Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Paolo Boffetta; Elisabeth Couto; Janine Wichmann; Pietro Ferrari; Dimitrios Trichopoulos; H Bas Bueno-de-Mesquita; Fränzel J B van Duijnhoven; Frederike L Büchner; Tim Key; Heiner Boeing; Ute Nöthlings; Jakob Linseisen; Carlos A Gonzalez; Kim Overvad; Michael R S Nielsen; Anne Tjønneland; Anja Olsen; Françoise Clavel-Chapelon; Marie-Christine Boutron-Ruault; Sophie Morois; Pagona Lagiou; Androniki Naska; Vassiliki Benetou; Rudolf Kaaks; Sabine Rohrmann; Salvatore Panico; Sabina Sieri; Paolo Vineis; Domenico Palli; Carla H van Gils; Petra H Peeters; Eiliv Lund; Magritt Brustad; Dagrun Engeset; José María Huerta; Laudina Rodríguez; Maria-José Sanchez; Miren Dorronsoro; Aurelio Barricarte; Göran Hallmans; Ingegerd Johansson; Jonas Manjer; Emily Sonestedt; Naomi E Allen; Sheila Bingham; Kay-Tee Khaw; Nadia Slimani; Mazda Jenab; Traci Mouw; Teresa Norat; Elio Riboli; Antonia Trichopoulou

doi:10.1093/jnci/djq072

Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Paolo Boffetta, Elisabeth Couto, Janine Wichmann, Pietro Ferrari, Dimitrios Trichopoulos, H Bas Bueno-de-Mesquita, Fränzel J B van Duijnhoven, Frederike L Büchner, Tim Key, Heiner Boeing, Ute Nöthlings, Jakob Linseisen, Carlos A Gonzalez, Kim Overvad, Michael R S Nielsen, Anne Tjønneland, Anja Olsen, Françoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, Sophie MoroisPagona Lagiou, Androniki Naska, Vassiliki Benetou, Rudolf Kaaks, Sabine Rohrmann, Salvatore Panico, Sabina Sieri, Paolo Vineis, Domenico Palli, Carla H van Gils, Petra H Peeters, Eiliv Lund, Magritt Brustad, Dagrun Engeset, José María Huerta, Laudina Rodríguez, Maria-José Sanchez, Miren Dorronsoro, Aurelio Barricarte, Göran Hallmans, Ingegerd Johansson, Jonas Manjer, Emily Sonestedt, Naomi E Allen, Sheila Bingham, Kay-Tee Khaw, Nadia Slimani, Mazda Jenab, Traci Mouw, Teresa Norat, Elio Riboli, Antonia Trichopoulou

292 Citations (Scopus)

Abstract

Background It is widely believed that cancer can be prevented by high intake of fruits and vegetables. However, inconsistent results from many studies have not been able to conclusively establish an inverse association between fruit and vegetable intake and overall cancer risk. Methods We conducted a prospective analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to assess relationships between intake of total fruits, total vegetables, and total fruits and vegetables combined and cancer risk during 1992-2000. Detailed information on the dietary habit and lifestyle variables of the cohort was obtained. Cancer incidence and mortality data were ascertained, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression models. Analyses were also conducted for cancers associated with tobacco and alcohol after stratification for tobacco smoking and alcohol drinking. Results Of the initial 142 605 men and 335 873 women included in the study, 9604 men and 21 000 women were identified with cancer after a median follow-up of 8.7 years. The crude cancer incidence rates were 7.9 per 1000 person- years in men and 7.1 per 1000 person-years in women. Associations between reduced cancer risk and increased intake of total fruits and vegetables combined and total vegetables for the entire cohort were similar (200 g/d increased intake of fruits and vegetables combined, HR = 0.97, 95% CI = 0.96 to 0.99; 100 g/d increased intake of total vegetables, HR = 0.98, 95% CI = 0.97 to 0.99); intake of fruits showed a weaker inverse association (100 g/d increased intake of total fruits, HR = 0.99, 95% CI = 0.98 to 1.00). The reduced risk of cancer associated with high vegetable intake was restricted to women (HR = 0.98, 95% CI = 0.97 to 0.99). Stratification by alcohol intake suggested a stronger reduction in risk in heavy drinkers and was confined to cancers caused by smoking and alcohol. Conclusions A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation.

Original language	English
Journal	JNCI - Journal of the National Cancer Institute
Volume	102
Issue number	8
Pages (from-to)	529-37
Number of pages	8
ISSN	0027-8874
DOIs	https://doi.org/10.1093/jnci/djq072
Publication status	Published - 21 Apr 2010

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Boffetta, P., Couto, E., Wichmann, J., Ferrari, P., Trichopoulos, D., Bueno-de-Mesquita, H. B., van Duijnhoven, F. J. B., Büchner, F. L., Key, T., Boeing, H., Nöthlings, U., Linseisen, J., Gonzalez, C. A., Overvad, K., Nielsen, M. R. S., Tjønneland, A., Olsen, A., Clavel-Chapelon, F., Boutron-Ruault, M-C., ... Trichopoulou, A. (2010). Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). JNCI - Journal of the National Cancer Institute, 102(8), 529-37. https://doi.org/10.1093/jnci/djq072

Boffetta, P, Couto, E, Wichmann, J, Ferrari, P, Trichopoulos, D, Bueno-de-Mesquita, HB, van Duijnhoven, FJB, Büchner, FL, Key, T, Boeing, H, Nöthlings, U, Linseisen, J, Gonzalez, CA, Overvad, K, Nielsen, MRS, Tjønneland, A, Olsen, A, Clavel-Chapelon, F, Boutron-Ruault, M-C, Morois, S, Lagiou, P, Naska, A, Benetou, V, Kaaks, R, Rohrmann, S, Panico, S, Sieri, S, Vineis, P, Palli, D, van Gils, CH, Peeters, PH, Lund, E, Brustad, M, Engeset, D, Huerta, JM, Rodríguez, L, Sanchez, M-J, Dorronsoro, M, Barricarte, A, Hallmans, G, Johansson, I, Manjer, J, Sonestedt, E, Allen, NE, Bingham, S, Khaw, K-T, Slimani, N, Jenab, M, Mouw, T, Norat, T, Riboli, E & Trichopoulou, A 2010, 'Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)', JNCI - Journal of the National Cancer Institute, vol. 102, no. 8, pp. 529-37. https://doi.org/10.1093/jnci/djq072

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title = "Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)",

abstract = "Background It is widely believed that cancer can be prevented by high intake of fruits and vegetables. However, inconsistent results from many studies have not been able to conclusively establish an inverse association between fruit and vegetable intake and overall cancer risk. Methods We conducted a prospective analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to assess relationships between intake of total fruits, total vegetables, and total fruits and vegetables combined and cancer risk during 1992-2000. Detailed information on the dietary habit and lifestyle variables of the cohort was obtained. Cancer incidence and mortality data were ascertained, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression models. Analyses were also conducted for cancers associated with tobacco and alcohol after stratification for tobacco smoking and alcohol drinking. Results Of the initial 142 605 men and 335 873 women included in the study, 9604 men and 21 000 women were identified with cancer after a median follow-up of 8.7 years. The crude cancer incidence rates were 7.9 per 1000 person- years in men and 7.1 per 1000 person-years in women. Associations between reduced cancer risk and increased intake of total fruits and vegetables combined and total vegetables for the entire cohort were similar (200 g/d increased intake of fruits and vegetables combined, HR = 0.97, 95% CI = 0.96 to 0.99; 100 g/d increased intake of total vegetables, HR = 0.98, 95% CI = 0.97 to 0.99); intake of fruits showed a weaker inverse association (100 g/d increased intake of total fruits, HR = 0.99, 95% CI = 0.98 to 1.00). The reduced risk of cancer associated with high vegetable intake was restricted to women (HR = 0.98, 95% CI = 0.97 to 0.99). Stratification by alcohol intake suggested a stronger reduction in risk in heavy drinkers and was confined to cancers caused by smoking and alcohol. Conclusions A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation.",

author = "Paolo Boffetta and Elisabeth Couto and Janine Wichmann and Pietro Ferrari and Dimitrios Trichopoulos and Bueno-de-Mesquita, {H Bas} and {van Duijnhoven}, {Fr{\"a}nzel J B} and B{\"u}chner, {Frederike L} and Tim Key and Heiner Boeing and Ute N{\"o}thlings and Jakob Linseisen and Gonzalez, {Carlos A} and Kim Overvad and Nielsen, {Michael R S} and Anne Tj{\o}nneland and Anja Olsen and Fran{\c c}oise Clavel-Chapelon and Marie-Christine Boutron-Ruault and Sophie Morois and Pagona Lagiou and Androniki Naska and Vassiliki Benetou and Rudolf Kaaks and Sabine Rohrmann and Salvatore Panico and Sabina Sieri and Paolo Vineis and Domenico Palli and {van Gils}, {Carla H} and Peeters, {Petra H} and Eiliv Lund and Magritt Brustad and Dagrun Engeset and Huerta, {Jos{\'e} Mar{\'i}a} and Laudina Rodr{\'i}guez and Maria-Jos{\'e} Sanchez and Miren Dorronsoro and Aurelio Barricarte and G{\"o}ran Hallmans and Ingegerd Johansson and Jonas Manjer and Emily Sonestedt and Allen, {Naomi E} and Sheila Bingham and Kay-Tee Khaw and Nadia Slimani and Mazda Jenab and Traci Mouw and Teresa Norat and Elio Riboli and Antonia Trichopoulou",

note = "Keywords: Adult; Aged; Alcohol Drinking; Europe; Female; Food Habits; Fruit; Humans; Incidence; Life Style; Male; Middle Aged; Neoplasms; Observer Variation; Odds Ratio; Prospective Studies; Questionnaires; Registries; Research Design; Risk Assessment; Risk Factors; Vegetables",

year = "2010",

month = apr,

day = "21",

doi = "10.1093/jnci/djq072",

language = "English",

volume = "102",

pages = "529--37",

journal = "National Cancer Institute. Journal (Print)",

issn = "0027-8874",

publisher = "Oxford University Press",

number = "8",

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TY - JOUR

T1 - Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

AU - Boffetta, Paolo

AU - Couto, Elisabeth

AU - Wichmann, Janine

AU - Ferrari, Pietro

AU - Trichopoulos, Dimitrios

AU - Bueno-de-Mesquita, H Bas

AU - van Duijnhoven, Fränzel J B

AU - Büchner, Frederike L

AU - Key, Tim

AU - Boeing, Heiner

AU - Nöthlings, Ute

AU - Linseisen, Jakob

AU - Gonzalez, Carlos A

AU - Overvad, Kim

AU - Nielsen, Michael R S

AU - Tjønneland, Anne

AU - Olsen, Anja

AU - Clavel-Chapelon, Françoise

AU - Boutron-Ruault, Marie-Christine

AU - Morois, Sophie

AU - Lagiou, Pagona

AU - Naska, Androniki

AU - Benetou, Vassiliki

AU - Kaaks, Rudolf

AU - Rohrmann, Sabine

AU - Panico, Salvatore

AU - Sieri, Sabina

AU - Vineis, Paolo

AU - Palli, Domenico

AU - van Gils, Carla H

AU - Peeters, Petra H

AU - Lund, Eiliv

AU - Brustad, Magritt

AU - Engeset, Dagrun

AU - Huerta, José María

AU - Rodríguez, Laudina

AU - Sanchez, Maria-José

AU - Dorronsoro, Miren

AU - Barricarte, Aurelio

AU - Hallmans, Göran

AU - Johansson, Ingegerd

AU - Manjer, Jonas

AU - Sonestedt, Emily

AU - Allen, Naomi E

AU - Bingham, Sheila

AU - Khaw, Kay-Tee

AU - Slimani, Nadia

AU - Jenab, Mazda

AU - Mouw, Traci

AU - Norat, Teresa

AU - Riboli, Elio

AU - Trichopoulou, Antonia

N1 - Keywords: Adult; Aged; Alcohol Drinking; Europe; Female; Food Habits; Fruit; Humans; Incidence; Life Style; Male; Middle Aged; Neoplasms; Observer Variation; Odds Ratio; Prospective Studies; Questionnaires; Registries; Research Design; Risk Assessment; Risk Factors; Vegetables

PY - 2010/4/21

Y1 - 2010/4/21

N2 - Background It is widely believed that cancer can be prevented by high intake of fruits and vegetables. However, inconsistent results from many studies have not been able to conclusively establish an inverse association between fruit and vegetable intake and overall cancer risk. Methods We conducted a prospective analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to assess relationships between intake of total fruits, total vegetables, and total fruits and vegetables combined and cancer risk during 1992-2000. Detailed information on the dietary habit and lifestyle variables of the cohort was obtained. Cancer incidence and mortality data were ascertained, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression models. Analyses were also conducted for cancers associated with tobacco and alcohol after stratification for tobacco smoking and alcohol drinking. Results Of the initial 142 605 men and 335 873 women included in the study, 9604 men and 21 000 women were identified with cancer after a median follow-up of 8.7 years. The crude cancer incidence rates were 7.9 per 1000 person- years in men and 7.1 per 1000 person-years in women. Associations between reduced cancer risk and increased intake of total fruits and vegetables combined and total vegetables for the entire cohort were similar (200 g/d increased intake of fruits and vegetables combined, HR = 0.97, 95% CI = 0.96 to 0.99; 100 g/d increased intake of total vegetables, HR = 0.98, 95% CI = 0.97 to 0.99); intake of fruits showed a weaker inverse association (100 g/d increased intake of total fruits, HR = 0.99, 95% CI = 0.98 to 1.00). The reduced risk of cancer associated with high vegetable intake was restricted to women (HR = 0.98, 95% CI = 0.97 to 0.99). Stratification by alcohol intake suggested a stronger reduction in risk in heavy drinkers and was confined to cancers caused by smoking and alcohol. Conclusions A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation.

AB - Background It is widely believed that cancer can be prevented by high intake of fruits and vegetables. However, inconsistent results from many studies have not been able to conclusively establish an inverse association between fruit and vegetable intake and overall cancer risk. Methods We conducted a prospective analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to assess relationships between intake of total fruits, total vegetables, and total fruits and vegetables combined and cancer risk during 1992-2000. Detailed information on the dietary habit and lifestyle variables of the cohort was obtained. Cancer incidence and mortality data were ascertained, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression models. Analyses were also conducted for cancers associated with tobacco and alcohol after stratification for tobacco smoking and alcohol drinking. Results Of the initial 142 605 men and 335 873 women included in the study, 9604 men and 21 000 women were identified with cancer after a median follow-up of 8.7 years. The crude cancer incidence rates were 7.9 per 1000 person- years in men and 7.1 per 1000 person-years in women. Associations between reduced cancer risk and increased intake of total fruits and vegetables combined and total vegetables for the entire cohort were similar (200 g/d increased intake of fruits and vegetables combined, HR = 0.97, 95% CI = 0.96 to 0.99; 100 g/d increased intake of total vegetables, HR = 0.98, 95% CI = 0.97 to 0.99); intake of fruits showed a weaker inverse association (100 g/d increased intake of total fruits, HR = 0.99, 95% CI = 0.98 to 1.00). The reduced risk of cancer associated with high vegetable intake was restricted to women (HR = 0.98, 95% CI = 0.97 to 0.99). Stratification by alcohol intake suggested a stronger reduction in risk in heavy drinkers and was confined to cancers caused by smoking and alcohol. Conclusions A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation.

U2 - 10.1093/jnci/djq072

DO - 10.1093/jnci/djq072

M3 - Journal article

C2 - 20371762

SN - 0027-8874

VL - 102

SP - 529

EP - 537

JO - National Cancer Institute. Journal (Print)

JF - National Cancer Institute. Journal (Print)

IS - 8

ER -

Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

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