Alcohol in cancer prevention: Integrated in dietary guidelines or addressed independently?

Abstract Background Following the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) recommendations has been associated with lower cancer risk. As operationalization of these guidelines expands and nutritional education campaigns are implemented, there is the need to evaluate whether alcohol should be included as part of the dietary intervention, or as an independent behaviour to target, in different population groups. Methods We analyzed adherence to WCRF/AICR recommendations in two independent samples: young adults from the University of the Balearic Islands (n = 112) and older adults from the PREDIMED-Plus study (n = 148), both in Spain. Polychoric correlation matrices between WCRF/AICR diet-related items, including alcohol were implemented and visualized through heatmaps and Gaussian graphical models. Centrality measures assessed item relevance in the networks. Results In the young adult sample (mean age 24.9 ± 5.8; 70.5% women), alcohol showed weak or negative correlations with core dietary components (e.g., fruits and vegetables, p=-0.03; whole grains, p=-0.14), corroborated with the network graph, indicating its independence from the dietary dimension. Conversely, in the older sample (mean age 72.0 ± 5.2; 48.2 % women), alcohol appeared more integrated into the dietary network, showing moderate positive correlations with items such as red meat (p = 0.28) and processed meat (p = 0.06) and higher centrality indices. Conclusions These findings suggest that, in younger populations, alcohol may be better addressed as a separate behavioral target rather than as part of the dietary construct when evaluating adherence to WCRF/AICR recommendations. This distinction does not diminish its importance, but it may inform public health initiatives to tailor prevention strategies by age group, particularly in educational campaigns on alcohol and diet. Key messages • In nutritional education campaigns, alcohol intake should be targeted independently in younger populations, while it can form part of the diet recommendations in older adults. • Network analysis reveals how lifestyle behaviors, such as diet and alcohol intake, cluster differently across age groups.