Fruits and vegetables and lung cancer: Findings from the European Prospective Investigation into Cancer and Nutrition.
Miller AB., Altenburg H-P., Bueno-de-Mesquita B., Boshuizen HC., Agudo A., Berrino F., Gram IT., Janson L., Linseisen J., Overvad K., Rasmuson T., Vineis P., Lukanova A., Allen N., Amiano P., Barricarte A., Berglund G., Boeing H., Clavel-Chapelon F., Day NE., Hallmans G., Lund E., Martinez C., Navarro C., Palli D., Panico S., Peeters PHM., Quirós JR., Tjønneland A., Tumino R., Trichopoulou A., Trichopoulos D., Slimani N., Riboli E.
Intake of fruits and vegetables is thought to protect against the development of lung cancer. However, some recent cohort and case-control studies have shown no protective effect. We have assessed the relation between fruit and vegetable intake and lung cancer incidence in the large prospective investigation on diet and cancer, the European Prospective Investigation Into Cancer and Nutrition (EPIC). We studied data from 478,021 individuals that took part in the EPIC study, who were recruited from 10 European countries and who completed a dietary questionnaire during 1992-1998. Follow-up was to December 1998 or 1999, but for some centres with active follow-up to June 2002. During follow-up, 1,074 participants were reported to have developed lung cancer, of whom 860 were eligible for our analysis. We used the Cox proportional hazard model to determine the effect of fruit and vegetable intake on the incidence of lung cancer. We paid particular attention to adjustment for smoking. Relative risk estimates were obtained using fruit and vegetable intake categorised by sex-specific, cohort-wide quintiles. After adjustment for age, smoking, height, weight and gender, there was a significant inverse association between fruit consumption and lung cancer risk: the hazard ratio for the highest quintile of consumption relative to the lowest being 0.60 (95% Confidence Interval 0.46-0.78), p for trend 0.0099. The association was strongest in the Northern Europe centres, and among current smokers at baseline, and was strengthened when the 293 lung cancers diagnosed in the first 2 years of follow-up were excluded from the analysis. There was no association between vegetable consumption or vegetable subtypes and lung cancer risk. The findings from this analysis can be regarded as re-enforcing recommendations with regard to enhanced fruit consumption for populations. However, the effect is likely to be small compared to smoking cessation.