Abstract
Background
Citrus fruit has shown a favorable effect against various cancers. To better understand their role in cancer risk, we analyzed data from a series of case–control studies conducted in Italy and Switzerland.
Patients and methods
The studies included 955 patients with oral and pharyngeal cancer, 395 with esophageal, 999 with stomach, 3,634 with large bowel, 527 with laryngeal, 2,900 with breast, 454 with endometrial, 1,031 with ovarian, 1,294 with prostate, and 767 with renal cell cancer. All cancers were incident and histologically confirmed. Controls were admitted to the same network of hospitals for acute, nonneoplastic conditions. Odds ratios (OR) were estimated by multiple logistic regression models, including terms for major identified confounding factors for each cancer site, and energy intake.
Results
The ORs for the highest versus lowest category of citrus fruit consumption were 0.47 (95% confidence interval, CI, 0.36–0.61) for oral and pharyngeal, 0.42 (95% CI, 0.25–0.70) for esophageal, 0.69 (95% CI, 0.52–0.92) for stomach, 0.82 (95% CI, 0.72–0.93) for colorectal, and 0.55 (95% CI, 0.37–0.83) for laryngeal cancer. No consistent association was found with breast, endometrial, ovarian, prostate, and renal cell cancer.
Conclusions
Our findings indicate that citrus fruit has a protective role against cancers of the digestive and upper respiratory tract.
Similar content being viewed by others
References
World Cancer Research Fund and American Institute for Cancer Research (1997) Food, Nutrition and the prevention of cancer: a global perspective. American Institute for Cancer Research, Washington, DC
La Vecchia C, Tavani A (1998) Fruit and vegetables, and human cancer. Eur J Cancer Prev 7:3–8
Hung HC, Joshipura KJ, Jiang R et al (2004) Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst 96:1577–1584
Riboli E, Norat T (2003) Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk. Am J Clin Nutr 78:559S–569S
Vastag B (2005) Recent studies show limited association of fruit and vegetable consumption and cancer risk. J Natl Cancer Inst 97:474–476
World Cancer Research Fund and American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. American Institute for Cancer Research, Washington, DC
Benavente-Garcia O, Castillo J, Alcaraz M, Vicente V, Del Rio JA, Ortuno A (2007) Beneficial action of citrus flavonoids on multiple cancer-related biological pathways. Curr Cancer Drug Targets 7:795–809
Franke AA, Cooney RV, Custer LJ, Mordan LJ, Tanaka Y (1998) Inhibition of neoplastic transformation and bioavailability of dietary flavonoid agents. Adv Exp Med Biol 439:237–248
Frei B, Lawson S (2008) Vitamin C and cancer revisited. Proc Natl Acad Sci USA 105:11037–11038
Nijveldt RJ, van Nood E, van Hoorn DE, Boelens PG, van Norren K, van Leeuwen PA (2001) Flavonoids: a review of probable mechanisms of action and potential applications. Am J Clin Nutr 74:418–425
Odin AP (1997) Vitamins as antimutagens: advantages and some possible mechanisms of antimutagenic action. Mutat Res 386:39–67
Onogi N, Okuno M, Matsushima-Nishiwaki R et al (1998) Antiproliferative effect of carotenoids on human colon cancer cells without conversion to retinoic acid. Nutr Cancer 32:20–24
Padayatty SJ, Katz A, Wang Y et al (2003) Vitamin C as an antioxidant: evaluation of its role in disease prevention. J Am Coll Nutr 22:18–35
Rauscher R, Edenharder R, Platt KL (1998) In vitro antimutagenic and in vivo anticlastogenic effects of carotenoids and solvent extracts from fruits and vegetables rich in carotenoids. Mutat Res 413:129–142
Steinmetz KA, Potter JD (1991) Vegetables, fruit, and cancer. II. Mechanisms. Cancer Causes Control 2:427–442
Thomasset SC, Berry DP, Garcea G, Marczylo T, Steward WP, Gescher AJ (2007) Dietary polyphenolic phytochemicals—promising cancer chemopreventive agents in humans? A review of their clinical properties. Int J Cancer 120:451–458
Pavia M, Pileggi C, Nobile CG, Angelillo IF (2006) Association between fruit and vegetable consumption and oral cancer: a meta-analysis of observational studies. Am J Clin Nutr 83:1126–1134
Bae JM, Lee EJ, Guyatt G (2008) Citrus fruit intake and stomach cancer risk: a quantitative systematic review. Gastric Cancer 11:23–32
Bae JM, Lee EJ, Guyatt G (2009) Citrus fruit intake and pancreatic cancer risk: a quantitative systematic review. Pancreas 38:168–174
Bae JM, Lee EJ, Guyatt G (2008) Citrus fruits intake and prostate cancer risk: a quantitative systematic review. J Prev Med Public Health 41:159–164
Bravi F, Bosetti C, Scotti L et al (2007) Food groups and renal cell carcinoma: a case–control study from Italy. Int J Cancer 120:681–685
Bosetti C, La Vecchia C, Talamini R et al (2000) Food groups and risk of squamous cell esophageal cancer in northern Italy. Int J Cancer 87:289–294
Levi F, Pasche C, Lucchini F, Chatenoud L, Jacobs DR Jr, La Vecchia C (2000) Refined and whole grain cereals and the risk of oral, oesophageal and laryngeal cancer. Eur J Clin Nutr 54:487–489
Lucenteforte E, Scita V, Bosetti C, Bertuccio P, Negri E, La Vecchia C (2008) Food groups and alcoholic beverages and the risk of stomach cancer: a case–control study in Italy. Nutr Cancer 60:577–584
Franceschi S, Favero A, La Vecchia C et al (1997) Food groups and risk of colorectal cancer in Italy. Int J Cancer 72:56–61
Franceschi S, Parpinel M, La Vecchia C, Favero A, Talamini R, Negri E (1998) Role of different types of vegetables and fruit in the prevention of cancer of the colon, rectum, and breast. Epidemiology 9:338–341
Bosetti C, La Vecchia C, Talamini R et al (2002) Food groups and laryngeal cancer risk: a case–control study from Italy and Switzerland. Int J Cancer 100:355–360
Franceschi S, Favero A, La Vecchia C et al (1995) Influence of food groups and food diversity on breast cancer risk in Italy. Int J Cancer 63:785–789
Levi F, Pasche C, Lucchini F, La Vecchia C (2001) Dietary intake of selected micronutrients and breast cancer risk. Int J Cancer 91:260–263
Lucenteforte E, Talamini R, Montella M et al (2008) Macronutrients, fatty acids and cholesterol intake and endometrial cancer. Ann Oncol 19:168–172
Bosetti C, Negri E, Franceschi S et al (2001) Diet and ovarian cancer risk: a case–control study in Italy. Int J Cancer 93:911–915
Bosetti C, Micelotta S, Dal Maso L et al (2004) Food groups and risk of prostate cancer in Italy. Int J Cancer 110:424–428
Franceschi S, Favero A, Conti E et al (1999) Food groups, oils and butter, and cancer of the oral cavity and pharynx. Br J Cancer 80:614–620
Ferraroni M, La Vecchia C, D’Avanzo B, Negri E, Franceschi S, Decarli A (1994) Selected micronutrient intake and the risk of colorectal cancer. Br J Cancer 70:1150–1155
La Vecchia C, D’Avanzo B, Negri E, Decarli A, Benichou J (1995) Attributable risks for stomach cancer in northern Italy. Int J Cancer 60:748–752
Decarli A, Franceschi S, Ferraroni M et al (1996) Validation of a food-frequency questionnaire to assess dietary intakes in cancer studies in Italy. Results for specific nutrients. Ann Epidemiol 6:110–118
Franceschi S, Negri E, Salvini S et al (1993) Reproducibility of an Italian food frequency questionnaire for cancer studies: results for specific food items. Eur J Cancer 29A:2298–2305
Breslow NE, Day NE (1980) Statistical methods in cancer research. Volume I—The analysis of case–control studies. IARC Sci Publ 32:5–338
Lagiou P, Samoli E, Lagiou A et al (2004) Flavonoids, vitamin C and adenocarcinoma of the stomach. Cancer Causes Control 15:67–72
Fountoulakis A, Martin IG, White KL et al (2004) Plasma and esophageal mucosal levels of vitamin C: role in the pathogenesis and neoplastic progression of Barrett’s esophagus. Dig Dis Sci 49:914–919
De Stefani E, Ronco A, Mendilaharsu M, Deneo-Pellegrini H (1999) Diet and risk of cancer of the upper aerodigestive tract. II. Nutrients. Oral Oncol 35:22–26
Rossi M, Garavello W, Talamini R et al (2007) Flavonoids and risk of squamous cell esophageal cancer. Int J Cancer 120:1560–1564
Neuhouser ML (2004) Dietary flavonoids and cancer risk: evidence from human population studies. Nutr Cancer 50:1–7
Hoensch HP, Kirch W (2005) Potential role of flavonoids in the prevention of intestinal neoplasia: a review of their mode of action and their clinical perspectives. Int J Gastrointest Cancer 35:187–195
La Vecchia C, Chatenoud L, Franceschi S, Soler M, Parazzini F, Negri E (1999) Vegetables and fruit and human cancer: update of an Italian study. Int J Cancer 82:151–152
D’Avanzo B, La Vecchia C, Katsouyanni K, Negri E, Trichopoulos D (1997) An assessment, and reproducibility of food frequency data provided by hospital controls. Eur J Cancer Prev 6:288–293
Acknowledgments
The authors thank Mrs. M. P. Bonifacino for editorial assistance, and Mrs. O. Volpato for study coordination (Unit of Epidemiology and Biostatistic). We are also deeply grateful to Drs. G. Chiara (I General Surgery Department), G. Tosolini (II General Surgery Department) for helping in case enrollment at the General Hospital, Pordenone, as well as to Drs. L. Forner (Eye Diseases Department), A. Mele (Hand Surgery and Microsurgery Department, and E. Trevisanutto (Dermatology Department) for providing control patients at the General Hospital, Pordenone. This study was conducted with the contribution of the Italian Association for Cancer Research and the Italian League against Cancer.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Foschi, R., Pelucchi, C., Dal Maso, L. et al. Citrus fruit and cancer risk in a network of case–control studies. Cancer Causes Control 21, 237–242 (2010). https://doi.org/10.1007/s10552-009-9454-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-009-9454-4