Fruits and Vegetables: Updating the Epidemiologic Evidence for the WCRF/AICR Lifestyle Recommendations for Cancer Prevention

  • Teresa Norat
  • Dagfinn Aune
  • Doris Chan
  • Dora Romaguera
Conference paper
Part of the Cancer Treatment and Research book series (CTAR, volume 159)

Abstract

The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) current dietary recommendations for cancer prevention include “eating at least five portions/servings of a variety of non-starchy vegetables and or fruits every day”. The most recent report coordinated by WCRF/AICR (2007) concluded that the evidence of a protective effect of fruits and vegetables on cancer was either “probable”—mouth, pharynx and larynx, oesophagus stomach, lung- or “limited suggestive”—nasopharynx, lung, colorectum, ovary, endometrium, pancreas, liver-. In a previous report published by WCRF/AICR in 1997, the evidence of the association of fruits and vegetables with cancer risk was considered convincing. This judgement was based mainly on the results of case-control studies. The association of fruit and vegetable intake and the risk of colorectal, breast and pancreatic cancer was re-examined in the Continuous Update Project (CUP) and the results were quantitatively summarised in meta-analyses. The CUP, with more data available, has confirmed the conclusion of the WCRF/AICR second expert report that there is no convincing evidence that fruits and vegetables play a role on cancer aetiology. On the other hand, evidence that is more consistent has been collected in the CUP about the role of dietary fibre and colorectal cancer. The evidence on the role of dietary fibre in colorectal cancer aetiology has been recently upgraded by the CUP expert panel from probable to convincing.

Keywords

Lifestyle recommendation Cancer prevention Cancer risk 

Abbreviations

WCRF/AICR

World Cancer Research Fund/American Institute for Cancer Research

CUP

Continuous Update Project

SLR

Systematic Literature Review

RR

Relative Risk

EPIC

European Investigation into Cancer and Nutrition

References

  1. 1.
    Aune D, Chan DS, Greenwood DC, Vieira AR, Rosenblatt DA, Vieira R, Norat T (2012) Dietary fiber and breast cancer risk: a systematic review and meta-analysis of prospective studies. Ann Oncol 23:1394–1402PubMedCrossRefGoogle Scholar
  2. 2.
    Aune D, Chan DS, Lau R, Vieira R, Greenwood DC, Kampman E, Norat T (2011) Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ 343:d6617. doi:10.1136/bmj.d6617.D6617 PubMedCrossRefGoogle Scholar
  3. 3.
    Aune D, Chan DS Vieira, AR, Navarro-Rosenblatt DA, Vieira R, Greenwood D, Norat T (2012) Dietary compared with blood concentrations of carotenoids and breast cancer risk: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr 96:356Google Scholar
  4. 4.
    Aune D, Chan DS Vieira AR, Rosenblatt DA Vieira R, Greenwood DC, Norat T (2012) Fruits vegetables and breast cancer risk: a systematic review and meta-analysis of prospective studies. Breast Cancer Res Treat 134:479Google Scholar
  5. 5.
    Aune D, Lau R, Chan DS, Vieira R, Greenwood DC, Kampman E, Norat T (2011) Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies. Gastroenterology 141:106–118PubMedCrossRefGoogle Scholar
  6. 6.
    Bagnardi V, Zambon A, Quatto P, Corrao G (2004) Flexible meta-regression functions for modeling aggregate dose-response data, with an application to alcohol and mortality. Am J Epidemiol 159:1077–1086PubMedCrossRefGoogle Scholar
  7. 7.
    Bandera EV, Kushi LH, Moore DF, Gifkins DM, McCullough M (2007) Fruits and vegetables and endometrial cancer risk: a systematic literature review and meta-analysis. Nutr Cancer 58:6–21PubMedCrossRefGoogle Scholar
  8. 8.
    Bekkering GE, Harris RJ, Thomas S, Mayer AM, Beynon R, Ness AR, Harbord RM, Bain C, Smith GD, Sterne JA (2008) How much of the data published in observational studies of the association between diet and prostate or bladder cancer is usable for meta-analysis? Am J Epidemiol 167:1017–1026PubMedCrossRefGoogle Scholar
  9. 9.
    Bingham S, Luben R, Welch A, Low YL, Khaw KT, Wareham N, Day N (2008) Associations between dietary methods and biomarkers, and between fruits and vegetables and risk of ischaemic heart disease, in the EPIC Norfolk Cohort Study. Int J Epidemiol 37:978–987PubMedCrossRefGoogle Scholar
  10. 10.
    Bingham S, Riboli E (2004) Diet and cancer—the European prospective investigation into cancer and nutrition. Nat Rev Cancer 4:206–215PubMedCrossRefGoogle Scholar
  11. 11.
    Chan DS, Lau R, Aune D, Vieira R, Greenwood DC, Kampman E, Norat T (2011) Red and processed meat and colorectal cancer incidence: meta-analysis of prospective studies. PLoS ONE 6:e20456PubMedCrossRefGoogle Scholar
  12. 12.
    Day NE, Wong MY, Bingham S, Khaw KT, Luben R, Michels KB, Welch A, Wareham NJ (2004) Correlated measurement error–implications for nutritional epidemiology. Int J Epidemiol 33:1373–1381PubMedCrossRefGoogle Scholar
  13. 13.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRefGoogle Scholar
  14. 14.
    Greenland S, Longnecker MP (1992) Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol 135:1301–1309PubMedGoogle Scholar
  15. 15.
    Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DJ, Cook RJ (1995) Users’ guides to the medical literature. IX. A method for grading health care recommendations. Evidence-based medicine working group. JAMA 274:1800–1804PubMedCrossRefGoogle Scholar
  16. 16.
    Harding AH, Wareham NJ, Bingham SA, Khaw K, Luben R, Welch A, Forouhi NG (2008) Plasma vitamin C level, fruit and vegetable consumption, and the risk of new-onset type 2 diabetes mellitus: the European prospective investigation of cancer–Norfolk prospective study. Arch Intern Med 168:1493–1499PubMedCrossRefGoogle Scholar
  17. 17.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRefGoogle Scholar
  18. 18.
    Jenab M, Riboli E, Ferrari P, Friesen M, Sabate J, Norat T, Slimani N, Tjonneland A, Olsen A, Overvad K, Boutron-Ruault MC, Clavel-Chapelon F, Boeing H, Schulz M, Linseisen J, Nagel G, Trichopoulou A, Naska A, Oikonomou E, Berrino F, Panico S, Palli D, Sacerdote C, Tumino R, Peeters PH, Numans ME, Bueno-de-Mesquita HB, Buchner FL, Lund E, Pera G, Chirlaque MD, Sanchez MJ, Arriola L, Barricarte A, Quiros JR, Johansson I, Johansson A, Berglund G, Bingham S, Khaw KT, Allen N, Key T, Carneiro F, Save V Del G.G, Plebani M, Kaaks R, Gonzalez CA (2006). Plasma and dietary carotenoid, retinol and tocopherol levels and the risk of gastric adenocarcinomas in the European prospective investigation into cancer and nutrition. Br J Cancer 95:406–415Google Scholar
  19. 19.
    Jenab M, Slimani N, Bictash M, Ferrari P, Bingham SA (2009) Biomarkers in nutritional epidemiology: applications, needs and new horizons. Hum Genet 125:507–525PubMedCrossRefGoogle Scholar
  20. 20.
    Riboli E, Norat T (2003) Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk. Am J Clin Nutr 78:559S–569SPubMedGoogle Scholar
  21. 21.
    Romaguera D, Vergnaud AC, Peeters PH, Van Gils CH, Chan DS, Ferrari P, Romieu I, Jenab M, Slimani N, Clavel-Chapelon F, Fagherazzi G, Perquier F, Kaaks R, Teucher B, Boeing H, Von RA, Tjonneland A, Olsen A, Dahm CC, Overvad K, Quiros JR, Gonzalez CA, Sanchez MJ, Navarro C, Barricarte A, Dorronsoro M, Khaw KT, Wareham NJ, Crowe FL, Key TJ, Trichopoulou A, Lagiou P, Bamia C, Masala G, Vineis P, Tumino R, Sieri S, Panico S, May AM, Bueno-de-Mesquita HB, Buchner FL, Wirfalt E, Manjer J, Johansson I, Hallmans G, Skeie G, Benjaminsen BK, Parr CL, Riboli E, Norat T (2012) Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am J Clin Nutr 96:150–163PubMedCrossRefGoogle Scholar
  22. 22.
    Thompson R, Bandera E, Burley V, Cade J, Forman D, Freudenheim J, Greenwood D, Jacobs D, Kalliecharan R, Kushi L, McCullough M, Miles L, Moore D, Moreton J, Rastogi T, Wiseman M (2008) Reproducibility of systematic literature reviews on food, nutrition, physical activity and endometrial cancer. Public Health Nutr 11:1006–1014PubMedGoogle Scholar
  23. 23.
    Wiseman M (2008) The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Proc Nutr Soc 67:253–256PubMedCrossRefGoogle Scholar
  24. 24.
    World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity and the prevention of cancer: a global perspective. AICR, Washington DCGoogle Scholar
  25. 25.
    World Cancer Research Fund/American Institute for Cancer Research (2009) Policy and action for cancer prevention food, nutrition and physical activity: a global perspective. AICR, Washington DCGoogle Scholar
  26. 26.
    Zhang X, Spiegelman D, Baglietto L, Bernstein L, Boggs DA, Van den Brandt PA, Buring JE, Gapstur SM, Giles GG, Giovannucci E, Goodman G, Hankinson SE, Helzlsouer KJ, Horn-Ross PL, Inoue M, Jung S, Khudyakov P, Larsson SC, Lof M, McCullough ML, Miller AB, Neuhouser ML, Palmer JR, Park Y, Robien K, Rohan TE, Ross JA, Schouten LJ, Shikany JM, Tsugane S, Visvanathan K, Weiderpass E, Wolk A, Willett WC, Zhang SM, Ziegler RG, Smith-Warner SA (2012) Carotenoid intakes and risk of breast cancer defined by estrogen receptor and progesterone receptor status: a pooled analysis of 18 prospective cohort studies. Am J Clin Nutr 95:713–725PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Teresa Norat
    • 1
  • Dagfinn Aune
    • 1
  • Doris Chan
    • 1
  • Dora Romaguera
    • 1
  1. 1.Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonPaddingtonLondon

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