0.99) Per 80 g/day increment of fruits and vegetables [90], 2018
Colorectal 9 1.08 (1.06,1.10) 100 vs 200 g/day of vegetable intake [90], 2018
Red meat Colorectal 8 1.12 (1.00,1.25) Per 100 g/day increment [97], 2018
22 1.10 (1.03,1.17) Highest vs lowest intake [99], 2021
Colon 13 1.17 (1.09,1.25) Highest vs lowest intake [99], 2021
Rectal 11 1.22 (1.01,1.46) Highest vs lowest intake [99], 2021
Processed meat Colorectal 10 1.16 (1.08,1.26) Per 50 g/day increment [97], 2018
23 1.18 (1.13–1.24) Highest vs lowest intake [99], 2021
Colon 15 1.21 (1.13,1.29) Highest vs lowest intake [99], 2021
Rectal 14 1.22 (1.09,1.36) Highest vs lowest intake [99], 2021
Breastfeeding Breast 13 0.98 (0.97,0.99) Per 5 months of breastfeeding [106],
2015
3 0.72 (0.58,0.90) Exclusive breastfeeding vs no breastfeeding [107],
2017
Pre-menopausal breast 8 0.86 (0.80,0.93) Ever breastfeeding vs no breastfeeding [107],
2017
Post-menopausal breast 8 0.89 (0.83,0.95) Ever breastfeeding vs no breastfeeding [107],
2017
Ovary 13 0.76 Ever breastfeeding vs no breastfeeding [108],
(0.71,0.80)* 2020
13 0.66 12 months or more of breastfeeding vs no [108],
(0.58,0.75)* breastfeeding 2020
Childhood leukemia (offspring) 33 0.77 Ever breastfed vs non-breastfed [111],
(0.65–0.91)* 2021
*
Odds Ratio instead of Relative Risk
2.3.2. Sugar-sweetened beverages and ultra-processed foods tested whether a diet comprised entirely of UPF would have an effect on
The WCRF/AIRC Report concluded that intake of SSBs is a strong ad libitum intake and weight change compared to an unprocessed diet,
cause of weight gain, overweight and obesity, thereby leading to an matched in calories, energy density, macronutrients, sodium, fiber, and
increased risk of cancer [74]. Currently, there is sufficient and robust sugar [83]. Results showed that energy intake during the UPF diet was
evidence that SSBs increase the risk for weight gain and obesity in both 508 kcal/day higher compared to the unprocessed diet. After 14-days,
children and adults [75–77]. In children, higher intake of SSBs was participants in the UPF diet gained 0.9 kg, whereas in the unprocessed
associated with 55% higher risk of being overweight or obese compared diet, participants lost the same amount of body weight [83].
with those with lower intake [78]. In adults, recent estimates show that Given that there is strong evidence that excess body weight increases
obesity risk increases 12% for each 250 ml/day of SSBs consumed [77]. the risk for several cancer sites, SSBs and UPF could increase the risk for
The WCRF/AIRC Report also concluded that “fast foods”, defined as cancer through excess body weight. Moreover, evidence about the direct
readily available convenience foods, were a strong cause of weight gain relationship of SSBs and UPF and cancer risk is now emerging. A recent
[74]. Similarly, the European Code identified high-calorie foods, meta-analysis estimated a positive association between SSBs intake and
including foods high in sugar or fat, as having a potential role at risk for breast and prostate cancer, with most individual studies
increasing calorie intake, thus promoting obesity and leading to adjusting by BMI (Table 3). However, author’s assessed that half the
increased cancer risk [79]. The Lifestyle Working Group suggested the prospective studies and most case-control studies had moderate or
use of the term UPF, considering that UPF include “fast foods”, plus UPF serious risk of bias [86]. Three recent studies have linked UPF intake
are commonly high in calories, sugar and fat [20]. Moreover, UPF is a with cancer. A recent analysis of three large prospective studies in the U.
term that has been precisely defined, and the evidence of their effect on S. with nearly three decades of follow-up found that compared with
health outcomes has been increasingly growing [80–83]. In children, those in the lowest quintile of UPF intake, men in the highest fifth of
longitudinal studies showed a positive association of UPF intake with consumption had a 29% higher risk of developing distal colorectal
weight and adiposity [84,85]. In adults, the risk for overweight or cancer, adjusting by energy intake and other relevant covariates [87].
obesity was 23% higher when comparing the highest vs. the lowest Moreover, authors conducted sensitivity analyses adjusting by BMI and
consumers of UPF [80]. Moreover, an experimental cross-over study found similar results. In a large prospective study conducted in France, a
7
10% increment in the proportion of UPF intake was associated with of heterocyclic amines, which are also carcinogenic, and cooking meats
higher overall cancer risk (RR=1.12; 95%CI=1.06,1.18) and breast over flames contributes to the formation of other types of carcinogenic
cancer risk (RR=1.11; 95%CI=1.02,1.22) [88]. In a multicenter compounds [100–102].
population-based case-control study conducted in four LAC countries
among premenopausal women, UPF intake was positively associated 2.3.5. Diet and cancer survival
with the risk of breast cancer (ORT3-T1=1.93; 95%CI=1.11,3.35). An Evidence also suggests that diets high in fruit and vegetables are
increase of 20% in calories from UPF was related to a 46% increase in associated with survivorship among head and neck, and ovarian cancer
the risk of breast cancer [89]. The last two studies account for BMI and a patients [103]. Similarly, a recent meta-analysis estimated that a higher
series of other potential confounding factors; though potential residual diet quality, characterized by high intake of fruits, vegetables and whole
confounding is still possible given that UPF intake is usually associated grains, was associated with reduced all-cause mortality among breast
with an unhealthy lifestyle. cancer survivors [104].
2.3.3. Wholegrains, fiber, fruits and vegetables 2.4. Breastfeeding

The European Code and the WCRF/AICR Report concluded that di
etary fiber and wholegrains protect against colorectal cancer and high The European Code concluded that there is convincing evidence of a
intake of fruits and non-starchy vegetables could reduce the risk of protective association between breastfeeding and breast cancer at all
aerodigestive cancers [79,90]. Recent studies support the benefits of ages [105] (Table 3). The WCRF/AICR Report estimated a 2% risk
fiber, wholegrains and fruits and vegetables on cancer and all-cause reduction per five months increase in breastfeeding [106]. This pro
mortality reduction. A cancer mortality risk reduction of 13% and tective effect increases with the duration of breastfeeding.
16% was estimated when comparing the highest vs. the lowest con Among parous women, any mode of breastfeeding decreased the risk
sumers of fiber and wholegrains, respectively [91]. Similarly, an esti of breast cancer by 14% and 11% in premenopausal and post
mated 15% and 17% risk reduction in cancer and all-cause mortality, menopausal women, respectively. Parous women who breastfed exclu
respectively, was reported per 90 g/day intake of wholegrains [92]. A sively had a 28% lower risk of breast cancer compared with parous
meta-analysis estimated a risk reduction of 13% in cancer mortality and women who never breastfed [107]. Results from a recently published
of 27% in all-cause mortality associated with an intake of 500 g/day of meta-analysis showed that breastfeeding was associated with 24% lower
fruits and vegetables compared to 0–40 g/day [93]. This study also odds of invasive ovarian cancer, with higher reduction in risk as
estimated that up to 10.1% of all cancer deaths in LAC were attributable breastfeeding duration increased [108].
to low intake of fruits and vegetables (<500 g/day) which is higher than The principal mechanisms proposed are the hormonal influence
the worldwide estimate (6.9%) [93]. associated with the amenorrhea period; differentiation of breast
The mechanisms linking wholegrains with reduced cancer risk are epithelium, making cells less susceptible to malignant transformation;
thought to be mainly related with their fiber content and the integrity of sustained exfoliation of breast tissue during lactation; and epithelial
the cell walls of the grains, which can bind to carcinogens in the intes apoptosis at the end of breastfeeding [105,106]. In addition, breast
tine, reducing intestinal transit time and increasing fecal volume, feeding might decrease postpartum weight [109].
decreasing exposure of colonocytes to carcinogens. Additionally, Risk of cancer in children who are breastfed could also be reduced,
fermentation of fiber by gut microbiota forms short-chain fatty acids since being breastfed reduces the likelihood of overweight or obesity at
that have antiproliferative effects on colon cancer cells [94,95]. Vege later stages of life [110]. Furthermore, there is suggesting evidence that
tables and fruits are also sources of vitamins C and E, selenium, folate, breastfeeding could also reduce the risk of childhood leukemia by 23%
carotenoids, flavonoids, phenols, and many other bioactive compounds [111].
that may have antitumor potential, improve cell signaling, and have
antioxidant properties [96]. 3. Justification of the recommendations for the general public of
the LAC Code Against Cancer 1st edition
2.3.4. Red and processed meats
The European Code and the WCRF/AICR Report concluded that red Between 30% and 50% of all cancer deaths globally are estimated to
and processed meats are strong causes of colorectal cancer [79,97]. In be preventable through changes in lifestyles (avoiding tobacco,
2015, the IARC did an exhaustive evaluation of the possible effect of red consuming a healthy diet, engaging in regular physical activity and
and processed meats on cancer. It was concluded that given the evidence maintaining a healthy weight), and avoiding key risk factors [112].
for colorectal cancer, red meat is a probable cause of cancer (type 2 A The proportion of cancer cases and deaths attributable to lifestyle
carcinogenic agent) and processed meat is a carcinogenic agent to risk factors have been estimated for two countries in LAC. A study in
humans (type 1) [98]. The latter classification is the highest level of Brazil estimated that 26.5% of all cancer cases and 33.7% of all cancer
evidence for a cancer-causing agent. deaths could be prevented by eliminating lifestyle risk factors. Particu
The WCRF/AICR Report estimated a 12% risk increase for colorectal larly, if high BMI, physical inactivity and dietary risk factors were
cancer per 100 g/day increase of red meat intake, and a 16% risk in eliminated, 12.7% of all cancer cases and 15.6% of all cancer deaths
crease per 50 g/day increase of processed meat intake [97]. A more could be prevented [113]. In Chile, high BMI accounted for 8.7% of all
recent meta-analysis of prospective studies estimated a positive associ cancer cases and 9.2% of all cancer deaths, whereas physical inactivity
ation between red meat intake and colorectal, colon, and rectal cancer accounted 2.6% and 2.4% of cancer cases and deaths, respectively, and
incidence. Red meat was also associated with increased risk for breast, low intake of fruits and vegetables accounted for 1.5% and 2.1% of
endometrial, lung, and liver cancers. Intake of processed meat was cancer cases and deaths, respectively [114].
associated with increased incidence for colorectal, colon, and rectal Cancer and its treatment have substantial economic consequences on
cancer when comparing the highest vs. the lowest category of intake. individuals, families and societies, with the greatest impact on the most
Processed meat was also associated with breast and lung cancers [99]. vulnerable populations [115]. In general, LAC is poorly equipped to deal
Consumption of red and processed meats increases nitrosamines in with the rise in cancer incidence and mortality rates compared with
the intestine, which are carcinogenic compounds that can cause damage other world regions [116]. The high number of new cancer cases and
to the DNA. Although these compounds are formed endogenously by the deaths in LAC, which impose a heavy burden on the health systems,
combination of amines in meat and nitrites in the diet, processed meats onerous economic costs, and enormous suffering call for stronger efforts
also contain nitrosamines formed in the meat itself as a consequence of and focus on primary prevention. Thus, the Lifestyle Working Group
processing. Cooking meats at high temperatures leads to the formation from the LAC Code Against Cancer 1st edition provides a set of
8
recommendations, based on the best available evidence described 4. Justification of the recommendations for policy-makers of the
above, reviewed and evaluated by the authors of this article, and LAC Code Against Cancer 1st edition
following the algorithm of criteria described elsewhere in this supple
ment [4]. A limitation in LAC is that most of the published evidence is The LAC Code Against Cancer recognizes that modifying behaviors
based on populations from other regions as a result, in part, of insuffi also requires fostering structural environments and incentives for in
cient infrastructure and investment in research; therefore we recom dividuals to make the healthy choices the easy choices. The trans
mend investing in the development of cohort studies aimed at assessing formation of structural environments for cancer prevention can only be
risk factors for cancer and other non-communicable diseases in LAC. achieved through normative, fiscal, and legal measures and organiza
Recommendations on excess body weight, physical activity, and tional change. These policy actions are crucial in LAC where poverty,
breastfeeding are based on the updated evidence explained above and inequity, and weak health services are obstacles for the adoption of
consistent with the science base already described in the European Code recommendations by individuals. Therefore, a set of policy recommen
[27,53,105]. These recommendations have been adapted to the reality dations were proposed to complement the recommendations directed to
of LAC and tailored to the communication needs of the region [117]. the general public (Fig. 4 and Supplementary material). While the aim of
Moreover, given the recent evidence of the associations of excess body the recommendations is to contribute to the prevention of cancer in the
weight and physical activity during childhood and adolescence with region by helping people make healthy choices through information and
cancer risk [39–42], recommendations emphasize the importance of counselling, the goal for policy recommendations is to inform policy
maintaining a healthy body weight and being physically active makers and civil society about the need of policies to shape environ
throughout all life stages. ments and create opportunities to facilitate adoption of healthy choices.
Recommendation on healthy diet is based on the one from the Eu These policy recommendations include implementing taxes and warning
ropean Code [79], but has been updated on several aspects. Specifically, labels to unhealthy food and beverages; promoting healthy environ
the LAC Code Against Cancer recommends limiting UPF intake. The ments and physical activity in and around schools; banning advertising
term UPF was selected given that the definition of UPF include “fast for baby formula and for unhealthy foods and beverages directed to
foods”, and UPF are commonly high in calories, sugar and fat; thus, children; protecting policies from potential conflicts of interest; and
including both concepts from the WCRF/IARC Report and the European implementing and enforcing guidelines, such as the International Code
Code. The Lifestyle Working Group considered the definition to be of Marketing of Breastmilk Substitutes [120–123].
precise and well defined in the literature [118], and relevant to LAC in
light of the constant rise in its purchases [21], along with evidence on 5. Conclusions
the association between UPF intake, weight gain and cancer risk [80–83,
87–89]. Furthermore, this recommendation also adds a new Given the high burden of cancer morbidity and mortality and the
sub-recommendation on limiting drinking beverages at very hot tem large proportion of cases that could be prevented, a set of individual and
peratures, which results very relevant for the LAC region, particularly policy recommendations were developed to be implemented in LAC.
for South American countries where mate is consumed through a metal This article presents the scientific evidence in which the recommenda
straw at very hot temperatures, allowing the liquid to reach the esoph tions of the 1st edition of the LAC Code Against Cancer are based for four
agus without cooling down. This recommendation is based upon the lifestyle risk factors: excess body weight, physical activity, diet, and
WCRF classification of “mate, traditionally drunk scalding hot” as a breastfeeding. It presents the most current information about cancer
strong cause for cancer. The Lifestyle Working Group considered that the burden and about prevalence of the risk factors in the LAC region, it also
systematic review conducted on the effect of drinking very hot bever presents the result of a review of updated scientific evidence about the
ages on the risk of esophageal cancer supported this recommendation. association of the risk factors with different type of cancer. The infor
And even though the evidence has its limitations; mainly, studies mation provided substantiates the lifestyle policy recommendations and
assessing the association are case-control studies, in which recall bias is the following recommendations directed to the general public from all
hard to avoid; and a possible change of drinking habits in cases following age groups:
their symptoms, such as dysphagia, could result in a spurious associa
tion, the direction of the available evidence is consistent and there is - Achieve or maintain a healthy weight throughout your life to help
robust evidence for plausible mechanisms [25,68]. Finally, it is worth prevent several types of cancer.
mentioning once again that LAC has become the largest consumer of - Get daily physical activity throughout your life and limit the time
SSBs worldwide, thus, the recommendation on SSBs avoidance is highly you spend sitting. Being a physically active person helps prevent
relevant in the region. several types of cancer.
Effective cancer prevention requires interventions at multiple levels - Eat a healthy diet:
of influence. With this in mind, the LAC Code Against Cancer includes a - Eat as many fruits and vegetables as possible at each meal, and
set of lifestyle recommendations based on robust scientific evidence, and regularly include legumes such as beans and lentils.
carefully shaped to be simple and comprehensible to influence knowl - Eat wholegrains, such as whole-wheat bread, corn tortillas and
edge, attitudes and beliefs, and promote willingness to adopt them brown rice, rather than refined grains such as white bread or rice.
(Fig. 1). Health promotion is key to ensure individuals are informed - Avoid sugar-sweetened beverages, drink water instead.
about evidence-based actions they should undertake to prevent and - Limit your consumption of ultra-processed foods, such as sweets,
reduce their cancer risk. sweetened breakfast cereals, salty snacks, pastries and cookies,
Primary care healthcare professionals play a key role in cancer pre among others. Instead, eat natural foods or foods prepared at home.
vention since they are population’s first contact point to healthcare - Avoid processed meat, such as deli meats, sausages, or cured meats,
system and, thereby, health promotion should be embedded in these and limit your consumption of red meat.
professionals’ daily practice. Therefore, the LAC Code Against Cancer - Limit your consumption of very hot beverages, such as tea, coffee,
1st edition, includes a knowledge translation output: an online and mate,. Wait a few minutes until the liquid no longer feels hot
competency-based microlearning program directed to primary health enough to burn your lips and tongue.
care professionals. The curriculum of this e-learning program has been - Breastfeed your baby - the more months the better - to help prevent
assembled to support the adoption of the recommendations by the breast cancer and excess body weight in you baby.
public through building capacity on how these professionals can help
their community prevent or reduce their risk of cancer [119].
9
Fig. 4. Latin America and the Caribbean Code Against Cancer 1st edition: Recommendations for policymakers on lifestyle.
CRediT authorship contribution statement Declaration of Competing Interest
Tania C. Aburto: Investigation, Writing – original draft, Writing – The authors declare that they have no known competing financial
review & editing. Isabelle Romieu, Mariana C. Stern, Simón Bar interests or personal relationships that could have appeared to influence
quera, Camila Corvalán, Pedro C. Hallal, Luz M. Reynales- the work reported in this paper.
Shigematsu, Joaquín Barnoya, Tania M. Cavalcante and Ariadna
Feliu: Writing – review & editing. Carlos Canelo-Aybar and Marilina Acknowledgements
Santero: Investigation, Witing – review & editing. Carolina Espina:
Conceptualization, Writing – review & editing. Juan A. Rivera: The Latin America and the Caribbean Code Against Cancer project
Conceptualization, Supervision, Writing – original draft, Writing – re was co-funded by the Sociedade Beneficente Israelita Brasileira Albert
view & editing. Einstein (HIAE) / amigo_h (Amigos Einstein da Oncologia e Hema
tologia), Brazil (Grant number: DCA-ENV-2020-01), and the
10
International Agency for Research on Cancer (IARC/WHO), France. The [19] V. Rawal, R. Charrondiere, M. Xipsiti, F. Grande, Pulses: nutritional benefits and
consumption patterns. In The Global Economy of Pulses, FAO, Rome, 2019,
systematic reviews have been conducted by the Iberoamerican Cochrane
pp. 9–19.
Centre/ Biomedical Research Institute Sant Pau (IIB Sant Pau) from [20] C.A. Monteiro, J.C. Moubarac, G. Cannon, S.W. Ng, B. Popkin, Ultra-processed
Spain. The authors alone are responsible for the views expressed in this products are becoming dominant in the global food system, 21–8, Obes. Rev. 14
manuscript. Where authors are identified as personnel of the Interna (Suppl 2) (2013), https://doi.org/10.1111/obr.12107.
[21] PAHO Ultra-processed food and drink products in Latin America: Trends, impact
tional Agency for Research on Cancer/World Health Organization, the on obesity, policy implications. Pan American Health Organization World Health
authors alone are responsible for the views expressed in this article and Organization: Washington, DC, USA 2015, 1–58.
they do not necessarily represent the decisions, policy or views of the [22] D. Martini, J. Godos, M. Bonaccio, P. Vitaglione, G. Grosso, Ultra-processed foods
and nutritional dietary profile: a meta-analysis of nationally representative
International Agency for Research on Cancer /World Health samples, Nutrients 13 (2021) 3390.
Organization. [23] D. Neri, E.M. Steele, N. Khandpur, G. Cediel, M.E. Zapata, F. Rauber, J.A. Marrón-
Ponce, P. Machado, M.L. da Costa Louzada, G.C. Andrade, et al., Ultraprocessed
food consumption and dietary nutrient profiles associated with obesity: a
Appendix A. Supporting information multicountry study of children and adolescents, Obes. Rev. 23 (Suppl 1) (2022),
e13387, https://doi.org/10.1111/obr.13387.
Supplementary data associated with this article can be found in the [24] B.M. Popkin, C. Hawkes, Sweetening of the global diet, particularly beverages:
patterns, trends, and policy responses, Lancet Diabetes Endocrinol. 4 (2016)
online version at doi:10.1016/j.canep.2023.102436. 174–186, https://doi.org/10.1016/s2213-8587(15)00419-2.
[25] IARC Working Group on the Evaluation of Carcinogenic Risks to Humans Drinking
References coffee, mate, and very hot beverages; International Agency for Research on
Cancer, World Health Organization: Lyon, France, 2016;
[26] World Health Organization; UNICEF Infant and young child feeding Available
[1] International Agency for Research on Cancer,WHO European Code Against
online: https://www.who.int/en/news-room/fact-sheets/detail/infant-and-
Cancer Available online: https://cancer-code-europe.iarc.fr/index.php/en/
young-child-feeding.
(Accessed on Jan 15, 2023).
[27] A.S. Anderson, T.J. Key, T. Norat, C. Scoccianti, M. Cecchini, F. Berrino, M.-
[2] J. Schüz, C. Espina, P. Villain, R. Herrero, M.E. Leon, S. Minozzi, I. Romieu,
C. Boutron-Ruault, C. Espina, M. Leitzmann, H. Powers, European code against
N. Segnan, J. Wardle, M. Wiseman, et al., European code against cancer 4th
cancer 4th edition: obesity, body fatness and cancer, Cancer Epidemiol. 39 (2015)
edition: 12 ways to reduce your cancer risk, Cancer Epidemiol. 39 (2015) S1–S10,
S34–S45.
https://doi.org/10.1016/j.canep.2015.05.009.
[28] IARC, Absence excess body fatness. IARC Handb. Cancer Prev. 16 (2018) 1–646.
[3] C. Espina, R. Herrero, R. Sankaranarayanan, E. Krug, C.P. Wild, J. Schüz, Toward
[29] World Cancer Research Fund / American Institute for Cancer Research.
the world code against cancer, J. Glob. Oncol. 4 (2018) 1–8.
Continuous Update Project Expert Report 2018. Body fatness and weight gain and
[4] C. Espina, A. Feliu, M. Maza, M. Almonte, C. Ferreccio, C. Finck, et al., Latin
the risk of cancer. 2018.
America and the Caribbean Code Against Cancer 1st Edition: 17 cancer
[30] E. Jenabi, J. Poorolajal, The effect of body mass index on endometrial cancer: a
prevention recommendations to the public and to policy-makers (World Code
meta-analysis, Public Health 129 (2015) 872–880, https://doi.org/10.1016/j.
Against Cancer Framework), Cancer Epidemiol. S1 (2023), 102402, https://doi.
puhe.2015.04.017.
org/10.1016/j.canep.2023.102402.
[31] X. Liu, Q. Sun, H. Hou, K. Zhu, Q. Wang, H. Liu, Q. Zhang, L. Ji, D. Li, The
[5] F. Bray, M. Laversanne, E. Weiderpass, I. Soerjomataram, The ever-increasing
association between BMI and kidney cancer risk: an updated dose-response meta-
importance of cancer as a leading cause of premature death worldwide, Cancer
analysis in accordance with PRISMA guideline, Medicine (2018) 97.
127 (2021) 3029–3030.
[32] W. Sohn, H.W. Lee, S. Lee, J.H. Lim, M.W. Lee, C.H. Park, S.K. Yoon, Obesity and
[6] H. Sung, J. Ferlay, R.L. Siegel, M. Laversanne, I. Soerjomataram, A. Jemal,
the risk of primary liver cancer: a systematic review and meta-analysis, Clin. Mol.
F. Bray, Global cancer statistics 2020: GLOBOCAN estimates of incidence and
Hepatol. 27 (2021) 157.
mortality worldwide for 36 cancers in 185 countries, CA: a Cancer J. Clin. 71
[33] M.R. Youssef, A.S. Reisner, A.S. Attia, M.H. Hussein, M. Omar, A. LaRussa, C.
(2021) 209–249.
A. Galvani, M. Aboueisha, M. Abdelgawad, E.A. Toraih, Obesity and the
[7] M. Piñeros, M. Laversanne, E. Barrios, M. de Camargo Cancela, E. de Vries,
prevention of thyroid cancer: impact of body mass index and weight change on
C. Pardo, F. Bray, An updated profile of the cancer burden, patterns and trends in
developing thyroid cancer–pooled results of 24 million cohorts, Oral. Oncol. 112
Latin America and the Caribbean, Lancet Reg. Health-Am. 13 (2022), 100294.
(2021), 105085.
[8] Ferlay, J.; Laversanne, M.; Ervik, M.; Lam, F.; Colombet, M.; Mery, L.; Piñeros, M.;
[34] D. Zhang, J. Chen, J. Wang, S. Gong, H. Jin, P. Sheng, X. Qi, L. Lv, Y. Dong,
Znaor, A.; Soerjomataram, I.; Bray, F. Global Cancer Observatory: Cancer
L. Hou, Body mass index and risk of brain tumors: a systematic review and dose-
Tomorrow. Available online: https://gco.iarc.fr/tomorrow (Accessed on Aug 15,
response meta-analysis, Eur. J. Clin. Nutr. 70 (2016) 757–765, https://doi.org/
2022).
10.1038/ejcn.2016.4.
[9] World Health Organization Obesity and overweight Available online: https://
[35] L. Abar, J.G. Sobiecki, M. Cariolou, N. Nanu, A.R. Vieira, C. Stevens, D. Aune, D.
www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (Accessed
C. Greenwood, D.S.M. Chan, T. Norat, Body size and obesity during adulthood,
on Aug 19, 2022).
and risk of lympho-haematopoietic cancers: an update of the WCRF-AICR
[10] OECD; Bank, T.W. Health at a Glance: Latin America and the Caribbean 2020
systematic review of published prospective studies, Ann. Oncol. 30 (2019)
2020.
528–541, https://doi.org/10.1093/annonc/mdz045.
[11] R. Guthold, G.A. Stevens, L.M. Riley, F.C. Bull, Worldwide trends in insufficient
[36] L. Tzelves, D. Xenou, A. Skolarikos, I. Varkarakis, C. Deliveliotis, E. Terpos,
physical activity from 2001 to 2016: a pooled analysis of 358 population-based
K. Stamatelopoulos, T.N. Sergentanis, T. Psaltopoulou, Association of obesity and
surveys with 1⋅9 million participants, Lancet Glob. Health 6 (2018) e1077–e1086.
other anthropometric characteristics with bladder cancer risk: a systematic
[12] R. Guthold, G.A. Stevens, L.M. Riley, F.C. Bull, Global trends in insufficient
review and meta-analysis of longitudinal cohort studies, J. BU . Off. J. Balk. Union
physical activity among adolescents: a pooled analysis of 298 population-based
Oncol. 26 (2021) 1040–1055.
surveys with 1⋅6 million participants, Lancet Child Adolesc. Health 4 (2020)
[37] M. Arnold, N. Pandeya, G. Byrnes, A.G. Renehan, G.A. Stevens, M. Ezzati,
23–35.
J. Ferlay, J.J. Miranda, I. Romieu, R. Dikshit, Global burden of cancer attributable
[13] R. Micha, S. Khatibzadeh, P. Shi, K.G. Andrews, R.E. Engell, D. Mozaffarian,
to high body-mass index in 2012: a population-based study, Lancet Oncol. 16
Global, regional and national consumption of major food groups in 1990 and
(2015) 36–46.
2010: a systematic analysis including 266 country-specific nutrition surveys
[38] E. Di Angelantonio, S.N. Bhupathiraju, D. Wormser, P. Gao, S. Kaptoge, A.B. de
worldwide, BMJ Open 5 (2015), e008705.
Gonzalez, B.J. Cairns, R. Huxley, C.L. Jackson, G. Joshy, Body-mass index and all-
[14] World Health Organization Diet, nutrition, and the prevention of chronic
cause mortality: individual-participant-data meta-analysis of 239 prospective
diseases: report of a joint WHO/FAO expert consultation; World Health
studies in four continents, Lancet 388 (2016) 776–786.
Organization, 2003; Vol. 916; ISBN 92–4-120916-X.
[39] J. Nuotio, T.T. Laitinen, A.R. Sinaiko, J.G. Woo, E.M. Urbina, D.R. Jacobs,
[15] A. Kalmpourtzidou, A. Eilander, E.F. Talsma, Global vegetable intake and supply
J. Steinberger, R.J. Prineas, M.A. Sabin, D.P. Burgner, Obesity during childhood is
compared to recommendations: a systematic review, Nutrients 12 (2020) 1558,
associated with higher cancer mortality rate during adulthood: the i3C
https://doi.org/10.3390/nu12061558.
Consortium, Int. J. Obes. 46 (2022) 393–399.
[16] I. Kovalskys, A. Rigotti, B. Koletzko, M. Fisberg, G. Gómez, M. Herrera-Cuenca, L.
[40] J. Célind, M. Bygdell, J. Martikainen, C. Ohlsson, J.M. Kindblom, Childhood
Y. Cortés Sanabria, M.C. Yépez García, R.G. Pareja, I.Z. Zimberg, Latin American
overweight and risk of obesity-related adult cancer in men, Cancer Commun. 42
consumption of major food groups: results from the ELANS study, PLoS One 14
(2022) 576.
(2019), e0225101, https://doi.org/10.1371/journal.pone.0225101.
[41] A. Furer, A. Afek, A. Sommer, L. Keinan-Boker, E. Derazne, Z. Levi, D. Tzur,
[17] R.M. Fisberg, M.M. Fontanelli, I. Kowalskys, G. Gómez, A. Rigotti, L.Y. Cortés, M.
S. Tiosano, A. Shina, Y. Glick, Adolescent obesity and midlife cancer risk: a
Y. García, R.G. Pareja, M. Herrera-Cuenca, M. Fisberg, Total and whole grain
population-based cohort study of 2⋅3 million adolescents in Israel, Lancet
intake in Latin America: findings from the multicenter cross-sectional Latin
Diabetes Endocrinol. 8 (2020) 216–225.
American Study of Health and Nutrition (ELANS, Eur. J. Nutr. 61 (2022)
[42] J. Aarestrup, L.G. Bjerregaard, K.D. Meyle, D.C. Pedersen, L.K. Gjærde, B.
489–501, https://doi.org/10.1007/s00394-021-02635-8.
W. Jensen, J.L. Baker, Birthweight, childhood overweight, height and growth and
[18] P.K. Joshi, P.P. Rao, Global pulses scenario: status and outlook, Ann. N. Y. Acad.
adult cancer risks: a review of studies using the Copenhagen School Health
Sci. 1392 (2017) 6–17.
Records Register, Int. J. Obes. 44 (2020) 1546–1560.
11
[43] J.L. Petrick, B.W. Jensen, T.I. Sørensen, M.B. Cook, J.L. Baker, Overweight Reviews, PLoS ONE 9 (2014), e105620, https://doi.org/10.1371/journal.
patterns between childhood and early adulthood and esophageal and gastric pone.0105620.
cardia adenocarcinoma risk, Obesity 27 (2019) 1520–1526. [68] World Cancer Research Fund / American Institute for Cancer Research.
[44] B.W. Jensen, L.G. Bjerregaard, L. Ängquist, I. Gögenur, A.G. Renehan, M. Osler, T. Continuous Update Project Expert Report 2018. Non-alcoholic drinks and the risk
I. Sørensen, J.L. Baker, Change in weight status from childhood to early of cancer 2018.
adulthood and late adulthood risk of colon cancer in men: a population-based [69] S. Minozzi, P. Armaroli, C. Espina, P. Villain, M. Wiseman, J. Schüz, N. Segnan,
cohort study, Int. J. Obes. 42 (2018) 1797–1803. European code against cancer 4th edition: process of reviewing the scientific
[45] J. Célind, C. Ohlsson, M. Bygdell, M. Nethander, J.M. Kindblom, Childhood body evidence and revising the recommendations, Cancer Epidemiol. 39 (2015)
mass index is associated with risk of adult colon cancer in men: an association S11–S19, https://doi.org/10.1016/j.canep.2015.08.014.
modulated by pubertal change in body mass IndexChildhood BMI, pubertal BMI [70] H. Luo, H. Ge, Hot tea consumption and esophageal cancer risk: a meta-analysis
change, and colorectal cancer, Cancer Epidemiol., Biomark. Prev. 28 (2019) of observational studies, Front Nutr. 9 (2022), 831567, https://doi.org/10.3389/
974–979. fnut.2022.831567.
[46] M. Simmonds, A. Llewellyn, C.G. Owen, N. Woolacott, Predicting adult obesity [71] S. Liu, Z. Lin, L. Huang, H. Chen, Y. Liu, F. He, X. Peng, W. Chen, R. Huang, W. Lu,
from childhood obesity: a systematic review and meta-analysis, Obes. Rev. 17 Oolong tea consumption and its interactions with a novel composite index on
(2016) 95–107. esophageal squamous cell carcinoma, BMC Complement. Altern. Med. 19 (2019)
[47] B. Rosner, A.H. Eliassen, A.T. Toriola, W.Y. Chen, S.E. Hankinson, W.C. Willett, C. 1–8.
S. Berkey, G.A. Colditz, Weight and weight changes in early adulthood and later [72] S. Lin, G. Xu, Z. Chen, X. Liu, J. Li, L. Ma, X. Wang, Tea drinking and the risk of
breast cancer risk, Int. J. Cancer 140 (2017) 2003–2014. esophageal cancer: focus on tea type and drinking temperature, Eur. J. Cancer
[48] R.T. Fortner, V. Katzke, T. Kühn, R. Kaaks, Obesity and breast cancer, Obes. Prev. 29 (2020) 382–387, https://doi.org/10.1097/CEJ.0000000000000568.
Cancer (2016) 43–65. [73] J.H. Lubin, De Stefani, E. Abnet, C.C. Acosta, G. Boffetta, P. Victora, C. Graubard,
[49] K.I. Avgerinos, N. Spyrou, C.S. Mantzoros, M. Dalamaga, Obesity and cancer risk: B.I. Muñoz, N. Deneo-Pellegrini, H. Franceschi, Drinking and esophageal
emerging biological mechanisms and perspectives, Metabolism 92 (2019) squamous cell carcinoma in South America: pooled results from two large multi-
121–135. center case-control studies, Cancer Epidemiol. Biomark. Prev. 23 (2014)
[50] Y. Pang, Y. Wei, C. Kartsonaki, Associations of adiposity and weight change with 107–116, https://doi.org/10.1158/1055-9965.EPI-13-0796.
recurrence and survival in breast cancer patients: a systematic review and meta- [74] World Cancer Research Fund / American Institute for Cancer Research.
analysis, Breast Cancer 29 (2022) 575–588. Continuous Update Project Expert Report 2018. Diet, nutrition and physical
[51] E. Cheng, J. Kirley, E.M. Cespedes Feliciano, B.J. Caan, Adiposity and cancer activity: Energy balance and body fatness 2018.
survival: a systematic review and meta-analysis, Cancer Causes Control 33 (2022) [75] V.S. Malik, A. Pan, W.C. Willett, F.B. Hu, Sugar-sweetened beverages and weight
1219–1246. gain in children and adults: a systematic review and meta-analysis, Am. J. Clin.
[52] A.S. Anderson, R.M. Martin, A.G. Renehan, J. Cade, E.R. Copson, A.J. Cross, Nutr. 98 (2013) 1084–1102.
C. Grimmett, L. Keaver, A. King, E. Riboli, Cancer survivorship, excess body [76] F.B. Hu, Resolved: there is sufficient scientific evidence that decreasing sugar-
fatness and weight-loss intervention—where are we in 2020? Br. J. Cancer 124 sweetened beverage consumption will reduce the prevalence of obesity and
(2021) 1057–1065. obesity-related diseases, Obes. Rev. 14 (2013) 606–619, https://doi.org/
[53] M. Leitzmann, H. Powers, A.S. Anderson, C. Scoccianti, F. Berrino, M.-C. Boutron- 10.1111/obr.12040.
Ruault, M. Cecchini, C. Espina, T.J. Key, T. Norat, European code against cancer [77] P. Qin, Q. Li, Y. Zhao, Q. Chen, X. Sun, Y. Liu, H. Li, T. Wang, X. Chen, Q. Zhou, et
4th edition: physical activity and cancer, Cancer Epidemiol. 39 (2015) S46–S55. al., Sugar and artificially sweetened beverages and risk of obesity, type 2 diabetes
[54] World Cancer Research Fund / American Institute for Cancer Research. mellitus, hypertension, and all-cause mortality: a dose–response meta-analysis of
Continuous Update Project Expert Report 2018. Physical activity and the risk of prospective cohort studies, Eur. J. Epidemiol. 35 (2020) 655–671, https://doi.
cancer. 2018. org/10.1007/s10654-020-00655-y.
[55] E. Shaw, M.S. Farris, C.R. Stone, J.W.G. Derksen, R. Johnson, R.J. Hilsden, C. [78] L. Te Morenga, S. Mallard, J. Mann, Dietary sugars and body weight: systematic
M. Friedenreich, D.R. Brenner, Effects of physical activity on colorectal cancer review and meta-analyses of randomised controlled trials and cohort studies, BMJ
risk among family history and body mass index subgroups: a systematic review Clin. Res. Ed. 346 (2012), e7492, https://doi.org/10.1136/bmj.e7492.
and meta-analysis, BMC Cancer 18 (2018) 71, https://doi.org/10.1186/s12885- [79] T. Norat, C. Scoccianti, M.-C. Boutron-Ruault, A. Anderson, F. Berrino,
017-3970-5. M. Cecchini, C. Espina, T. Key, M. Leitzmann, H. Powers, et al., European code
[56] X. Chen, Q. Wang, Y. Zhang, Q. Xie, X. Tan, Physical activity and risk of breast against cancer 4th edition: diet and cancer, Cancer Epidemiol. 39 (2015)
cancer: a meta-analysis of 38 cohort studies in 45 STudy Reports, Value Health 22 S56–S66, https://doi.org/10.1016/j.canep.2014.12.016.
(2019) 104–128, https://doi.org/10.1016/j.jval.2018.06.020. [80] G. Pagliai, M. Dinu, M. Madarena, M. Bonaccio, L. Iacoviello, F. Sofi,
[57] D. Schmid, G. Behrens, M. Keimling, C. Jochem, C. Ricci, M. Leitzmann, Consumption of ultra-processed foods and health status: a systematic review and
A systematic review and meta-analysis of physical activity and endometrial meta-analysis, Br. J. Nutr. 125 (2021) 308–318.
cancer risk, Eur. J. Epidemiol. 30 (2015) 397–412, https://doi.org/10.1007/ [81] W. Suksatan, S. Moradi, F. Naeini, R. Bagheri, H. Mohammadi, S. Talebi,
s10654-015-0017-6. S. Mehrabani, Ultra-processed food consumption and adult mortality risk: a
[58] K. Hidayat, H.-J. Zhou, B.-M. Shi, Influence of physical activity at a young age and systematic review and dose–response meta-analysis of 207,291 participants,
lifetime physical activity on the risks of 3 obesity-related cancers: systematic Nutrients 14 (2021) 174.
review and meta-analysis of observational studies, Nutr. Rev. 78 (2020) 1–18, [82] S.J. Dicken, R.L. Batterham, The role of diet quality in mediating the association
https://doi.org/10.1093/nutrit/nuz024. between ultra-processed food intake, obesity and health-related outcomes: a
[59] S.C. Moore, I.-M. Lee, E. Weiderpass, P.T. Campbell, J.N. Sampson, C.M. Kitahara, review of prospective cohort studies, Nutrients 14 (2021) 23.
S.K. Keadle, H. Arem, A.B. De Gonzalez, P. Hartge, Association of leisure-time [83] K.D. Hall, A. Ayuketah, R. Brychta, H. Cai, T. Cassimatis, K.Y. Chen, S.T. Chung,
physical activity with risk of 26 types of cancer in 1.44 million adults, JAMA E. Costa, A. Courville, V. Darcey, et al., Ultra-processed diets cause excess calorie
Intern. Med. 176 (2016) 816–825. intake and weight gain: an inpatient randomized controlled trial of ad libitum
[60] T. Li, S. Wei, Y. Shi, S. Pang, Q. Qin, J. Yin, Y. Deng, Q. Chen, S. Wei, S. Nie, The food intake, e3, Cell Metab. 30 (2019) 67–77, https://doi.org/10.1016/j.
dose–response effect of physical activity on cancer mortality: findings from 71 cmet.2019.05.008.
prospective cohort studies, Br. J. Sports Med. 50 (2016) 339–345. [84] K. Chang, N. Khandpur, D. Neri, M. Touvier, I. Huybrechts, C. Millett, E.P. Vamos,
[61] P. Posadzki, D. Pieper, R. Bajpai, H. Makaruk, N. Könsgen, A.L. Neuhaus, Association between childhood consumption of ultraprocessed food and adiposity
M. Semwal, Exercise/physical activity and health outcomes: an overview of trajectories in the avon longitudinal study of parents and children birth Cohort,
Cochrane systematic reviews, BMC Public Health 20 (2020) 1724, https://doi. JAMA Pedia 175 (2021), e211573, https://doi.org/10.1001/
org/10.1186/s12889-020-09855-3. jamapediatrics.2021.1573.
[62] C.M. Friedenreich, H.K. Neilson, M.S. Farris, K.S. Courneya, Physical activity and [85] C. Costa, S. dos, M.C.F. Assunção, C. Loret de Mola, J. Cardoso, S. de,
cancer outcomes: a precision medicine approach, Clin. Cancer Res 22 (2016) A. Matijasevich, A.J.D. Barros, I.S. Santos, Role of ultra-processed food in fat mass
4766–4775, https://doi.org/10.1158/1078-0432.CCR-16-0067. index between 6 and 11 years of age: a cohort study, Int. J. Epidemiol. 50 (2021)
[63] World Cancer Research Fund/American Institute for Cancer Research World 256–265, https://doi.org/10.1093/ije/dyaa141.
Cancer Research Fund / American Institute for Cancer Research. Diet, Nutrition, [86] F. Llaha, M. Gil-Lespinard, P. Unal, I. de Villasante, J. Castañeda, R. Zamora-Ros,
Physical Activity and Cancer: a Global Perspective. Continuous Update Project Consumption of sweet beverages and cancer risk. A systematic review and meta-
Expert Report 2018. 2018. analysis of observational studies, Nutrients 13 (2021) 516, https://doi.org/
[64] R. Hermelink, M.F. Leitzmann, G. Markozannes, K. Tsilidis, T. Pukrop, F. Berger, 10.3390/nu13020516.
H. Baurecht, C. Jochem, Sedentary behavior and cancer–an umbrella review and [87] L. Wang, M. Du, K. Wang, N. Khandpur, S.L. Rossato, J.-P. Drouin-Chartier, E.
meta-analysis, Eur. J. Epidemiol. 37 (2022) 447–460, https://doi.org/10.1007/ M. Steele, E. Giovannucci, M. Song, F.F. Zhang, Association of ultra-processed
s10654-022-00873-6. food consumption with colorectal cancer risk among men and women: results
[65] C.M. Friedenreich, C. Ryder-Burbidge, J. McNeil, Physical activity, obesity and from three prospective US cohort studies, BMJ (2022), e068921, https://doi.org/
sedentary behavior in cancer etiology: epidemiologic evidence and biologic 10.1136/bmj-2021-068921.
mechanisms, Mol. Oncol. 15 (2021) 790–800, https://doi.org/10.1002/1878- [88] T. Fiolet, B. Srour, L. Sellem, E. Kesse-Guyot, B. Allès, C. Méjean, M. Deschasaux,
0261.12772. P. Fassier, P. Latino-Martel, M. Beslay, et al., Consumption of ultra-processed
[66] J.-M. Oppert, A. Bellicha, C. Ciangura, Physical activity in management of foods and cancer risk: results from NutriNet-Santé prospective cohort, BMJ 360
persons with obesity, Eur. J. Intern. Med. 93 (2021) 8–12, https://doi.org/ (2018) k322, https://doi.org/10.1136/bmj.k322.
10.1016/j.ejim.2021.04.028. [89] I. Romieu, N. Khandpur, A. Katsikari, C. Biessy, G. Torres-Mejía, A. Ángeles-
[67] L.F.M. Rezende, M. de; Rodrigues Lopes, J.P. Rey-López, V.K.R. Matsudo, O. Luiz, Llerenas, I. Alvarado-Cabrero, G.I. Sánchez, M.E. Maldonado, C. Porras, et al.,
C. do, Sedentary Behavior and Health Outcomes: An Overview of Systematic Consumption of industrial processed foods and risk of premenopausal breast
12
cancer among Latin American women: the PRECAMA study, BMJ Nutr. Prev. [107] M. Unar-Munguía, G. Torres-Mejía, M.A. Colchero, Breastfeeding mode and risk
Health 5 (2022) 1–9, https://doi.org/10.1136/bmjnph-2021-000335. of breast cancer: a dose–response meta-analysis, J. Hum. Lact 33 (2017) 422–434,
[90] World Cancer Research Fund / American Institute for Cancer Research. https://doi.org/10.1177/0890334416683676.
Continuous Update Project Expert Report 2018. Wholegrains, vegetables and fruit [108] A. Babic, N. Sasamoto, B.A. Rosner, S.S. Tworoger, S.J. Jordan, H.A. Risch, H.
and the risk of cancer 2018. R. Harris, M.A. Rossing, J.A. Doherty, R.T. Fortner, et al., Association between
[91] A. Reynolds, J. Mann, J. Cummings, N. Winter, E. Mete, L. Te Morenga, breastfeeding and ovarian cancer risk, JAMA Oncol. 6 (2020), e200421, https://
Carbohydrate quality and human health: a series of systematic reviews and meta- doi.org/10.1001/jamaoncol.2020.0421.
analyses, Lancet 393 (2019) 434–445, https://doi.org/10.1016/S0140-6736(18) [109] X. He, M. Zhu, C. Hu, X. Tao, Y. Li, Q. Wang, Y. Liu, Breast-feeding and
31809-9. postpartum weight retention: a systematic review and meta-analysis, Public
[92] D. Aune, N. Keum, E. Giovannucci, L.T. Fadnes, P. Boffetta, D.C. Greenwood, Health Nutr. 18 (2015) 3308–3316, https://doi.org/10.1017/
S. Tonstad, L.J. Vatten, E. Riboli, T. Norat, Whole grain consumption and risk of S1368980015000828.
cardiovascular disease, cancer, and all cause and cause specific mortality: [110] C.G. Victora, R. Bahl, A.J. Barros, G.V. Franca, S. Horton, J. Krasevec, S. Murch,
systematic review and dose-response meta-analysis of prospective studies, BMJ M.J. Sankar, N. Walker, N.C. Rollins, Breastfeeding in the 21st century:
(2016) i2716, https://doi.org/10.1136/bmj.i2716. epidemiology, mechanisms, and lifelong effect, Lancet 387 (2016) 475–490,
[93] D. Aune, E. Giovannucci, P. Boffetta, L.T. Fadnes, N. Keum, T. Norat, D. https://doi.org/10.1016/s0140-6736(15)01024-7.
C. Greenwood, E. Riboli, L.J. Vatten, S. Tonstad, Fruit and vegetable intake and [111] Q. Su, X. Sun, L. Zhu, Q. Yan, P. Zheng, Y. Mao, D. Ye, Breastfeeding and the risk
the risk of cardiovascular disease, total cancer and all-cause mortality—a of childhood cancer: a systematic review and dose-response meta-analysis, BMC
systematic review and dose-response meta-analysis of prospective studies, Int. J. Med. 19 (2021) 1–23.
Epidemiol. 46 (2017) 1029–1056, https://doi.org/10.1093/ije/dyw319. [112] World Health Organization Cancer Available online: https://www.who.int/health
[94] J.L. Slavin, Mechanisms for the impact of whole grain foods on cancer risk, J. Am. -topics/cancer#tab=tab_2 (Accessed on Nov 4, 2022).
Coll. Nutr. 19 (2000) 300S–307S, https://doi.org/10.1080/ [113] L.F.M. de Rezende, D.H. Lee, M.L. da Costa Louzada, M. Song, E. Giovannucci,
07315724.2000.10718964. J. Eluf-Neto, Proportion of cancer cases and deaths attributable to lifestyle risk
[95] S.J. Bultman, Interplay between diet, gut microbiota, epigenetic events, and factors in Brazil, Cancer Epidemiol. 59 (2019) 148–157.
colorectal cancer, Mol. Nutr. Food Res. 61 (2017) 1500902, https://doi.org/ [114] L.F.M. Rezende, E. Murata, B. Giannichi, L.Y. Tomita, G.A. Wagner, Z.M. Sanchez,
10.1002/mnfr.201500902. C. Celis-Morales, G. Ferrari, Cancer cases and deaths attributable to lifestyle risk
[96] A. Kaulmann, T. Bohn, Carotenoids, inflammation, and oxidative factors in Chile, BMC Cancer 20 (2020) 693, https://doi.org/10.1186/s12885-
stress—implications of cellular signaling pathways and relation to chronic disease 020-07187-4.
prevention, Nutr. Res. 34 (2014) 907–929, https://doi.org/10.1016/j. [115] F.M. Knaul, R. Wong, H. Arreola-Ornelas, O. Méndez, R. Bitran, A.C. Campino,
nutres.2014.07.010. Household catastrophic health expenditures: a comparative analysis of twelve
[97] World Cancer Research Fund / American Institute for Cancer Research. Latin American and Caribbean Countries, Salud pública De. méxico 53 (2011)
Continuous Update Project Expert Report 2018. Meat, fish and dairy products and s85–s95.
the risk of cancer 2018. [116] P.E. Goss, B.L. Lee, T. Badovinac-Crnjevic, K. Strasser-Weippl, Y. Chavarri-
[98] Red meat and processed meat; International Agency for Research on Cancer, Guerra St, J. Louis, C. Villarreal-Garza, K. Unger-Saldaña, M. Ferreyra, M. Debiasi,
World Health Organization: Lyon, France, 2018; Planning cancer control in Latin America and the Caribbean, Lancet Oncol. 14
[99] M.S. Farvid, E. Sidahmed, N.D. Spence, K. Mante Angua, B.A. Rosner, J. (2013) 391–436.
B. Barnett, Consumption of red meat and processed meat and cancer incidence: a [117] M. Lemos, J. Restrepo, C. Espina, A. Feliu, C. Ferreccio, et al., and the “Working
systematic review and meta-analysis of prospective studies, Eur. J. Epidemiol. 36 Group on Communication and education of the LAC Code Against Cancer", Latin
(2021) 937–951, https://doi.org/10.1007/s10654-021-00741-9. America and the Caribbean Code Against Cancer 1st edition: Formative research
[100] V. Bouvard, D. Loomis, K.Z. Guyton, Y. Grosse, F. El Ghissassi, L. Benbrahim- on the comprehension and persuasiveness of the recommendations by the general
Tallaa, N. Guha, H. Mattock, K. Straif, Carcinogenicity of consumption of red and population, Cancer Epidemiol. S1 (2023), 102456, https://doi.org/10.1016/j.
processed meat, Lancet Oncol. 16 (2015) 1599–1600. canep.2023.102456.
[101] E.B. Richi, B. Baumer, B. Conrad, R. Darioli, A. Schmid, U. Keller, Health risks [118] C.A. Monteiro, G. Cannon, R.B. Levy, J.-C. Moubarac, M.L. Louzada, F. Rauber,
associated with meat consumption: a review of epidemiological studies, Int. J. N. Khandpur, G. Cediel, D. Neri, E. Martinez-Steele, Ultra-processed foods: what
Vitam. Nutr. Res 85 (2015) 70–78. they are and how to identify them, Public Health Nutr. 22 (2019) 936–941.
[102] IARC, Working Group on the Evaluation of Carcinogenic Risks to Humans Red [119] A. Feliu, C. Finck, M. Lemos, A. Bahena Botello, F. de Albuquerque Melo
Meat and Processed Meat, International Agency for Research on Cancer, Lyon, Nogueira, A. Bonvecchio Arenas, et al., Latin America and the Caribbean Code
France, 2018. Against Cancer 1st edition: Building capacity on cancer prevention to primary
[103] S. Hurtado-Barroso, M. Trius-Soler, R.M. Lamuela-Raventós, R. Zamora-Ros, healthcare professionals, Cancer Epidemiol. S1 (2023), 102400, https://doi.org/
Vegetable and fruit consumption and prognosis among cancer survivors: a 10.1016/j.canep.2023.102400.
systematic review and meta-analysis of cohort studies, Adv. Nutr. 11 (2020) [120] W.H. Organization, Tackling NCDs:’Best Buys’ and Other Recommended
1569–1582. Interventions for the Prevention and Control of Noncommunicable Diseases,
[104] C. Castro-Espin, A. Agudo, The role of diet in prognosis among cancer survivors: a World Health Organization, 2017.
systematic review and meta-analysis of dietary patterns and diet interventions, [121] International, W.C.R.F. Driving Action to Prevent Cancer and Other Non-
Nutrients 14 (2022) 348. Communicable Diseases: A New Policy Framework for Promoting Healthy Diets,
[105] C. Scoccianti, T.J. Key, A.S. Anderson, P. Armaroli, F. Berrino, M. Cecchini, M.- Physical Activity, Breastfeeding and Reducing Alcohol Consumption; World
C. Boutron-Ruault, M. Leitzmann, T. Norat, H. Powers, et al., European Code Cancer Research Fund International London, 2018;
against Cancer 4th Edition: Breastfeeding and cancer, Cancer Epidemiol. 39 [122] W.H. Organization, International Code of Marketing of Breast-milk Substitutes,
(2015) S101–S106, https://doi.org/10.1016/j.canep.2014.12.007. World Health Organization, 1981. ISBN 92-4-154160-1.
[106] World Cancer Research Fund / American Institute for Cancer Research. [123] Pan American Health Organization PAHO Nutrient Profile Model 2016.
Continuous Update Project Expert Report 2018. Lactation and the risk of cancer
2018.
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Esophagus (adenocarcinoma) 9 1.48 (1.35,1.62) Per 5 kg/m2 increment [29], 2018

Table 2 recurrence and survival of patients living with cancer [62].

2.3.3. Wholegrains, fiber, fruits and vegetables 2.4. Breastfeeding

CRediT authorship contribution statement Declaration of Competing Interest

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