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Fruit and vegetable intake and gastric cancer risk in a large United States prospective cohort study

Abstract

Objective

Fruit and vegetable intake may protect against gastric cancer incidence. Results from case–control studies have indicated an inverse association, but results from cohort studies are inconsistent.

Methods

We prospectively investigated the association in 490,802 participants of the NIH-AARP Diet and Health Study using Cox proportional hazards models adjusted for gastric cancer risk factors. We present hazard ratios (HR) and 95% confidence intervals (CI) per increase of one daily serving per 1,000 calories.

Results

During 2,193,751 person years, 394 participants were diagnosed with incident gastric cancer. We observed no significant associations between total fruit and vegetable intake (1.01, 0.95–1.08), fruit intake (1.04, 0.95–1.14), or vegetable intake (0.98, 0.88–1.08) and gastric cancer risk. Results did not vary by sex or anatomic subsite (cardia versus non-cardia). All 13 botanical subgroups examined had no significant associations with either anatomic sub-site.

Conclusion

We did not observe significant associations between overall fruit and vegetable intake and gastric cancer risk in this large prospective cohort study.

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References

  1. 1.

    Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.

    PubMed  Article  Google Scholar 

  2. 2.

    IARC Handbooks of Cancer Prevention: Fruit and vegetables. Lyon, France: IARC Press, 2003.

    Google Scholar 

  3. 3.

    Galanis DJ, Kolonel LN, Lee J, Nomura A. Intakes of selected foods and beverages and the incidence of gastric cancer among the Japanese residents of Hawaii: a prospective study. Int J Epidemiol. 1998;27:173–80.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Nomura AM, Stemmermann GN, Chyou PH. Gastric cancer among the Japanese in Hawaii. Jpn J Cancer Res. 1995;86:916–23.

    PubMed  CAS  Google Scholar 

  5. 5.

    Nouraie M, Pietinen P, Kamangar F, et al. Fruits, vegetables, and antioxidants and risk of gastric cancer among male smokers. Cancer Epidemiol Biomarkers Prev. 2005;14:2087–92.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Sauvaget C, Nagano J, Hayashi M, et al. Vegetables and fruit intake and cancer mortality in the Hiroshima/Nagasaki Life Span Study. Br J Cancer.2003;88:689–94.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Tran GD, Sun XD, Abnet CC, et al. Prospective study of risk factors for esophageal and gastric cancers in the Linxian general population trial cohort in China. Int J Cancer 2005;113:456–63.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Chyou PH, Nomura AM, Hankin JH, Stemmermann GN. A case-cohort study of diet and stomach cancer. Cancer Res. 1990;50:7501–4.

    PubMed  CAS  Google Scholar 

  9. 9.

    Larsson SC, Bergkvist L, Wolk A. Fruit and vegetable consumption and incidence of gastric cancer: a prospective study. Cancer Epidemiol Biomarkers Prev 2006;15:1998–01.

    PubMed  Article  Google Scholar 

  10. 10.

    Gonzalez CA, Pera G, Agudo A, et al. Fruit and vegetable intake and the risk of stomach and oesophagus adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST). Int J Cancer. 2006;118:2559–66.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Lunet N, Lacerda-Vieira A, Barros H. Fruit and vegetables consumption and gastric cancer: a systematic review and meta-analysis of cohort studies. Nutr Cancer. 2005;53:1–10.

    PubMed  Article  Google Scholar 

  12. 12.

    Riboli E, Norat T. Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk. Am J Clin Nutr. 2003;78:559S–69S.

    PubMed  CAS  Google Scholar 

  13. 13.

    Devesa SS, Blot WJ, Fraumeni JF, Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 1998;83:2049–53.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Corley DA, Kubo A. Influence of site classification on cancer incidence rates: an analysis of gastric cardia carcinomas. J Natl Cancer Inst. 2004;96:1383–7.

    PubMed  Google Scholar 

  15. 15.

    Engel LS, Chow WH, Vaughan TL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst. 2003;l95:1404–13.

    Google Scholar 

  16. 16.

    Kamangar F, Dawsey SM, Blaser MJ, et al. Opposing risks of gastric cardia and noncardia gastric adenocarcinomas associated with Helicobacter pylori seropositivity. J Natl Cancer Inst. 2006;98:1445–52.

    PubMed  Google Scholar 

  17. 17.

    Schatzkin A, Subar AF, Thompson FE, et al. Design and serendipity in establishing a large cohort with wide dietary intake distributions : the National Institutes of Health-American Association of Retired Persons Diet and Health Study. Am J Epidemiol. 2001;154:1119–25.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Fritz AG. International classification of diseases for oncology: ICD-O. 3rd ed. Geneva: World Health Organization, 2000.

  19. 19.

    Freedman ND, Abnet CC, Leitzmann MF, et al. A prospective study of tobacco, alcohol, and the risk of esophageal and gastric cancer subtypes. Am J Epidemiol. 2007;165:1424–33.

    PubMed  Article  Google Scholar 

  20. 20.

    Michaud DS, Midthune D, Hermansen S, et al. Comparison of cancer registry case ascertainment with SEER estimates and self-reporting in a subset of the NIH-AARP Diet and Health Study. J Registry Manag. 2005;32:70–5.

    Google Scholar 

  21. 21.

    Park Y, Subar AF, Kipnis V, et al. Fruit and vegetable intakes and risk of colorectal cancer in the NIH-AARP diet and health study. Am J Epidemiol. 2007;166:170–80.

    PubMed  Article  Google Scholar 

  22. 22.

    U.S. Department of Agriculture. The food guide pyramid. Home and Garden Bulletin No. 252. Washington, DC: GPO, 1992.

  23. 23.

    Thompson FE, Kipnis V, Midthune D, et al. Performance of a food-frequency questionnaire in the US NIH-AARP (National Institutes of Health-American Association of Retired Persons) Diet and Health Study. Public Health Nutr1-13, 2007.

  24. 24.

    Smith SA, Campbell DR, Elmer PJ, et al. The University of Minnesota Cancer Prevention Research Unit vegetable and fruit classification scheme (United States). Cancer Causes Control. 1995;6:292–302.

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Cox DR. Regression models and life-tables. J R Stat Soc Ser B-Stat Meth. 1972;34:187.

    Google Scholar 

  26. 26.

    Lunet N, Valbuena C, Vieira AL, et al. Fruit and vegetable consumption and gastric cancer by location and histological type: case–control and meta-analysis. Eur J Cancer Prev. 2007;16:312–27.

    PubMed  Article  Google Scholar 

  27. 27.

    Kobayashi M, Tsubono Y, Sasazuki S, Sasaki S, Tsugane S. Vegetables, fruit and risk of gastric cancer in Japan: a 10-year follow-up of the JPHC Study Cohort I. Int J Cancer. 2002;102:39–44.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Lee SA, Kang D, Shim KN, et al. Effect of diet and Helicobacter pylori infection to the risk of early gastric cancer. J Epidemiol. 2003;13:162–8.

    PubMed  Google Scholar 

  29. 29.

    Machida-Montani A, Sasazuki S, Inoue M, et al. Association of Helicobacter pylori infection and environmental factors in non-cardia gastric cancer in Japan. Gastric Cancer. 2004;7:46–53.

    PubMed  Article  Google Scholar 

  30. 30.

    Schatzkin A, Kipnis V. Could exposure assessment problems give us wrong answers to nutrition and cancer questions? J Natl Cancer Inst. 2004;96:1564–5.

    PubMed  Article  Google Scholar 

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Acknowledgments

Cancer incidence data from the Atlanta metropolitan area were collected by the Georgia Center for Cancer Statistics, Department of Epidemiology, Rollins School of Public Health, Emory University. Cancer incidence data from California were collected by the California Department of Health Services, Cancer Surveillance Section. Cancer incidence data from the Detroit metropolitan area were collected by the Michigan Cancer Surveillance Program, Community Health Administration, State of Michigan. The Florida cancer incidence data used in this report were collected by the Florida Cancer Data System under contract to the Department of Health (DOH). The views expressed herein are solely those of the authors and do not necessarily reflect those of the contractor or DOH. Cancer incidence data from Louisiana were collected by the Louisiana Tumor Registry, Louisiana State University Medical Center in New Orleans. Cancer incidence data from New Jersey were collected by the New Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey State Department of Health and Senior Services. Cancer incidence data from North Carolina were collected by the North Carolina Central Cancer Registry. Cancer incidence data from Pennsylvania were supplied by the Division of Health Statistics and Research, Pennsylvania Department of Health, Harrisburg, Pennsylvania. The Pennsylvania Department of Health specifically disclaims responsibility for any analyses, interpretations or conclusions. We are indebted to the participants in the NIH-AARP Diet and Health Study for their outstanding cooperation. This research was supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health.

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Correspondence to Neal D. Freedman.

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Freedman, N.D., Subar, A.F., Hollenbeck, A.R. et al. Fruit and vegetable intake and gastric cancer risk in a large United States prospective cohort study. Cancer Causes Control 19, 459–467 (2008). https://doi.org/10.1007/s10552-007-9107-4

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Keywords

  • Gastric cancer
  • Fruits
  • Vegetables
  • Cohort