Fruits and vegetables and lung cancer: Findings from the European Prospective Investigation into Cancer and Nutrition.
Intake of fruits and vegetables is thought to protect against the development of lung cancer. However, some recent cohort and case-control studies have shown no protective effect. We have assessed the relation between fruit and vegetable intake and lung cancer incidence in the large prospective investigation on diet and cancer, the European Prospective Investigation Into Cancer and Nutrition (EPIC). We studied data from 478,021 individuals that took part in the EPIC study, who were recruited from 10 European countries and who completed a dietary questionnaire during 1992-1998. Follow-up was to December 1998 or 1999, but for some centres with active follow-up to June 2002. During follow-up, 1,074 participants were reported to have developed lung cancer, of whom 860 were eligible for our analysis. We used the Cox proportional hazard model to determine the effect of fruit and vegetable intake on the incidence of lung cancer. We paid particular attention to adjustment for smoking. Relative risk estimates were obtained using fruit and vegetable intake categorised by sex-specific, cohort-wide quintiles. After adjustment for age, smoking, height, weight and gender, there was a significant inverse association between fruit consumption and lung cancer risk: the hazard ratio for the highest quintile of consumption relative to the lowest being 0.60 (95% Confidence Interval 0.46-0.78), p for trend 0.0099. The association was strongest in the Northern Europe centres, and among current smokers at baseline, and was strengthened when the 293 lung cancers diagnosed in the first 2 years of follow-up were excluded from the analysis. There was no association between vegetable consumption or vegetable subtypes and lung cancer risk. The findings from this analysis can be regarded as re-enforcing recommendations with regard to enhanced fruit consumption for populations. However, the effect is likely to be small compared to smoking cessation.
Miller
Anthony B
AB
Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany. a.miller@dkfz-heidelberg.de
Altenburg
Hans-Peter
HP
Bueno-de-Mesquita
Bas
B
Boshuizen
Hendriek C
HC
Agudo
Antonio
A
Berrino
Franco
F
Gram
Inger Torhild
IT
Janson
Lars
L
Linseisen
Jacob
J
Overvad
Kim
K
Rasmuson
Torgney
T
Vineis
Paolo
P
Lukanova
Annekatrin
A
Allen
Naomi
N
Amiano
Pilar
P
Barricarte
Aurelio
A
Berglund
Göran
G
Boeing
Heiner
H
Clavel-Chapelon
Françoise
F
Day
Nicholas E
NE
Hallmans
Göran
G
Lund
Eiliv
E
Martinez
Carmen
C
Navarro
Carmen
C
Palli
Domenico
D
Panico
Salvatore
S
Peeters
Petra H M
PH
Quirós
José Ramón
JR
Tjønneland
Anne
A
Tumino
Rosario
R
Trichopoulou
Antonia
A
Trichopoulos
Dimitrios
D
Slimani
Nadia
N
Riboli
Elio
E
Palli
Dominico
D
D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D004032:Diet; D005260:Female; D005638:Fruit; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011446:Prospective Studies; D012307:Risk Factors; D014675:Vegetables