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.
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.
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.
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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Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.
IARC Handbooks of Cancer Prevention: Fruit and vegetables. Lyon, France: IARC Press, 2003.
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.
Nomura AM, Stemmermann GN, Chyou PH. Gastric cancer among the Japanese in Hawaii. Jpn J Cancer Res. 1995;86:916–23.
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.
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.
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.
Chyou PH, Nomura AM, Hankin JH, Stemmermann GN. A case-cohort study of diet and stomach cancer. Cancer Res. 1990;50:7501–4.
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.
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.
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.
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.
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.
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.
Engel LS, Chow WH, Vaughan TL, et al. Population attributable risks of esophageal and gastric cancers. J Natl Cancer Inst. 2003;l95:1404–13.
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.
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.
Fritz AG. International classification of diseases for oncology: ICD-O. 3rd ed. Geneva: World Health Organization, 2000.
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.
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.
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.
U.S. Department of Agriculture. The food guide pyramid. Home and Garden Bulletin No. 252. Washington, DC: GPO, 1992.
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.
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.
Cox DR. Regression models and life-tables. J R Stat Soc Ser B-Stat Meth. 1972;34:187.
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.
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.
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.
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.
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.
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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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