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Improving any of these lifestyle factors could plausibly reduce cancer deaths, yet the magnitude of benefit differs across nutrition quality, activity and fitness, and loss of excess adiposity. This review synthesizes epidemiological evidence, using meta-analyses for cross-intervention comparisons and individual studies within them to enable more quantitative inferences. 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Dougherty * and Joshua E. Meyer  \nCitation: Dougherty, T.P.; Meyer, J.E. Comparing Lifestyle Modifications and the Magnitude of Their Associated Benefit on Cancer Mortality. Nutrients 2023, 15, 2038 . [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)nu15092038  \nAcademic Editor: Susanna C. Larsson  \nReceived: 21 March 2023  \nRevised: 16 April 2023  \nAccepted: 20 April 2023  \nPublished: 23 April 2023  \nCopyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) .  \nDepartment of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111-2497, USA  \n* Correspondence: [timothy.dougherty@fccc.edu](timothy.dougherty@fccc.edu)  \nAbstract: Many cancers are associated with poor diet, lack of physical activity, and excess weight. Improving any of these three lifestyle factors would likely reduce cancer deaths. However, modifications to each of these—better nutrition, enhanced activity and fitness, and loss of extra body fat—have different effect sizes on cancer mortality. This review will highlight the relative benefit that each lifestyle change, enacted prior to a diagnosis of cancer, might impart on cancer-related deaths, as well as attempt to quantify the changes required to derive such a benefit. The review relies primarily on epidemiological data, with meta-analyses serving as the backbone for comparisons across interventions and individual studies within the larger meta-analyses providing the data necessary to form more quantitative conclusions. The reader can then use this information to better understand, recommend, and implement behaviors that might ultimately reduce cancer mortality. Of all the interventions, it seems clear that exercise, specifically improving cardiorespiratory fitness, is the best way to decrease the risk of dying from cancer.  \nKeywords: dietary modification; cardiorespiratory fitness; physical activity; obesity; cancer mortality  \n1. Introduction  \nAccording to The World Cancer Fund, nearly one in five cancers in the United States is directly attributable to suboptimal diet, low physical activity, and/or excess adiposity [1,2] . This information clearly suggests that many cancers are preventable. However, the contribution of either nutrition or physical activity to risk reduction are quite varied in effect size. This review aims to highlight the different magnitudes that dietary modifications, physical activity, and excess adiposity might contribute to cancer mortality before a diagnosis of cancer.  \nMany of the studies cited in this article are epidemiological in nature. Many nutritional epidemiological studies rely on self-report, often food frequency questionnaires (FFQs), to record types of foods eaten (red meat, nuts, beverages, etc.) . Although these FFQshave high reproducibility person to person and year to year [3,4], they do not necessarily relate well to total calorie intake and expenditure as suggested by doubly-labeled water experiments [5–7] . In addition, epidemiology does not establish causation, but rather association. To complicate matters, interpretation and application of epidemiological data, especially nutritional epidemiology, can be difficult [8] . Foods are also connected with one another, since a person needs to choose one meal or food group over another on a daily basis. Additionally, foods are often correlated—a person is more likely to consume a hamburger with a side of fries than a burger with a side of cashews. Lastly, differences between the highest and lowest intake of any food occupy a rather narrow range. For instance, the ","cbCaiaJw60t1YfMU","https://ap.wps.com/l/cbCaiaJw60t1YfMU","pdf",370709,"English","# Abstract\n# Introduction\n## Nutrition and physical activity in epidemiology\n## Measurement issues and bias\n# Methods\n## Meta-analysis hazard ratio synthesis","[{\"question\":\"Which lifestyle factors does the review focus on for cancer mortality reduction?\",\"answer\":\"It focuses on dietary quality, physical activity and fitness, and excess body fat (obesity). The review argues these factors are associated with cancer deaths and may be modifiable before diagnosis.\"},{\"question\":\"How does the review compare the magnitude of benefit across lifestyle interventions?\",\"answer\":\"It synthesizes hazard ratios from multiple meta-analyses and uses meta-analytic results as the core for comparisons across interventions, supported by individual studies within those meta-analyses.\"},{\"question\":\"Why does the review discuss limitations of nutrition and exercise epidemiology?\",\"answer\":\"Nutrition studies often rely on self-report tools like food frequency questionnaires, which may not precisely reflect total intake and expenditure, and epidemiology demonstrates association rather than causation. Exercise studies also face biases such as healthy user effects and lack of randomization.\"}]","Comparing Lifestyle Modifications and the Magnitude of Their Associated Benefit on Cancer Mortality - Review | PDF",1790271204]