title: Intake of fruits and vegetables and risk of cancer of the upper aero-digestive tract: the prospective EPIC-study.
abstract: Epidemiologic studies suggest that a high intake of fruits and vegetables is associated with decreased risk of cancers of the upper aero-digestive tract. We studied data from 345,904 subjects of the prospective European Investigation into Cancer and Nutrition (EPIC) recruited in seven European countries, who had completed a dietary questionnaire in 1992-1998. During 2,182,560 person years of observation 352 histologically verified incident squamous cell cancer (SCC) cases (255 males; 97 females) of the oral cavity, pharynx, larynx, and esophagus were identified. Linear and restricted cubic spline Cox regressions were fitted on variables of intake of fruits and vegetables and adjusted for potential confounders. We observed a significant inverse association with combined total fruits and vegetables intake (estimated relative risk (RR) = 0.91; 95% confidence interval (95% CI) 0.83-1.00 per 80 g/d of consumption), and nearly significant inverse associations in separate analyses with total fruits and total vegetables intake (RR: 0.97 (95% CI: 0.92-1.02) and RR = 0.89 (95% CI: 0.78-1.02) per 40 g/d of consumption). Overall, vegetable subgroups were not related to risk with the exception of intake of root vegetables in men. Restricted cubic spline regression did not improve the linear model fits except for total fruits and vegetables and total fruits with a significant decrease in risk at low intake levels (<120 g/d) for fruits. Dietary recommendations should consider the potential benefit of increasing fruits and vegetables consumption for reducing the risk of cancers of the upper aero-digestive tract, particularly at low intake.
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany. boeing@mail.dife.de
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Thomas
authors.initials: T
authors.lastname: Dietrich
authors.forename: Kurt
authors.initials: K
authors.lastname: Hoffmann
authors.forename: Tobias
authors.initials: T
authors.lastname: Pischon
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.forename: Petra H
authors.initials: PH
authors.lastname: Lahmann
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.forename: Francoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.forename: Naomi
authors.initials: N
authors.lastname: Allen
authors.forename: Tim
authors.initials: T
authors.lastname: Key
authors.forename: Guri
authors.initials: G
authors.lastname: Skeie
authors.forename: Eiliv
authors.initials: E
authors.lastname: Lund
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.forename: Anne
authors.initials: A
authors.lastname: Tjonneland
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Majken K
authors.initials: MK
authors.lastname: Jensen
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.forename: Jakob
authors.initials: J
authors.lastname: Linseisen
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Christina
authors.initials: C
authors.lastname: Bamia
authors.forename: Theodora
authors.initials: T
authors.lastname: Psaltopoulou
authors.forename: Lars
authors.initials: L
authors.lastname: Weinehall
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Johansson
authors.forename: Maria-José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Paula
authors.initials: P
authors.lastname: Jakszyn
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.forename: Pilar
authors.initials: P
authors.lastname: Amiano
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Chirlaque
authors.forename: J Ramón
authors.initials: JR
authors.lastname: Quirós
authors.forename: Elisabet
authors.initials: E
authors.lastname: Wirfalt
authors.forename: Göran
authors.initials: G
authors.lastname: Berglund
authors.forename: Petra H
authors.initials: PH
authors.lastname: Peeters
authors.forename: Carla H
authors.initials: CH
authors.lastname: van Gils
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: Frederike L
authors.initials: FL
authors.lastname: Büchner
authors.forename: Franco
authors.initials: F
authors.lastname: Berrino
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Sheila
authors.initials: S
authors.lastname: Bingham
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nadia
authors.initials: N
authors.lastname: Slimani
authors.forename: Teresa
authors.initials: T
authors.lastname: Norat
authors.forename: Mazda
authors.initials: M
authors.lastname: Jenab
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000517:prevention & control; D015331:Cohort Studies; D004032:Diet; D004938:Esophageal Neoplasms / Q000517:prevention & control*; D005260:Female; D005638:Fruit; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000517:prevention & control*; D008297:Male; D009062:Mouth Neoplasms / Q000517:prevention & control*; D010610:Pharyngeal Neoplasms / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D014675:Vegetables