title: Fruit and vegetable consumption and risk of aggressive and non-aggressive urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition.
abstract: BACKGROUND
  Many epidemiological studies have examined fruit and vegetable consumption in relation to the risk of urothelial cell carcinoma (UCC) of the bladder, but results are inconsistent. The association between fruit and vegetable consumption and UCC risk may vary by bladder tumour aggressiveness. Therefore, we examined the relation between fruit and vegetable consumption and the risk of aggressive and non-aggressive UCC in the European Prospective Investigation into Cancer and Nutrition (EPIC).
  
  
  METHODS
  After 8.9 years of follow-up, 947UCC were diagnosed among 468,656 EPIC participants. Of these, 421 could be classified as aggressive UCC and 433 as non-aggressive UCC cases. At recruitment, fruit and vegetable consumption was assessed by validated dietary questionnaires. Multivariable hazard ratios were estimated using Cox regression stratified by age, sex and center and adjusted for smoking status, duration and intensity of smoking, and energy intake.
  
  
  RESULTS
  Total consumption of fruits and vegetables was not associated with aggressive UCC nor with non-aggressive UCC. A 25 g/day increase in leafy vegetables and grapes consumption was associated with a reduced risk of non-aggressive UCC (hazard ratio (HR) 0.88; 95%confidence interval (CI) 0.78-1.00 and HR 0.87; 95%CI 0.77-0.98, respectively), while the intake of root vegetables was inversely associated with risk of aggressive UCC (HR 0.87; 95%CI 0.77-0.98).
  
  
  CONCLUSIONS
  Our study did not confirm a protective effect of total fruit and/or vegetable consumption on aggressive or non-aggressive UCC. High consumption of certain types of vegetables and of fruits may reduce the risk of aggressive or non-aggressive UCC; however chance findings cannot be excluded.
authors.affiliation: Centre for Nutrition and Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. martine.ros@rivm.nl
authors.forename: Martine M
authors.initials: MM
authors.lastname: Ros
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: Ellen
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authors.lastname: Kampman
authors.forename: Frederike L
authors.initials: FL
authors.lastname: Büchner
authors.forename: Katja K H
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authors.lastname: Overvad
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authors.lastname: Roswall
authors.forename: Francoise
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authors.forename: Sophie
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authors.forename: Rudolf
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authors.forename: Androniki
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authors.lastname: Naska
authors.forename: Vassiliki
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authors.forename: Calogero
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authors.lastname: Saieva
authors.forename: Valeria
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authors.lastname: Pala
authors.forename: Fulvio
authors.initials: F
authors.lastname: Ricceri
authors.forename: Rosario
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authors.lastname: Tumino
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Carla H
authors.initials: CH
authors.lastname: van Gils
authors.forename: Inger T
authors.initials: IT
authors.lastname: Gram
authors.forename: Dagrun
authors.initials: D
authors.lastname: Engeset
authors.forename: Maria-Dolores
authors.initials: MD
authors.lastname: Chirlaque
authors.forename: Eva
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authors.lastname: Ardanazx
authors.forename: Laudina
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authors.lastname: Rodríguez
authors.forename: Pilar
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authors.lastname: Amanio
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Gonzalez
authors.forename: María José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: David
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authors.lastname: Ulmert
authors.forename: Roy
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authors.lastname: Ernström
authors.forename: Börje
authors.initials: B
authors.lastname: Ljungberg
authors.forename: Naomi E
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authors.lastname: Allen
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.forename: Kee-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: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.forename: Lambertus A
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authors.lastname: Kiemeney
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mesh_terms: D004032:Diet; D005060:Europe; D005260:Female; D005638:Fruit; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D001749:Urinary Bladder Neoplasms / Q000517:prevention & control*; D014675:Vegetables