Intake of fruits and vegetables and risk of cancer of the upper aero-digestive tract: the prospective EPIC-study (original) (raw)

Abstract

Epidemiologic studies suggest that a high intake of fruits and vegetables is associated with decreased risk of cancers of the upper aero-digestive tract. We studied data from 345,904 subjects of the prospective European Investigation into Cancer and Nutrition (EPIC) recruited in seven European countries, who had completed a dietary questionnaire in 1992–1998. During 2,182,560 person years of observation 352 histologically verified incident squamous cell cancer (SCC) cases (255 males; 97 females) of the oral cavity, pharynx, larynx, and esophagus were identified. Linear and restricted cubic spline Cox regressions were fitted on variables of intake of fruits and vegetables and adjusted for potential confounders. We observed a significant inverse association with combined total fruits and vegetables intake (estimated relative risk (RR) = 0.91; 95% confidence interval (95% CI) 0.83–1.00 per 80 g/d of consumption), and nearly significant inverse associations in separate analyses with total fruits and total vegetables intake (RR: 0.97 (95% CI: 0.92–1.02) and RR = 0.89 (95% CI: 0.78–1.02) per 40 g/d of consumption). Overall, vegetable subgroups were not related to risk with the exception of intake of root vegetables in men. Restricted cubic spline regression did not improve the linear model fits except for total fruits and vegetables and total fruits with a significant decrease in risk at low intake levels (<120 g/d) for fruits. Dietary recommendations should consider the potential benefit of increasing fruits and vegetables consumption for reducing the risk of cancers of the upper aero-digestive tract, particularly at low intake.

Access this article

Log in via an institution

Subscribe and save

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

1. Ferlay J, Bray F, Pisani P, Parkin DM (2004) Cancer incidence, mortality and prevalence worldwide. In: Globocan 2002: version 2.0. IARC, Lyon
2. Austin DF, Reynolds P (1996) Laryngeal cancer. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer epidemiology and prevention. Oxford University Press, New York, London, pp 619–636
   Google Scholar
3. Blot WJ, McLaughlin JK, Devessa SS, Fraumeni JF (1996) Cancers of the oral cavity and pharynx. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer epidemiology and prevention. Oxford University Press, New York, London, pp 666–680
   Google Scholar
4. Munoz N, Day NE (1996) Esophageal cancer. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer epidemiology and prevention. Oxford University Press, New York, Oxford, pp 681–706
   Google Scholar
5. IARC (2003) Fruit and vegetables. In: Handbooks of cancer prevention No.8. IARC, Lyon
6. Boeing H (2002) Alcohol and risk of cancer of the upper gastrointestinal tract: first analysis of the EPIC data. IARC Sci Publ 156:151–154
   PubMed CAS Google Scholar
7. Chyou PH, Nomura AM, Stemmermann GN (1995) Diet, alcohol, smoking and cancer of the upper aerodigestive tract: a prospective study among Hawaii Japanese men. Int J Cancer 60:616–621
   PubMed CAS Google Scholar
8. Guo W, Blot WJ, Li JY et al (1994) A nested case–control study of esophageal and stomach cancers in the Linxian nutrition intervention trial. Int J Epidemiol 23:444–450
   PubMed CAS Google Scholar
9. Kasum CM, Jacobs DR Jr, Nicodemus K, Folsom AR (2002) Dietary risk factors for upper aerodigestive tract cancers. Int J Cancer 99:267–272
   Article PubMed CAS Google Scholar
10. Kjaerheim K, Gaard M, Andersen A (1998) The role of alcohol, tobacco, and dietary factors in upper aerogastric tract cancers: a prospective study of 10,900 Norwegian men. Cancer Cause Control 9:99–108
    Article CAS Google Scholar
11. Sauvaget C, Nagano J, Allen N, Kodama K (2003) Vegetable and fruit intake and stroke mortality in the Hiroshima/Nagasaki Life Span Study. Stroke 34:2355–2360
    Article PubMed CAS Google Scholar
12. Riboli E, Hunt KJ, Slimani N et al (2002) European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5:1113–1124
    Article PubMed CAS Google Scholar
13. Riboli E, Kaaks R (1997) The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26:S6–S14
    Article PubMed Google Scholar
14. Slimani N, Ferrari P, Ocke M, et al (2000) Standardization of the 24-hour diet recall calibration method used in the European prospective investigation into cancer and nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr 54:900–917
    Article PubMed CAS Google Scholar
15. Slimani N, Kaaks R, Ferrari P, et al (2002) European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics. Public Health Nutr 5:1125–1145
    Article PubMed CAS Google Scholar
16. Agudo A, Slimani N, Ocke MC, et al (2002) Consumption of vegetables, fruit and other plant foods in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts from 10 European countries. Public Health Nutr 5:1179–1196
    Article PubMed CAS Google Scholar
17. Klipstein-Grobusch K, Slimani N, Krogh V, et al (2002) Trends in self-reported past alcoholic beverage consumption and ethanol intake from 1950 to 1995 observed in eight European countries participating in the European Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5:1297–1310
    Article PubMed CAS Google Scholar
18. Department of Health RoHaSS (1991) Reference Values for Food Energy and Nutrients for the United Kingdom, vol 41. Department of Health, Report on Health and Social Subjects
19. Kaaks R, Riboli E, van Staveren W (1995) Calibration of dietary-intake measurements in prospective cohort studies. Am J Epidemiol 142:548–556
    PubMed CAS Google Scholar
20. Ferrari P, Slimani N, Ciampi A, et al (2002) Evaluation of under- and over-reporting of energy intake in the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC). Publ Health Nutr 5:1243–1258
    Article Google Scholar
21. Ferrari P, Kaaks R, Fahey M (2004) Within and between cohort variation in measured macronutrient intakes in the EPIC study taking account of measurement errors. Am J Epidemiol 160:814–822
    Article PubMed Google Scholar
22. van Gils CH, Peeters PH, Bueno-de-Mesquita HB, et al (2005) Consumption of vegetables and fruits and risk of breast cancer. JAMA 293:183–193
    Article PubMed Google Scholar
23. Tuyns AJ, Riboli E, Doornbos G, Pequignot G (1987) Diet and esophageal cancer in Calvados (France). Nutr Cancer 9:81–92
    Article PubMed CAS Google Scholar
24. Hirayama T (1990) Life-style and mortality. A large-scale census-based cohort study in Japan. Institute of Preventive Oncology

Download references

Acknowledgments

We would like to thank all participants for their contribution to this study. Important technical statistical support to this study was given by Wolfgang Bernigau. EPIC is financially supported by: Europe Against Cancer Program of the European Commission (SANCO); Deutsche Krebshilfe; Deutsches Krebsforschungszentrum; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; Spanish Regional Governments of Andalucia, Asturia, Basque Country, Murcia and Navarra; ISCIII, red de centros RCESP, C03/09, Spain; Cancer Research UK; Medical Research Council, United Kingdom; Stroke Association, United Kingdom; British Heart Foundation; Department of Health, United Kingdom; Food Standards Agency, United Kingdom; Welcome Trust, United Kingdom; Greek Ministry of Health; Greek Ministry of Education; Italian Association for Research on Cancer (AIRC); Italian National Research Council; Dutch Ministry of Public Health, Welfare and Sports; National Cancer Registry and the Regional Cancer Registries Amsterdam, Utrecht, East and Maastricht of The Netherlands; Swedish Cancer Society; Swedish Scientific Council; Regional Government of Skane, Sweden

Author information

Authors and Affiliations

1. German Institute of Human Nutrition Potsdam-Rehbrücke , Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
   Heiner Boeing, Thomas Dietrich, Kurt Hoffmann, Tobias Pischon & Petra H. Lahmann
2. Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
   Pietro Ferrari, Nadia Slimani, Teresa Norat, Mazda Jenab & Elio Riboli
3. Institute Gustave Roussy, INSERM U521, Villejuif, France
   Marie Christine Boutron-Ruault & Francoise Clavel-Chapelon
4. Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, UK
   Naomi Allen & Tim Key
5. Institute of Community Medicine, University of Tromso, Tromso, Norway
   Guri Skeie & Eiliv Lund
6. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
   Anja Olsen & Anne Tjonneland
7. Department of Clinical Epidemiology, Aalborg Hospital and the Aarhus University Hospital, Department of Epidemiology and Social Medicine, University of Aarhus, Aarhus, Denmark
   Kim Overvad & Majken K. Jensen
8. Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany
   Sabine Rohrmann & Jakob Linseisen
9. Department of Hygiene and Epidemiology, Medical School, University of Athens, Athens, Greece
   Antonia Trichopoulou, Christina Bamia & Theodora Psaltopoulou
10. Department of Nutritional Research and The Department of Medical Biosciences, Pathology, University of Umeå, Umeå, Sweden
    Lars Weinehall & Ingegerd Johansson
11. Andalusian School of Public Health, Granada, Spain
    Maria-José Sánchez
12. Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain
    Paula Jakszyn
13. Public Health Institute of Navarra, Pamplona, Spain
    Eva Ardanaz
14. Health Department of Basque Country, San Sebastian, Spain
    Pilar Amiano
15. Epidemiology Department, Murcia Health Council, Murcia, Spain
    Maria Dolores Chirlaque
16. Council for Health and Social Affairs of Asturias, Oviedo, Spain
    J. Ramón Quirós
17. Malmö Diet and Cancer Study, Department of Clinical Sciences, Lund University, Malmö, Sweden
    Elisabet Wirfalt & Göran Berglund
18. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
    Petra H. Peeters & Carla H. van Gils
19. Center for Nutrition and Health, National Institute for Public Health and The Environment, Bilthoven, The Netherlands
    H. Bas Bueno-de-Mesquita & Frederike L. Büchner
20. Epidemiology Unit, Istituto Tumori, Milan, Italy
    Franco Berrino
21. The Molecular and Nutritional Epidemiology Unit, CSPO, Scientific Institute of Tuscany, Florence, Italy
    Domenico Palli
22. University of Torino, Torino, Italy
    Carlotta Sacerdote
23. Cancer Registry, Azienda Ospedaliera “Civile M. P. Arezzo”, Ragusa, Italy
    Rosario Tumino
24. Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
    Salvatore Panico
25. Dunn Human Nutrition Unit, Cambridge, UK
    Sheila Bingham
26. The Clinical Gerontology Unit, University of Cambridge, Cambridge, UK
    Kay-Tee Khaw

Authors

1. Heiner Boeing
   You can also search for this author inPubMed Google Scholar
2. Thomas Dietrich
   You can also search for this author inPubMed Google Scholar
3. Kurt Hoffmann
   You can also search for this author inPubMed Google Scholar
4. Tobias Pischon
   You can also search for this author inPubMed Google Scholar
5. Pietro Ferrari
   You can also search for this author inPubMed Google Scholar
6. Petra H. Lahmann
   You can also search for this author inPubMed Google Scholar
7. Marie Christine Boutron-Ruault
   You can also search for this author inPubMed Google Scholar
8. Francoise Clavel-Chapelon
   You can also search for this author inPubMed Google Scholar
9. Naomi Allen
   You can also search for this author inPubMed Google Scholar
10. Tim Key
    You can also search for this author inPubMed Google Scholar
11. Guri Skeie
    You can also search for this author inPubMed Google Scholar
12. Eiliv Lund
    You can also search for this author inPubMed Google Scholar
13. Anja Olsen
    You can also search for this author inPubMed Google Scholar
14. Anne Tjonneland
    You can also search for this author inPubMed Google Scholar
15. Kim Overvad
    You can also search for this author inPubMed Google Scholar
16. Majken K. Jensen
    You can also search for this author inPubMed Google Scholar
17. Sabine Rohrmann
    You can also search for this author inPubMed Google Scholar
18. Jakob Linseisen
    You can also search for this author inPubMed Google Scholar
19. Antonia Trichopoulou
    You can also search for this author inPubMed Google Scholar
20. Christina Bamia
    You can also search for this author inPubMed Google Scholar
21. Theodora Psaltopoulou
    You can also search for this author inPubMed Google Scholar
22. Lars Weinehall
    You can also search for this author inPubMed Google Scholar
23. Ingegerd Johansson
    You can also search for this author inPubMed Google Scholar
24. Maria-José Sánchez
    You can also search for this author inPubMed Google Scholar
25. Paula Jakszyn
    You can also search for this author inPubMed Google Scholar
26. Eva Ardanaz
    You can also search for this author inPubMed Google Scholar
27. Pilar Amiano
    You can also search for this author inPubMed Google Scholar
28. Maria Dolores Chirlaque
    You can also search for this author inPubMed Google Scholar
29. J. Ramón Quirós
    You can also search for this author inPubMed Google Scholar
30. Elisabet Wirfalt
    You can also search for this author inPubMed Google Scholar
31. Göran Berglund
    You can also search for this author inPubMed Google Scholar
32. Petra H. Peeters
    You can also search for this author inPubMed Google Scholar
33. Carla H. van Gils
    You can also search for this author inPubMed Google Scholar
34. H. Bas Bueno-de-Mesquita
    You can also search for this author inPubMed Google Scholar
35. Frederike L. Büchner
    You can also search for this author inPubMed Google Scholar
36. Franco Berrino
    You can also search for this author inPubMed Google Scholar
37. Domenico Palli
    You can also search for this author inPubMed Google Scholar
38. Carlotta Sacerdote
    You can also search for this author inPubMed Google Scholar
39. Rosario Tumino
    You can also search for this author inPubMed Google Scholar
40. Salvatore Panico
    You can also search for this author inPubMed Google Scholar
41. Sheila Bingham
    You can also search for this author inPubMed Google Scholar
42. Kay-Tee Khaw
    You can also search for this author inPubMed Google Scholar
43. Nadia Slimani
    You can also search for this author inPubMed Google Scholar
44. Teresa Norat
    You can also search for this author inPubMed Google Scholar
45. Mazda Jenab
    You can also search for this author inPubMed Google Scholar
46. Elio Riboli
    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence toHeiner Boeing.

Additional information

Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke

Rights and permissions

About this article

Cite this article

Boeing, H., Dietrich, T., Hoffmann, K. et al. Intake of fruits and vegetables and risk of cancer of the upper aero-digestive tract: the prospective EPIC-study.Cancer Causes Control 17, 957–969 (2006). https://doi.org/10.1007/s10552-006-0036-4

Download citation

• Received: 15 November 2005
• Accepted: 18 April 2006
• Issue Date: September 2006
• DOI: https://doi.org/10.1007/s10552-006-0036-4

Keywords