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Intake of vegetables and fruit and risk of esophageal adenocarcinoma: a meta-analysis of observational studies



To study the association between the intake of fruit and vegetables and risk of esophageal adenocarcinoma (EAC), we summarized the evidence from observational studies in categorical and linear dose–response meta-analyses.


Eligible studies published up to June 2013 were retrieved via computerized searches of MEDLINE and EMBASE. Random-effects models were used to calculate summary relative risks (SRRs) and the corresponding 95 % confidence intervals (CIs). Between-study heterogeneity was assessed using the Cochran’s Q and I 2 statistics.


A total of 12 studies involving 1,572 cases of EAC were included in this meta-analysis. Based on the highest versus lowest analysis, inverse associations were observed between intakes of vegetable (SRRs = 0.76, 95 % CIs 0.59–0.96; P heterogeneity = 0.098, I 2 40.4 %; n = 9 studies), intakes of fruit (SRRs = 0.73, 95 % CIs, 0.55–0.98; P heterogeneity = 0.03, I 2 = 52.9 %; n = 9 studies), and intakes of total vegetables and fruit combined (SRRs = 0.68, 95 % CI 0.49–0.93; P heterogeneity = 0.162, I 2 = 38.9 %; n = 5 studies). Similar results were also observed in a linear dose–response analysis.


These data support the hypothesis that intakes of vegetables and fruit may significantly reduce the risk of EAC. Further investigation with prospective designs, validated questionnaires, and good control of important confounders is warranted.

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Fig. 1
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Esophageal cancer


Esophageal squamous cell carcinoma


Esophageal adenocarcinoma


Body mass index


Food frequency questionnaire


Summary relative risk


Confidence interval


Gastroesophageal reflux disease


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This work was supported by the National Natural Scientific Foundation of China (No. 81201780)and Science and Technology Commission of Shanghai Municipality medical guide foundation Research Grant (No. 114119a9300).

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The authors disclose no conflicts of interests.

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Corresponding author

Correspondence to Tiejun Zhao.

Additional information

Bailing Li and Gengxi Jiang have contributed equally to this paper.

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Li, B., Jiang, G., Zhang, G. et al. Intake of vegetables and fruit and risk of esophageal adenocarcinoma: a meta-analysis of observational studies. Eur J Nutr 53, 1511–1521 (2014).

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  • Esophageal adenocarcinoma
  • Meta-analysis
  • Fruit
  • Vegetable