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Cancer Causes & Control

, 17:957 | Cite as

Intake of fruits and vegetables and risk of cancer of the upper aero-digestive tract: the prospective EPIC-study

  • Heiner BoeingEmail author
  • Thomas Dietrich
  • Kurt Hoffmann
  • Tobias Pischon
  • Pietro Ferrari
  • Petra H. Lahmann
  • Marie Christine Boutron-Ruault
  • Francoise Clavel-Chapelon
  • Naomi Allen
  • Tim Key
  • Guri Skeie
  • Eiliv Lund
  • Anja Olsen
  • Anne Tjonneland
  • Kim Overvad
  • Majken K. Jensen
  • Sabine Rohrmann
  • Jakob Linseisen
  • Antonia Trichopoulou
  • Christina Bamia
  • Theodora Psaltopoulou
  • Lars Weinehall
  • Ingegerd Johansson
  • Maria-José Sánchez
  • Paula Jakszyn
  • Eva Ardanaz
  • Pilar Amiano
  • Maria Dolores Chirlaque
  • J. Ramón Quirós
  • Elisabet Wirfalt
  • Göran Berglund
  • Petra H. Peeters
  • Carla H. van Gils
  • H. Bas Bueno-de-Mesquita
  • Frederike L. Büchner
  • Franco Berrino
  • Domenico Palli
  • Carlotta Sacerdote
  • Rosario Tumino
  • Salvatore Panico
  • Sheila Bingham
  • Kay-Tee Khaw
  • Nadia Slimani
  • Teresa Norat
  • Mazda Jenab
  • Elio Riboli
Original Paper

Abstract

Epidemiologic studies suggest that a high intake of fruits and vegetables is associated with decreased risk of cancers of the upper aero-digestive tract. We studied data from 345,904 subjects of the prospective European Investigation into Cancer and Nutrition (EPIC) recruited in seven European countries, who had completed a dietary questionnaire in 1992–1998. During 2,182,560 person years of observation 352 histologically verified incident squamous cell cancer (SCC) cases (255 males; 97 females) of the oral cavity, pharynx, larynx, and esophagus were identified. Linear and restricted cubic spline Cox regressions were fitted on variables of intake of fruits and vegetables and adjusted for potential confounders. We observed a significant inverse association with combined total fruits and vegetables intake (estimated relative risk (RR) = 0.91; 95% confidence interval (95% CI) 0.83–1.00 per 80 g/d of consumption), and nearly significant inverse associations in separate analyses with total fruits and total vegetables intake (RR: 0.97 (95% CI: 0.92–1.02) and RR = 0.89 (95% CI: 0.78–1.02) per 40 g/d of consumption). Overall, vegetable subgroups were not related to risk with the exception of intake of root vegetables in men. Restricted cubic spline regression did not improve the linear model fits except for total fruits and vegetables and total fruits with a significant decrease in risk at low intake levels (<120 g/d) for fruits. Dietary recommendations should consider the potential benefit of increasing fruits and vegetables consumption for reducing the risk of cancers of the upper aero-digestive tract, particularly at low intake.

Keywords

Upper aero-digestive cancer Fruits and vegetables Root vegetables Prospective study EPIC Relative risk 

Notes

Acknowledgments

We would like to thank all participants for their contribution to this study. Important technical statistical support to this study was given by Wolfgang Bernigau. EPIC is financially supported by: Europe Against Cancer Program of the European Commission (SANCO); Deutsche Krebshilfe; Deutsches Krebsforschungszentrum; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; Spanish Regional Governments of Andalucia, Asturia, Basque Country, Murcia and Navarra; ISCIII, red de centros RCESP, C03/09, Spain; Cancer Research UK; Medical Research Council, United Kingdom; Stroke Association, United Kingdom; British Heart Foundation; Department of Health, United Kingdom; Food Standards Agency, United Kingdom; Welcome Trust, United Kingdom; Greek Ministry of Health; Greek Ministry of Education; Italian Association for Research on Cancer (AIRC); Italian National Research Council; Dutch Ministry of Public Health, Welfare and Sports; National Cancer Registry and the Regional Cancer Registries Amsterdam, Utrecht, East and Maastricht of The Netherlands; Swedish Cancer Society; Swedish Scientific Council; Regional Government of Skane, Sweden

References

  1. 1.
    Ferlay J, Bray F, Pisani P, Parkin DM (2004) Cancer incidence, mortality and prevalence worldwide. In: Globocan 2002: version 2.0. IARC, LyonGoogle Scholar
  2. 2.
    Austin DF, Reynolds P (1996) Laryngeal cancer. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer epidemiology and prevention. Oxford University Press, New York, London, pp 619–636Google Scholar
  3. 3.
    Blot WJ, McLaughlin JK, Devessa SS, Fraumeni JF (1996) Cancers of the oral cavity and pharynx. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer epidemiology and prevention. Oxford University Press, New York, London, pp 666–680Google Scholar
  4. 4.
    Munoz N, Day NE (1996) Esophageal cancer. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer epidemiology and prevention. Oxford University Press, New York, Oxford, pp 681–706Google Scholar
  5. 5.
    IARC (2003) Fruit and vegetables. In: Handbooks of cancer prevention No.8. IARC, LyonGoogle Scholar
  6. 6.
    Boeing H (2002) Alcohol and risk of cancer of the upper gastrointestinal tract: first analysis of the EPIC data. IARC Sci Publ 156:151–154PubMedGoogle Scholar
  7. 7.
    Chyou PH, Nomura AM, Stemmermann GN (1995) Diet, alcohol, smoking and cancer of the upper aerodigestive tract: a prospective study among Hawaii Japanese men. Int J Cancer 60:616–621PubMedGoogle Scholar
  8. 8.
    Guo W, Blot WJ, Li JY et al (1994) A nested case–control study of esophageal and stomach cancers in the Linxian nutrition intervention trial. Int J Epidemiol 23:444–450PubMedGoogle Scholar
  9. 9.
    Kasum CM, Jacobs DR Jr, Nicodemus K, Folsom AR (2002) Dietary risk factors for upper aerodigestive tract cancers. Int J Cancer 99:267–272PubMedCrossRefGoogle Scholar
  10. 10.
    Kjaerheim K, Gaard M, Andersen A (1998) The role of alcohol, tobacco, and dietary factors in upper aerogastric tract cancers: a prospective study of 10,900 Norwegian men. Cancer Cause Control 9:99–108CrossRefGoogle Scholar
  11. 11.
    Sauvaget C, Nagano J, Allen N, Kodama K (2003) Vegetable and fruit intake and stroke mortality in the Hiroshima/Nagasaki Life Span Study. Stroke 34:2355–2360PubMedCrossRefGoogle Scholar
  12. 12.
    Riboli E, Hunt KJ, Slimani N et al (2002) European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5:1113–1124PubMedCrossRefGoogle Scholar
  13. 13.
    Riboli E, Kaaks R (1997) The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26:S6–S14PubMedCrossRefGoogle Scholar
  14. 14.
    Slimani N, Ferrari P, Ocke M, et al (2000) Standardization of the 24-hour diet recall calibration method used in the European prospective investigation into cancer and nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr 54:900–917PubMedCrossRefGoogle Scholar
  15. 15.
    Slimani N, Kaaks R, Ferrari P, et al (2002) European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics. Public Health Nutr 5:1125–1145PubMedCrossRefGoogle Scholar
  16. 16.
    Agudo A, Slimani N, Ocke MC, et al (2002) Consumption of vegetables, fruit and other plant foods in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts from 10 European countries. Public Health Nutr 5:1179–1196PubMedCrossRefGoogle Scholar
  17. 17.
    Klipstein-Grobusch K, Slimani N, Krogh V, et al (2002) Trends in self-reported past alcoholic beverage consumption and ethanol intake from 1950 to 1995 observed in eight European countries participating in the European Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5:1297–1310PubMedCrossRefGoogle Scholar
  18. 18.
    Department of Health RoHaSS (1991) Reference Values for Food Energy and Nutrients for the United Kingdom, vol 41. Department of Health, Report on Health and Social SubjectsGoogle Scholar
  19. 19.
    Kaaks R, Riboli E, van Staveren W (1995) Calibration of dietary-intake measurements in prospective cohort studies. Am J Epidemiol 142:548–556PubMedGoogle Scholar
  20. 20.
    Ferrari P, Slimani N, Ciampi A, et al (2002) Evaluation of under- and over-reporting of energy intake in the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC). Publ Health Nutr 5:1243–1258CrossRefGoogle Scholar
  21. 21.
    Ferrari P, Kaaks R, Fahey M (2004) Within and between cohort variation in measured macronutrient intakes in the EPIC study taking account of measurement errors. Am J Epidemiol 160:814–822PubMedCrossRefGoogle Scholar
  22. 22.
    van Gils CH, Peeters PH, Bueno-de-Mesquita HB, et al (2005) Consumption of vegetables and fruits and risk of breast cancer. JAMA 293:183–193PubMedCrossRefGoogle Scholar
  23. 23.
    Tuyns AJ, Riboli E, Doornbos G, Pequignot G (1987) Diet and esophageal cancer in Calvados (France). Nutr Cancer 9:81–92PubMedCrossRefGoogle Scholar
  24. 24.
    Hirayama T (1990) Life-style and mortality. A large-scale census-based cohort study in Japan. Institute of Preventive OncologyGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Heiner Boeing
    • 1
    Email author
  • Thomas Dietrich
    • 1
  • Kurt Hoffmann
    • 1
  • Tobias Pischon
    • 1
  • Pietro Ferrari
    • 2
  • Petra H. Lahmann
    • 1
  • Marie Christine Boutron-Ruault
    • 3
  • Francoise Clavel-Chapelon
    • 3
  • Naomi Allen
    • 4
  • Tim Key
    • 4
  • Guri Skeie
    • 5
  • Eiliv Lund
    • 5
  • Anja Olsen
    • 6
  • Anne Tjonneland
    • 6
  • Kim Overvad
    • 7
  • Majken K. Jensen
    • 7
  • Sabine Rohrmann
    • 8
  • Jakob Linseisen
    • 8
  • Antonia Trichopoulou
    • 9
  • Christina Bamia
    • 9
  • Theodora Psaltopoulou
    • 9
  • Lars Weinehall
    • 10
  • Ingegerd Johansson
    • 10
  • Maria-José Sánchez
    • 11
  • Paula Jakszyn
    • 12
  • Eva Ardanaz
    • 13
  • Pilar Amiano
    • 14
  • Maria Dolores Chirlaque
    • 15
  • J. Ramón Quirós
    • 16
  • Elisabet Wirfalt
    • 17
  • Göran Berglund
    • 17
  • Petra H. Peeters
    • 18
  • Carla H. van Gils
    • 18
  • H. Bas Bueno-de-Mesquita
    • 19
  • Frederike L. Büchner
    • 19
  • Franco Berrino
    • 20
  • Domenico Palli
    • 21
  • Carlotta Sacerdote
    • 22
  • Rosario Tumino
    • 23
  • Salvatore Panico
    • 24
  • Sheila Bingham
    • 25
  • Kay-Tee Khaw
    • 26
  • Nadia Slimani
    • 2
  • Teresa Norat
    • 2
  • Mazda Jenab
    • 2
  • Elio Riboli
    • 2
  1. 1.German Institute of Human Nutrition Potsdam-Rehbrücke NuthetalGermany
  2. 2.Nutrition and Hormones GroupInternational Agency for Research on CancerLyonFrance
  3. 3.Institute Gustave RoussyINSERM U521VillejuifFrance
  4. 4.Cancer Research UK Epidemiology UnitUniversity of OxfordOxfordUK
  5. 5.Institute of Community MedicineUniversity of TromsoTromsoNorway
  6. 6.Institute of Cancer EpidemiologyDanish Cancer SocietyCopenhagenDenmark
  7. 7.Department of Clinical Epidemiology, Aalborg Hospital and the Aarhus University Hospital, Department of Epidemiology and Social MedicineUniversity of AarhusAarhusDenmark
  8. 8.Division of Clinical EpidemiologyGerman Cancer Research CenterHeidelbergGermany
  9. 9.Department of Hygiene and Epidemiology, Medical SchoolUniversity of AthensAthensGreece
  10. 10.Department of Nutritional Research and The Department of Medical Biosciences, PathologyUniversity of UmeåUmeåSweden
  11. 11.Andalusian School of Public HealthGranadaSpain
  12. 12.Department of EpidemiologyCatalan Institute of OncologyBarcelonaSpain
  13. 13.Public Health Institute of NavarraPamplonaSpain
  14. 14.Health Department of Basque CountrySan SebastianSpain
  15. 15.Epidemiology DepartmentMurcia Health CouncilMurciaSpain
  16. 16.Council for Health and Social Affairs of AsturiasOviedoSpain
  17. 17.Malmö Diet and Cancer Study, Department of Clinical SciencesLund UniversityMalmöSweden
  18. 18.Julius Center for Health Sciences and Primary CareUniversity Medical CenterUtrechtThe Netherlands
  19. 19.Center for Nutrition and HealthNational Institute for Public Health and The EnvironmentBilthovenThe Netherlands
  20. 20.Epidemiology UnitIstituto TumoriMilanItaly
  21. 21.The Molecular and Nutritional Epidemiology Unit, CSPOScientific Institute of TuscanyFlorenceItaly
  22. 22.University of TorinoTorinoItaly
  23. 23.Cancer RegistryAzienda Ospedaliera “Civile M. P. Arezzo”RagusaItaly
  24. 24.Department of Clinical and Experimental MedicineFederico II UniversityNaplesItaly
  25. 25.Dunn Human Nutrition UnitCambridgeUK
  26. 26.The Clinical Gerontology UnitUniversity of CambridgeCambridgeUK

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