Table 1 Study characteristics and effect estimates from cohort studies on the association between sustainable diets and cancer incidence

González et al., 2020 [8]

EPIC-Spain, Spain

62.3% women,

49.3 years

40,621

Cancer incidence

4457

HR for total cancer:

1.031 (95% CI: 0.998–1.065) for 1-unit increase in GHG emissions

Sex; stratified by Spanish center and age at recruitment

Laine et al., 2021 [13]

EPIC,

9 European countries

71% women,

52 years

443,991

Cancer incidence

58,925

HR per quartiles of GHGs emissions

_{Q4 vs. Q1}: 1.11 (95% CI: 1.09–1.14)

HR per land use contributions

_{Q4 vs. Q1}: 1.13 (95% CI: 1.10–1.15)

In site-specific analyses, there was a positive association between GHGs emissions and cancers of the bladder, renal pelvis, ureter, and other urinary organs, breast, colorectum, esophagus, kidney, larynx, lung, skin melanoma, stomach, and thyroid. There was also a positive association between land use and cancers of the brain and CNS, bladder, renal pelvis, ureter and other urinary organs, breast, colorectum, esophagus, kidney, larynx, liver, lung, myeloma, pancreas, prostate, skin melanoma, stomach, and thyroid

Age at recruitment, marital status, education, physical activity, smoking status, BMI

Sandoval-Insausti et al., 2021 [14]

Nurses’ Health Study, Nurses’ Health Study II and Health Professionals Follow-up Study, USA

Sex and mean age not given

Not given

Cancer incidence

23,678

HRs of total cancer associated with a 1 serving/day increase in intake:

1.01 (95% CI: 0.99–1.02) for low-pesticide-residue FVs

0.99 (95% CI: 0.97–1.01) for high pesticide residue fruits and vegetables

High-pesticide-residue fruit and vegetable intake

HR_{Q5 vs.Q1}: 1.00 (95% CI: 0.95–1.05), p-trend 0.77

Low-pesticide-residue fruit and vegetable intake

HR_Q5vs.Q1: 0.99 (95% CI: 0.95–1.04), p-trend 0.74

In site-specific analyses, no association between intake of high-pesticide-residue FVs or low-pesticide-residue FV and risk of any sites was seen

Age, height, BMI, ethnicity, physical activity, family history of cancer, physical examination in the past 2 years, history of colonoscopy or sigmoidoscopy, mammography in the past 2 years, prostate-specific antigen testing in the past 2 years, number of pack-years among ever smokers, postmenopausal hormone use, current multivitamin use, regular aspirin use, total energy intake, alcohol intake, and Alternate Healthy Eating Index score excluding criteria for intake of fruits and vegetables and alcohol. Additionally adjusted for intakes fruits and vegetables with undetermined residues and low-pesticide-residue fruits and vegetables, or high-pesticide-residue fruits and vegetables, respectively

Rebouillat et al., 2021 [15]

NutriNet-Santé, France

100% women,

60.5 years

13,149

Cancer incidence

169

NMF component 1 HR_{Q5 vs. Q1}:

1.77 (95% CI: 1.07–2.91), p-trend: 0.08;

NMF Component 2 HR_{Q5 vs. Q1}:

0.99 (95% CI: 0.61–1.62), p-trend: 0.37;

NMF component 3 HR_{Q5 vs. Q1}:

0.59 (95% CI: 0.36–0.98), p-trend: 0.01;

NMF component 4 HR_{Q5 vs. Q1}:

0.66 (95% CI: 0.39–1.12), p-trend: 0.13;

There was a significant negative association between NMF Component 3 (low synthetic-pesticide-exposure profile) and postmenopausal breast cancer risk

Stratified analysis among women with BMI > 25 kg/m² found a positive association between NMF component 1 and postmenopausal breast cancer risk: HR_{Q5 vs. Q1}: 4.13 (95% CI: 1.50–11.44), p-trend: 0.006)

Age, smoking practices, educational level, physical activity, alcohol intake, alcohol-free energy intake, BMI, height, family history of cancer, menopausal treatment and parity, a score for overall quality of the diet based on the level of adherence to 2017 French dietary guidelines, a provegetarian score, the percentage of ultra-processed foods in the diets, or residing in an agricultural area

Seconda et al., 2020 [18]

NutriNet-Santé, France

Sex distribution by quartiles of Sustainable Diet Index (SDI): Q1: 76.2%, Q2: 74.5%, Q3: 78.6% and Q4: 74.5% female, respectively. Mean age not given

25,589

Cancer incidence

483 (138 breast, 78 prostate, 46 colorectal, 45 skin, 22 lung and 154 other cancers)

All cancers:

HR SDI _{Q4 vs. Q1}:

0.56 (95% CI: 0.41–0.77), p-trend: 0.0002

Inverse associations were also reported for breast, and smoking-related cancer (model without adjustment for BMI)

Age, sex, scholar graduation, smoking status, income by household units, occupational status, alcohol status, family history of cancer, physical activity, energy consumption, height, BMI and (for women) parity, postmenopausal status, use of hormonal treatment for menopause, and use of oral contraception

Baudry et al., 2018 [16]

Nutrinet-Santé, France

78.0% women, 44.2 years

68,946

Cancer incidence

1340 (459 breast, 180 prostate, 135 skin, 99 colorectal, 47 non-Hodgkin lymphomas, and 15 other lymphomas)

All cancers

HR OFS _{Q4 vs. Q1}:

0.76 (95% CI: 0.64–0.90), p-trend: 0.003

HR per 5-point increase (model 3):

0.93 (95% CI: 0.89–0.97)

In site-specific analyses, a higher OFS was associated with a reduced risk of postmenopausal breast cancer, non-Hodgkin lymphoma, and all lymphomas. No statistically significant association was observed for overall breast, premenopausal breast, prostate, colorectal, and skin cancer

Age, sex, month of inclusion, occupational status, educational level, marital status, monthly income per household unit, physical activity, smoking status, alcohol intake, family history of cancer, BMI, height, energy intake, a score for overall quality of the diet reflecting adherence to the official French nutritional guidelines, fiber intake, processed meat intake and red meat intake, ultraprocessed food consumption, fruit and vegetable consumption, and dietary patterns extracted by principal component analysis and (for women) parity, postmenopausal status, use of hormonal treatment for menopause, and use of oral contraception

Bradbury et al., 2014 [17]

Million Women Study, UK

100% women

623,080

Cancer incidence

53,769

RR “Sometimes OF” vs. “Never OF”: 1.03 (95% group-specific CI: 1.01–1.04)

RR “Usually/always OF” vs. “Never OF”: 1.03 (95% group-specific CI: 1.00–1.06)

In site-specific analyses, more frequent consumption of was associated with higher risk for breast cancer, and lower risk for non-Hodgkin lymphoma

Age, region, deprivation, smoking, BMI, physical activity, alcohol intake, height, parity and age at first birth, fiber intake, type of meat eaten