Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC).
BACKGROUND
It is widely believed that cancer can be prevented by high intake of fruits and vegetables. However, inconsistent results from many studies have not been able to conclusively establish an inverse association between fruit and vegetable intake and overall cancer risk.


METHODS
We conducted a prospective analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to assess relationships between intake of total fruits, total vegetables, and total fruits and vegetables combined and cancer risk during 1992-2000. Detailed information on the dietary habit and lifestyle variables of the cohort was obtained. Cancer incidence and mortality data were ascertained, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression models. Analyses were also conducted for cancers associated with tobacco and alcohol after stratification for tobacco smoking and alcohol drinking.


RESULTS
Of the initial 142 605 men and 335 873 women included in the study, 9604 men and 21 000 women were identified with cancer after a median follow-up of 8.7 years. The crude cancer incidence rates were 7.9 per 1000 person-years in men and 7.1 per 1000 person-years in women. Associations between reduced cancer risk and increased intake of total fruits and vegetables combined and total vegetables for the entire cohort were similar (200 g/d increased intake of fruits and vegetables combined, HR = 0.97, 95% CI = 0.96 to 0.99; 100 g/d increased intake of total vegetables, HR = 0.98, 95% CI = 0.97 to 0.99); intake of fruits showed a weaker inverse association (100 g/d increased intake of total fruits, HR = 0.99, 95% CI = 0.98 to 1.00). The reduced risk of cancer associated with high vegetable intake was restricted to women (HR = 0.98, 95% CI = 0.97 to 0.99). Stratification by alcohol intake suggested a stronger reduction in risk in heavy drinkers and was confined to cancers caused by smoking and alcohol.


CONCLUSIONS
A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation.
Boffetta
Paolo
P
The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY 10029, USA. paolo.boffetta@mssm.edu
Couto
Elisabeth
E
Wichmann
Janine
J
Ferrari
Pietro
P
Trichopoulos
Dimitrios
D
Bueno-de-Mesquita
H Bas
HB
van Duijnhoven
Fränzel J B
FJ
Büchner
Frederike L
FL
Key
Tim
T
Boeing
Heiner
H
Nöthlings
Ute
U
Linseisen
Jakob
J
Gonzalez
Carlos A
CA
Overvad
Kim
K
Nielsen
Michael R S
MR
Tjønneland
Anne
A
Olsen
Anja
A
Clavel-Chapelon
Françoise
F
Boutron-Ruault
Marie-Christine
MC
Morois
Sophie
S
Lagiou
Pagona
P
Naska
Androniki
A
Benetou
Vassiliki
V
Kaaks
Rudolf
R
Rohrmann
Sabine
S
Panico
Salvatore
S
Sieri
Sabina
S
Vineis
Paolo
P
Palli
Domenico
D
van Gils
Carla H
CH
Peeters
Petra H
PH
Lund
Eiliv
E
Brustad
Magritt
M
Engeset
Dagrun
D
Huerta
José María
JM
Rodríguez
Laudina
L
Sánchez
Maria-José
MJ
Dorronsoro
Miren
M
Barricarte
Aurelio
A
Hallmans
Göran
G
Johansson
Ingegerd
I
Manjer
Jonas
J
Sonestedt
Emily
E
Allen
Naomi E
NE
Bingham
Sheila
S
Khaw
Kay-Tee
KT
Slimani
Nadia
N
Jenab
Mazda
M
Mouw
Traci
T
Norat
Teresa
T
Riboli
Elio
E
Trichopoulou
Antonia
A
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D015588:Observer Variation; D016017:Odds Ratio; D011446:Prospective Studies; D012042:Registries; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014675:Vegetables