title: Variety in vegetable and fruit consumption and the risk of gastric and esophageal cancer in the European Prospective Investigation into Cancer and Nutrition.
abstract: Diets high in vegetables and fruits have been suggested to be inversely associated with risk of gastric cancer. However, the evidence of the effect of variety of consumption is limited. We therefore investigated whether consumption of a variety of vegetables and fruit is associated with gastric and esophageal cancer in the European Prospective Investigation into Cancer and Nutrition study. Data on food consumption and follow-up on cancer incidence were available for 452,269 participants from 10 European countries. After a mean follow-up of 8.4 years, 475 cases of gastric and esophageal adenocarcinomas (180 noncardia, 185 cardia, gastric esophageal junction and esophagus, 110 not specified) and 98 esophageal squamous cell carcinomas were observed. Diet Diversity Scores were used to quantify the variety in vegetable and fruit consumption. We used multivariable Cox proportional hazard models to calculate risk ratios. Independent from quantity of consumption, variety in the consumption of vegetables and fruit combined and of fruit consumption alone were statistically significantly inversely associated with the risk of esophageal squamous cell carcinoma (continuous hazard ratio per 2 products increment 0.88; 95% CI 0.79-0.97 and 0.76; 95% CI 0.62-0.94, respectively) with the latter particularly seen in ever smokers. Variety in vegetable and/or fruit consumption was not associated with risk of gastric and esophageal adenocarcinomas. Independent from quantity of consumption, more variety in vegetable and fruit consumption combined and in fruit consumption alone may decrease the risk of esophageal squamous cell carcinoma. However, residual confounding by lifestyle factors cannot be excluded.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Jeurnink
authors.forename: F L
authors.initials: FL
authors.lastname: Büchner
authors.forename: H B
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.forename: H C
authors.initials: HC
authors.lastname: Boshuizen
authors.forename: M E
authors.initials: ME
authors.lastname: Numans
authors.forename: C C
authors.initials: CC
authors.lastname: Dahm
authors.forename: K
authors.initials: K
authors.lastname: Overvad
authors.forename: A
authors.initials: A
authors.lastname: Tjønneland
authors.forename: N
authors.initials: N
authors.lastname: Roswall
authors.forename: F
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.forename: M C
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.forename: S
authors.initials: S
authors.lastname: Morois
authors.forename: R
authors.initials: R
authors.lastname: Kaaks
authors.forename: B
authors.initials: B
authors.lastname: Teucher
authors.forename: H
authors.initials: H
authors.lastname: Boeing
authors.forename: B
authors.initials: B
authors.lastname: Buijsse
authors.forename: A
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: V
authors.initials: V
authors.lastname: Benetou
authors.forename: D
authors.initials: D
authors.lastname: Zylis
authors.forename: D
authors.initials: D
authors.lastname: Palli
authors.forename: S
authors.initials: S
authors.lastname: Sieri
authors.forename: P
authors.initials: P
authors.lastname: Vineis
authors.forename: R
authors.initials: R
authors.lastname: Tumino
authors.forename: S
authors.initials: S
authors.lastname: Panico
authors.forename: M C
authors.initials: MC
authors.lastname: Ocké
authors.forename: P H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: G
authors.initials: G
authors.lastname: Skeie
authors.forename: M
authors.initials: M
authors.lastname: Brustad
authors.forename: E
authors.initials: E
authors.lastname: Lund
authors.forename: E
authors.initials: E
authors.lastname: Sánchez-Cantalejo
authors.forename: C
authors.initials: C
authors.lastname: Navarro
authors.forename: P
authors.initials: P
authors.lastname: Amiano
authors.forename: E
authors.initials: E
authors.lastname: Ardanaz
authors.forename: J
authors.initials: J
authors.lastname: Ramón Quirós
authors.forename: G
authors.initials: G
authors.lastname: Hallmans
authors.forename: I
authors.initials: I
authors.lastname: Johansson
authors.forename: B
authors.initials: B
authors.lastname: Lindkvist
authors.forename: S
authors.initials: S
authors.lastname: Regnér
authors.forename: K T
authors.initials: KT
authors.lastname: Khaw
authors.forename: N
authors.initials: N
authors.lastname: Wareham
authors.forename: T J
authors.initials: TJ
authors.lastname: Key
authors.forename: N
authors.initials: N
authors.lastname: Slimani
authors.forename: T
authors.initials: T
authors.lastname: Norat
authors.forename: A C
authors.initials: AC
authors.lastname: Vergnaud
authors.forename: D
authors.initials: D
authors.lastname: Romaguera
authors.forename: C A
authors.initials: CA
authors.lastname: Gonzalez
mesh_terms: D000230:Adenocarcinoma / Q000517:prevention & control; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000517:prevention & control; D004938:Esophageal Neoplasms / Q000517:prevention & control*; D005060:Europe; D005260:Female; D005638:Fruit; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D013274:Stomach Neoplasms / Q000517:prevention & control*; D014675:Vegetables