title: Variety in fruit and vegetable consumption and the risk of lung cancer in the European prospective investigation into cancer and nutrition.
abstract: 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.
authors.affiliation: National Institute ofPublicHealth and the Environment, Bilthoven, The Netherlands. frederike.buchner@rivm.nl
authors.forename: Frederike L
authors.initials: FL
authors.lastname: Büchner
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: Martine M
authors.initials: MM
authors.lastname: Ros
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Christina C
authors.initials: CC
authors.lastname: Dahm
authors.forename: Louise
authors.initials: L
authors.lastname: Hansen
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.forename: Marina
authors.initials: M
authors.lastname: Touillaud
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Ute
authors.initials: U
authors.lastname: Nöthlings
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Dimosthenis
authors.initials: D
authors.lastname: Zylis
authors.forename: Vardis
authors.initials: V
authors.lastname: Dilis
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Sabina
authors.initials: S
authors.lastname: Sieri
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Carla H
authors.initials: CH
authors.lastname: van Gils
authors.forename: Eiliv
authors.initials: E
authors.lastname: Lund
authors.forename: Inger T
authors.initials: IT
authors.lastname: Gram
authors.forename: Tonje
authors.initials: T
authors.lastname: Braaten
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Antonio
authors.initials: A
authors.lastname: Agudo
authors.forename: Nerea
authors.initials: N
authors.lastname: Larrañaga
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.forename: Carmen
authors.initials: C
authors.lastname: Navarro
authors.forename: Marcial V
authors.initials: MV
authors.lastname: Argüelles
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.forename: Elisabet
authors.initials: E
authors.lastname: Wirfält
authors.forename: Göran
authors.initials: G
authors.lastname: Hallmans
authors.forename: Torgny
authors.initials: T
authors.lastname: Rasmuson
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Key
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nick
authors.initials: N
authors.lastname: Wareham
authors.forename: Nadia
authors.initials: N
authors.lastname: Slimani
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Vergnaud
authors.forename: Wei W
authors.initials: WW
authors.lastname: Xun
authors.forename: Lambertus A L M
authors.initials: LA
authors.lastname: Kiemeney
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
mesh_terms: 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