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Fruit and vegetable consumption and risk of esophageal cancer in the Asian region: a systematic review and meta-analysis

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Abstract

The consumption of fruit and vegetables was reported to be associated with a reduced risk of esophageal cancer (EC) in many studies of esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC) from different regions worldwide. Therefore, to provide precise information to reduce the risk of EC in Asia, we performed a systematic review and meta-analysis of studies conducted in the Asian region about fruit and vegetable consumption and the risk of EC. We searched the MEDLINE (PubMed) and ICHUSHI (Japana Centra Revuo Medicina) databases from January 2010 to December 2020. The summary relative risk (SRR) and 95% CI were calculated using a random-effects model. In addition, I2 statistics were used to detect heterogeneity. Twenty-two studies were eligible for meta-analysis (16 case–control studies and 6 cohort studies). The SRR for the lowest versus highest fruit consumption was 0.64 (95% CI 0.53–0.77, I2 = 82%). That for the lowest versus highest vegetable consumption was 0.61 (95% CI 0.50–0.74, I2 = 81%). Based on subgroup analysis, a validated Food Frequency Questionnaire (FFQ) was significantly associated (SRR for fruit: 0.54; 95% CI 0.40–0.74, SRR for vegetable: 0.60; 95% CI 0.48–0.76) with low heterogeneity (I2 = 48% for fruit, I2 = 0% for vegetables). Egger’s funnel plot asymmetry test demonstrated publication bias (P < 0.001 for fruit, P = 0.009 for vegetables). Fruit and vegetable consumption might be associated with a lower risk of EC in the Asian region. However, further substantial prospective studies with a validated FFQ and well-controlled important confounding factors are required to confirm the association.

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Acknowledgements

The author names of the group "The Esophageal Cancer Practice Guidelines Preparation Committee" were as follows; Yuko Kitagawa, Kenji Nemoto, Tsuneo Oyama, Manabu Muto, Hiroya Takeuchi, Yasushi Toh, Hisahiro Matsubara, Masayuki Mano, Koji Kono, Tatsuya Miyazaki, Ken Kato, Masahiro Yoshida, Hirofumi Kawakubo, Eisuke Booka, Tomoki Yamatsuji, Hiroyuki Kato, Yoshinori Ito, Hitoshi Ishikawa, Ryu Ishihara, Takahiro Tsushima, Hiroshi Kawachi, Takashi Oyama, Takashi Kojima, Taiki Yamaji, Shiko Kuribayashi, Tomoki Makino, Satoru Matsuda.

Author information

Authors and Affiliations

  1. Department of General Surgical Science, Division of Gastroenterological Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan

    Makoto Sakai, Hiroshi Saeki & Makoto Sohda

  2. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Yuko Kitagawa, Hirofumi Kawakubo & Satoru Matsuda

  3. Department of Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan

    Tatsuya Miyazaki

  4. Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan

    Taiki Yamaji

  5. Department of Radiology, Yamagata University Graduate School of Medicine, Yonezawa, Japan

    Kenji Nemoto

  6. Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan

    Tsuneo Oyama

  7. Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan

    Manabu Muto

  8. Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Hiroya Takeuchi & Eisuke Booka

  9. National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Yasushi Toh

  10. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Hisahiro Matsubara

  11. Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, Osaka, Japan

    Masayuki Mano

  12. Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima, Japan

    Koji Kono

  13. Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan

    Ken Kato

  14. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Ichikawa, Japan

    Masahiro Yoshida

  15. Department of General Surgery, Kawasaki Medical School, Okayama, Japan

    Tomoki Yamatsuji

  16. Kiryu Kousei General Hospital, Kiryu, Japan

    Hiroyuki Kato

  17. Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan

    Yoshinori Ito

  18. National Institutes for Quantum and Radiological Science and Technology, QST Hospital, Chiba, Japan

    Hitoshi Ishikawa

  19. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

    Ryu Ishihara

  20. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan

    Takahiro Tsushima

  21. Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Hiroshi Kawachi

  22. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan

    Takashi Oyama

  23. Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan

    Takashi Kojima

  24. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan

    Shiko Kuribayashi

  25. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Tomoki Makino, Yuto Kubo & Yuichiro Doki

Authors
  1. Makoto Sakai
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  2. Yuko Kitagawa
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  3. Hiroshi Saeki
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  4. Tatsuya Miyazaki
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  5. Taiki Yamaji
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  6. Kenji Nemoto
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  7. Tsuneo Oyama
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  9. Hiroya Takeuchi
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  10. Yasushi Toh
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  11. Hisahiro Matsubara
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  12. Masayuki Mano
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  13. Koji Kono
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  14. Ken Kato
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  15. Masahiro Yoshida
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  16. Hirofumi Kawakubo
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  17. Eisuke Booka
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  18. Tomoki Yamatsuji
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  19. Hiroyuki Kato
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  20. Yoshinori Ito
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  21. Hitoshi Ishikawa
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  22. Ryu Ishihara
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  23. Takahiro Tsushima
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  24. Hiroshi Kawachi
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  25. Takashi Oyama
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  26. Takashi Kojima
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  27. Shiko Kuribayashi
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  28. Tomoki Makino
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  29. Satoru Matsuda
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  30. Makoto Sohda
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  31. Yuto Kubo
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  32. Yuichiro Doki
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Consortia

The Esophageal Cancer Practice Guidelines Preparation Committee

  • Yuko Kitagawa
  • , Kenji Nemoto
  • , Tsuneo Oyama
  • , Manabu Muto
  • , Hiroya Takeuchi
  • , Yasushi Toh
  • , Hisahiro Matsubara
  • , Masayuki Mano
  • , Koji Kono
  • , Tatsuya Miyazaki
  • , Ken Kato
  • , Masahiro Yoshida
  • , Hirofumi Kawakubo
  • , Eisuke Booka
  • , Tomoki Yamatsuji
  • , Hiroyuki Kato
  • , Yoshinori Ito
  • , Hitoshi Ishikawa
  • , Ryu Ishihara
  • , Takahiro Tsushima
  • , Hiroshi Kawachi
  • , Takashi Oyama
  • , Takashi Kojima
  • , Taiki Yamaji
  • , Shiko Kuribayashi
  • , Tomoki Makino
  •  & Satoru Matsuda

Contributions

Systematic review and meta-analysis: MS and HS, advisement on article inclusion and exclusion: TM and TY, interpretation of data: MS, HS, TM, and TY, drafting of manuscript: MS, critical revision: KN, TO, MM, HT, YT, HM, MM, KK, KK, MY, HK, EB, TY, HK, YI, HI, RI, TT, HK, TO, TK, SK, TM, SM, MS, and YK, supervision: YK and YD.

Corresponding author

Correspondence to Makoto Sakai.

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Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and its later versions.

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The authors declare no conflicts of interest associated with this manuscript.

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Members of The Esophageal Cancer Practice Guidelines Preparation Committee are listed in the Acknowledgement section at the end of the article.

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Sakai, M., Kitagawa, Y., Saeki, H. et al. Fruit and vegetable consumption and risk of esophageal cancer in the Asian region: a systematic review and meta-analysis. Esophagus 19, 27–38 (2022). https://doi.org/10.1007/s10388-021-00882-6

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  • DOI: https://doi.org/10.1007/s10388-021-00882-6

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