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Int J Cancer. 2015 Dec 1;137(11):2705-14. doi: 10.1002/ijc.29640. Epub 2015 Jul 16.

Subtypes of fruit and vegetables, variety in consumption and risk of colon and rectal cancer in the European Prospective Investigation into Cancer and Nutrition.

Author information

1
Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
2
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
3
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
4
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
5
Danish Cancer Society Research Center, Copenhagen, Denmark.
6
INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France.
7
Université Paris Sud, Villejuif, France.
8
Institut Gustave Roussy, Villejuif, France.
9
Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
10
Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.
11
Hellenic Health Foundation, Athens, Greece.
12
Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
13
Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
14
Department of Epidemiology, Harvard School of Public Health, Boston, MA.
15
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
16
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
17
Department of Clinical and Experimental Medicine, Azienda Universitaria Ospedaliera Federico II, Naples, Italy.
18
Cancer Registry and Histopathology Unit, "Civic - M. P. Arezzo" Hospital, ASP Ragusa, Italy.
19
Unit of Cancer Epidemiology - CERMS, Department of Medical Sciences, University of Turin and Città della Salute e della Scienza Hospital, Turin, Italy.
20
Julius Center for Health Sciences and Primary Care, Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands.
21
Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway.
22
Department of Research, Cancer Registry of Norway, Oslo, Norway.
23
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
24
Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
25
Public Health Directorate, Asturias, Spain.
26
Unit of Nutrition and Cancer, IDIBELL, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.
27
Escuela Andaluza de Salud Pública, , Instituto de Investigación Biosanitaria ibs, GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
28
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
29
Basque Regional Health Department San Sebastian, San Sebastian, Spain.
30
Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
31
Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain.
32
Navarre Public Health Institute, Pamplona, Spain.
33
Division of Internal Medicine, Department of Clinical Sciences, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
34
Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.
35
Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
36
Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden.
37
Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
38
MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
39
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
40
International Agency for Research on Cancer (IARC-WHO), Lyon, France.
41
Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom.
42
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
43
Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Abstract

Previously, a lower risk of colorectal cancer was observed with fruit and vegetable consumption in the European Prospective Investigation into Cancer and Nutrition within a follow-up period of 9 years which was not fully supported by a recent meta-analysis. Therefore, we were interested in the relation with extended follow-up, also focusing on single subtypes and a variety of intake of fruit and vegetables. Fruit and vegetable consumption was assessed at baseline. After an average of 13 years of follow-up, 3,370 participants were diagnosed with colon or rectal cancer. Diet diversity scores were constructed to quantify variety in fruit and vegetable consumption. A lower risk of colon cancer was observed with higher self-reported consumption of fruit and vegetable combined (HR Q4 vs. Q1 0.87, 95% CI 0.75-1.01, p for trend 0.02), but no consistent association was observed for separate consumption of fruits and vegetables. No associations with risk of rectal cancer were observed. The few observed associations for some fruit and vegetable subtypes with colon cancer risk may have been due to chance. Variety in consumption of fruits and vegetables was not associated with a lower risk of colon or rectal cancer. Although a lower risk of colon cancer is suggested with high consumption of fruit and vegetables, this study does not support a clear inverse association between fruit and vegetable consumption and colon or rectal cancer beyond a follow-up of more than 10 years. Attenuation of the risk estimates from dietary changes over time cannot be excluded, but appears unlikely.

KEYWORDS:

colorectal cancer; fruits and vegetables; variety

PMID:
26077137
DOI:
10.1002/ijc.29640
[Indexed for MEDLINE]
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