Fruits and vegetables and lung cancer: Findings from the European prospective investigation into cancer and nutrition
Corresponding Author
Anthony B. Miller
Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
Fax: +49 6221 42 2203
Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, D-69120 Heidelberg, GermanySearch for more papers by this authorHans-Peter Altenburg
Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
Search for more papers by this authorBas Bueno-de-Mesquita
Centre of Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
Search for more papers by this authorHendriek C. Boshuizen
Centre of Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
Search for more papers by this authorAntonio Agudo
Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain
Search for more papers by this authorFranco Berrino
Epidemiology Unit, Instituto Tumori, Milan, Italy
Search for more papers by this authorInger Torhild Gram
Institute of Community Medicine, University of Tromsø, Tromsø, Norway
Search for more papers by this authorLars Janson
Malmö Diet and Cancer Study, Lund University, Malmö, Sweden
Search for more papers by this authorJacob Linseisen
Unit of Human Nutrition and Cancer Prevention, Technical University, Munich, Germany
Search for more papers by this authorKim Overvad
Department of Clinical Epidemiology, Aalborg Hospital and Aarhus University Hospital, and Department of Epidemiology and Social Medicine, University of Aarhus, Denmark
Search for more papers by this authorTorgney Rasmuson
Department of Radiation Sciences, Oncology, Umea University, Umea, Sweden
Search for more papers by this authorAnnekatrin Lukanova
Unit of Nutrition, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorNaomi Allen
Cancer Research UK Epidemiology Unit, University of Oxford, Radcliffe Infirmary, Oxford, United Kingdom
Search for more papers by this authorPilar Amiano
Direccion de Salud de Guipuzkoa, San Sebastian, Spain
Search for more papers by this authorAurelio Barricarte
Instituto de Salud Pública de Navarra, Spain
Search for more papers by this authorGöran Berglund
Malmö Diet and Cancer Study, Lund University, Malmö, Sweden
Search for more papers by this authorHeiner Boeing
German Institute of Human Nutrition, Potsdam-Rehbücke, Germany
Search for more papers by this authorFrançoise Clavel-Chapelon
E3N-EPIC group, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorNicholas E. Day
Strangeways Research Laboratory, University of Cambridge, United Kingdom
Search for more papers by this authorGöran Hallmans
Department of Nutritional Research, University of Umeå, Sweden
Search for more papers by this authorEiliv Lund
Institute of Community Medicine, University of Tromsø, Tromsø, Norway
Search for more papers by this authorCarmen Martinez
Andalusian School of Public Health, Granada, Spain
Search for more papers by this authorCarmen Navarro
Consejería de Sanidad y Política Social. Murcia, Spain
Search for more papers by this authorDominico Palli
Molecular and Nutritional Epidemiology, CSPO Scientific Institute of Tuscany, Florence, Italy
Search for more papers by this authorSalvatore Panico
Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
Search for more papers by this authorPetra H.M. Peeters
Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
Search for more papers by this authorJosé Ramón Quirós
Consejería de Sanidad y Servicios Sociales de Asturias, Spain
Search for more papers by this authorAnne Tjønneland
Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
Search for more papers by this authorRosario Tumino
Registro Tumori, Azienda Ospedaliera“Civile M.P. Arezzo,” Ragusa, Italy
Search for more papers by this authorAntonia Trichopoulou
Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece
Search for more papers by this authorDimitrios Trichopoulos
Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece
Search for more papers by this authorNadia Slimani
Unit of Nutrition, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorElio Riboli
Unit of Nutrition, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorCorresponding Author
Anthony B. Miller
Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
Fax: +49 6221 42 2203
Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, D-69120 Heidelberg, GermanySearch for more papers by this authorHans-Peter Altenburg
Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
Search for more papers by this authorBas Bueno-de-Mesquita
Centre of Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
Search for more papers by this authorHendriek C. Boshuizen
Centre of Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
Search for more papers by this authorAntonio Agudo
Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain
Search for more papers by this authorFranco Berrino
Epidemiology Unit, Instituto Tumori, Milan, Italy
Search for more papers by this authorInger Torhild Gram
Institute of Community Medicine, University of Tromsø, Tromsø, Norway
Search for more papers by this authorLars Janson
Malmö Diet and Cancer Study, Lund University, Malmö, Sweden
Search for more papers by this authorJacob Linseisen
Unit of Human Nutrition and Cancer Prevention, Technical University, Munich, Germany
Search for more papers by this authorKim Overvad
Department of Clinical Epidemiology, Aalborg Hospital and Aarhus University Hospital, and Department of Epidemiology and Social Medicine, University of Aarhus, Denmark
Search for more papers by this authorTorgney Rasmuson
Department of Radiation Sciences, Oncology, Umea University, Umea, Sweden
Search for more papers by this authorAnnekatrin Lukanova
Unit of Nutrition, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorNaomi Allen
Cancer Research UK Epidemiology Unit, University of Oxford, Radcliffe Infirmary, Oxford, United Kingdom
Search for more papers by this authorPilar Amiano
Direccion de Salud de Guipuzkoa, San Sebastian, Spain
Search for more papers by this authorAurelio Barricarte
Instituto de Salud Pública de Navarra, Spain
Search for more papers by this authorGöran Berglund
Malmö Diet and Cancer Study, Lund University, Malmö, Sweden
Search for more papers by this authorHeiner Boeing
German Institute of Human Nutrition, Potsdam-Rehbücke, Germany
Search for more papers by this authorFrançoise Clavel-Chapelon
E3N-EPIC group, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorNicholas E. Day
Strangeways Research Laboratory, University of Cambridge, United Kingdom
Search for more papers by this authorGöran Hallmans
Department of Nutritional Research, University of Umeå, Sweden
Search for more papers by this authorEiliv Lund
Institute of Community Medicine, University of Tromsø, Tromsø, Norway
Search for more papers by this authorCarmen Martinez
Andalusian School of Public Health, Granada, Spain
Search for more papers by this authorCarmen Navarro
Consejería de Sanidad y Política Social. Murcia, Spain
Search for more papers by this authorDominico Palli
Molecular and Nutritional Epidemiology, CSPO Scientific Institute of Tuscany, Florence, Italy
Search for more papers by this authorSalvatore Panico
Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
Search for more papers by this authorPetra H.M. Peeters
Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
Search for more papers by this authorJosé Ramón Quirós
Consejería de Sanidad y Servicios Sociales de Asturias, Spain
Search for more papers by this authorAnne Tjønneland
Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
Search for more papers by this authorRosario Tumino
Registro Tumori, Azienda Ospedaliera“Civile M.P. Arezzo,” Ragusa, Italy
Search for more papers by this authorAntonia Trichopoulou
Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece
Search for more papers by this authorDimitrios Trichopoulos
Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece
Search for more papers by this authorNadia Slimani
Unit of Nutrition, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorElio Riboli
Unit of Nutrition, International Agency for Research on Cancer, Lyon, France
Search for more papers by this authorAbstract
Intake of fruits and vegetables is thought to protect against the development of lung cancer. However, some recent cohort and case-control studies have shown no protective effect. We have assessed the relation between fruit and vegetable intake and lung cancer incidence in the large prospective investigation on diet and cancer, the European Prospective Investigation Into Cancer and Nutrition (EPIC). We studied data from 478,021 individuals that took part in the EPIC study, who were recruited from 10 European countries and who completed a dietary questionnaire during 1992–1998. Follow-up was to December 1998 or 1999, but for some centres with active follow-up to June 2002. During follow-up, 1,074 participants were reported to have developed lung cancer, of whom 860 were eligible for our analysis. We used the Cox proportional hazard model to determine the effect of fruit and vegetable intake on the incidence of lung cancer. We paid particular attention to adjustment for smoking. Relative risk estimates were obtained using fruit and vegetable intake categorised by sex-specific, cohort-wide quintiles. After adjustment for age, smoking, height, weight and gender, there was a significant inverse association between fruit consumption and lung cancer risk: the hazard ratio for the highest quintile of consumption relative to the lowest being 0.60 (95% Confidence Interval 0.46–0.78), p for trend 0.0099. The association was strongest in the Northern Europe centres, and among current smokers at baseline, and was strengthened when the 293 lung cancers diagnosed in the first 2 years of follow-up were excluded from the analysis. There was no association between vegetable consumption or vegetable subtypes and lung cancer risk. The findings from this analysis can be regarded as re-enforcing recommendations with regard to enhanced fruit consumption for populations. However, the effect is likely to be small compared to smoking cessation. © 2003 Wiley-Liss, Inc.
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