title: Citrus Consumption and Risk of Cutaneous Malignant Melanoma.
abstract: OBJECTIVE
  Citrus products are widely consumed foods that are rich in psoralens and furocoumarins, a group of naturally occurring chemicals with potential photocarcinogenic properties. We prospectively evaluated the risk of cutaneous malignant melanoma associated with citrus consumption.
  
  
  METHODS
  A total of 63,810 women in the Nurses' Health Study (1984 to 2010) and 41,622 men in the Health Professionals Follow-Up Study (1986 to 2010) were included. Dietary information was repeatedly assessed every 2 to 4 years during follow-up. Incident melanoma cases were identified through self-report and confirmed by pathologic records.
  
  
  RESULTS
  Over 24 to 26 years of follow-up, we documented 1,840 incident melanomas. After adjustment for other risk factors, the pooled multivariable hazard ratios for melanoma were 1.00 for overall citrus consumption < twice per week (reference), 1.10 (95% CI, 0.94 to 1.30) for two to four times per week, 1.26 (95% CI, 1.08 to 1.47) for five to six times per week, 1.27 (95% CI, 1.09 to 1.49) for once to 1.5 times per day, and 1.36 (95% CI, 1.14 to 1.63) for ≥ 1.6 times per day (Ptrend < .001). Among individual citrus products, grapefruit showed the most apparent association with risk of melanoma, which was independent of other lifestyle and dietary factors. The pooled multivariable hazard ratio for melanoma comparing the extreme consumption categories of grapefruit (≥ three times per week v never) was 1.41 (95% CI, 1.10 to 1.82; Ptrend < .001).
  
  
  CONCLUSIONS
  Citrus consumption was associated with an increased risk of malignant melanoma in two cohorts of women and men. Nevertheless, further investigation is needed to confirm our findings and explore related health implications.
authors.affiliation: Shaowei Wu, Diane Feskanich, Eunyoung Cho, Meir J. Stampfer, Walter C. Willett, and Abrar A. Qureshi, Brigham and Women's Hospital and Harvard Medical School; Meir J. Stampfer and Walter C. Willett, Harvard School of Public Health, Boston, MA; Shaowei Wu, Eunyoung Cho, and Abrar A. Qureshi, Brown University, Providence, RI; and Jiali Han, Indiana University, Indianapolis, IN.
authors.forename: Shaowei
authors.initials: S
authors.lastname: Wu
authors.affiliation: Shaowei Wu, Diane Feskanich, Eunyoung Cho, Meir J. Stampfer, Walter C. Willett, and Abrar A. Qureshi, Brigham and Women's Hospital and Harvard Medical School; Meir J. Stampfer and Walter C. Willett, Harvard School of Public Health, Boston, MA; Shaowei Wu, Eunyoung Cho, and Abrar A. Qureshi, Brown University, Providence, RI; and Jiali Han, Indiana University, Indianapolis, IN.
authors.forename: Jiali
authors.initials: J
authors.lastname: Han
authors.affiliation: Shaowei Wu, Diane Feskanich, Eunyoung Cho, Meir J. Stampfer, Walter C. Willett, and Abrar A. Qureshi, Brigham and Women's Hospital and Harvard Medical School; Meir J. Stampfer and Walter C. Willett, Harvard School of Public Health, Boston, MA; Shaowei Wu, Eunyoung Cho, and Abrar A. Qureshi, Brown University, Providence, RI; and Jiali Han, Indiana University, Indianapolis, IN.
authors.forename: Diane
authors.initials: D
authors.lastname: Feskanich
authors.affiliation: Shaowei Wu, Diane Feskanich, Eunyoung Cho, Meir J. Stampfer, Walter C. Willett, and Abrar A. Qureshi, Brigham and Women's Hospital and Harvard Medical School; Meir J. Stampfer and Walter C. Willett, Harvard School of Public Health, Boston, MA; Shaowei Wu, Eunyoung Cho, and Abrar A. Qureshi, Brown University, Providence, RI; and Jiali Han, Indiana University, Indianapolis, IN.
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Cho
authors.affiliation: Shaowei Wu, Diane Feskanich, Eunyoung Cho, Meir J. Stampfer, Walter C. Willett, and Abrar A. Qureshi, Brigham and Women's Hospital and Harvard Medical School; Meir J. Stampfer and Walter C. Willett, Harvard School of Public Health, Boston, MA; Shaowei Wu, Eunyoung Cho, and Abrar A. Qureshi, Brown University, Providence, RI; and Jiali Han, Indiana University, Indianapolis, IN.
authors.forename: Meir J
authors.initials: MJ
authors.lastname: Stampfer
authors.affiliation: Shaowei Wu, Diane Feskanich, Eunyoung Cho, Meir J. Stampfer, Walter C. Willett, and Abrar A. Qureshi, Brigham and Women's Hospital and Harvard Medical School; Meir J. Stampfer and Walter C. Willett, Harvard School of Public Health, Boston, MA; Shaowei Wu, Eunyoung Cho, and Abrar A. Qureshi, Brown University, Providence, RI; and Jiali Han, Indiana University, Indianapolis, IN.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.affiliation: Shaowei Wu, Diane Feskanich, Eunyoung Cho, Meir J. Stampfer, Walter C. Willett, and Abrar A. Qureshi, Brigham and Women's Hospital and Harvard Medical School; Meir J. Stampfer and Walter C. Willett, Harvard School of Public Health, Boston, MA; Shaowei Wu, Eunyoung Cho, and Abrar A. Qureshi, Brown University, Providence, RI; and Jiali Han, Indiana University, Indianapolis, IN. abrar_qureshi@brown.edu.
authors.forename: Abrar A
authors.initials: AA
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D002957:Citrus / Q000009:adverse effects*; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology