Variety in fruit and vegetable consumption and the risk of lung cancer in the European prospective investigation into cancer and nutrition.
BACKGROUND
We investigated whether a varied consumption of vegetables and fruits is associated with lower lung cancer risk in the European Prospective Investigation into Cancer and Nutrition study.


METHODS
After a mean follow-up of 8.7 years, 1,613 of 452,187 participants with complete information were diagnosed with lung cancer. Diet diversity scores (DDS) were used to quantify the variety in fruit and vegetable consumption. Multivariable proportional hazards models were used to assess the associations between DDS and lung cancer risk. All models were adjusted for smoking behavior and the total consumption of fruit and vegetables.


RESULTS
With increasing variety in vegetable subgroups, risk of lung cancer decreases [hazard ratios (HR), 0.77; 95% confidence interval (CI), 0.64-0.94 highest versus lowest quartile; P trend = 0.02]. This inverse association is restricted to current smokers (HR, 0.73; 95% CI, 0.57-0.93 highest versus lowest quartile; P trend = 0.03). In continuous analyses, in current smokers, lower risks were observed for squamous cell carcinomas with more variety in fruit and vegetable products combined (HR/two products, 0.88; 95% CI, 0.82-0.95), vegetable subgroups (HR/subgroup, 0.88; 95% CI, 0.79-0.97), vegetable products (HR/two products, 0.87; 95% CI, 0.79-0.96), and fruit products (HR/two products, 0.84; 95% CI, 0.72-0.97).


CONCLUSIONS
Variety in vegetable consumption was inversely associated with lung cancer risk among current smokers. Risk of squamous cell carcinomas was reduced with increasing variety in fruit and/or vegetable consumption, which was mainly driven by the effect in current smokers.


CONCLUSIONS
Independent from quantity of consumption, variety in fruit and vegetable consumption may decrease lung cancer risk.
Büchner
Frederike L
FL
National Institute ofPublicHealth and the Environment, Bilthoven, The Netherlands. frederike.buchner@rivm.nl
Bueno-de-Mesquita
H Bas
HB
Ros
Martine M
MM
Overvad
Kim
K
Dahm
Christina C
CC
Hansen
Louise
L
Tjønneland
Anne
A
Clavel-Chapelon
Françoise
F
Boutron-Ruault
Marie-Christine
MC
Touillaud
Marina
M
Kaaks
Rudolf
R
Rohrmann
Sabine
S
Boeing
Heiner
H
Nöthlings
Ute
U
Trichopoulou
Antonia
A
Zylis
Dimosthenis
D
Dilis
Vardis
V
Palli
Domenico
D
Sieri
Sabina
S
Vineis
Paolo
P
Tumino
Rosario
R
Panico
Salvatore
S
Peeters
Petra H M
PH
van Gils
Carla H
CH
Lund
Eiliv
E
Gram
Inger T
IT
Braaten
Tonje
T
Sánchez
María-José
MJ
Agudo
Antonio
A
Larrañaga
Nerea
N
Ardanaz
Eva
E
Navarro
Carmen
C
Argüelles
Marcial V
MV
Manjer
Jonas
J
Wirfält
Elisabet
E
Hallmans
Göran
G
Rasmuson
Torgny
T
Key
Tim J
TJ
Khaw
Kay-Tee
KT
Wareham
Nick
N
Slimani
Nadia
N
Vergnaud
Anne-Claire
AC
Xun
Wei W
WW
Kiemeney
Lambertus A L M
LA
Riboli
Elio
E
D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D004032:Diet; D005060:Europe / Q000453:epidemiology; D005260:Female; D005638:Fruit; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014675:Vegetables