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This Article Full Text (Publish Ahead of Print[PDF]) All Versions of this Article: 89/5/1441    most recent ajcn.2008.27120v1 Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van Duijnhoven, F. J. Articles by Riboli, E. Search for Related Content PubMed PubMed Citation Articles by van Duijnhoven, F. J. Articles by Riboli, E. Agricola Articles by van Duijnhoven, F. J. Articles by Riboli, E.

Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and Nutrition^1,2,3,4

¹ From the National Institute for Public Health and the Environment, Bilthoven, Netherlands (FJBvD, HBB-D-M, MMR, HCB, and MCO); the Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands (FJBvD, PHMP, and CHvG); the International Agency for Research on Cancer, Lyon, France (PF, MJ, CC, PB, NS, and SR); the Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands (MMR); the Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark (A Tjønneland and AO); the Departments of Clinical Epidemiology (KO) and Surgical Gastroenterology (OT-U), Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; INSERM, ERI 20, EA 4045, and Institut Gustave Roussy, Villejuif, France (FC-C, M-CB-R, and SM); the Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany (RK and JL); the Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (HB and UN); the Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece (A Trichopoulou, DT, and GM); the Molecular and Nutritional Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy (DP); the Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy (SS); the Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy (SP); the Cancer Registry, Azienda Ospedaliera "Civile MP Arezzo," Ragusa, Italy (RT); the Department of Biomedical Sciences and Human Oncology, University of Torino, Torino, Italy (PV); the Division of Epidemiology, Public Health and Primary Care, Imperial College London, London, United Kingdom (PV, VG, TN, and ER); the Faculty of Medicine, Institute of Community Medicine, University of Tromsø, Tromsø, Norway (EL, DE, and GS); the Public Health Directorate, Asturias, Spain (LRS); the Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, Spain (CAG); the Andalusian School of Public Health–Granada and CIBER Epidemiología y Salud Pública, Barcelona, Spain (M-JS); the Department of Public Health of Guipuzkoa, San Sebastian, Spain (MD); the Epidemiology Department, Murcia Health Council and CIBER Epidemiología y Salud Pública, Barcelona, Spain (CN); the Public Health Institute of Navarra, Pamplona, Spain (AB); the Departments of Clinical Sciences (GB) and Surgery (JM), Malmö University Hospital, Malmö, Sweden; the Departments of Public Health and Clinical Medicine (GH) and Medical Biosciences, Pathology (RP), Umeå University, Umeå, Sweden; the Medical Research Council Dunn Human Nutrition Unit, Cambridge, United Kingdom (SAB); the Clinical Gerontology, Department of Public Health and Primary Care, University of Cambridge, United Kingdom (K-TK); and the Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom (TJK and NEA).

² FJBvD and HBB-D-M contributed equally to this work as first authors.

³ Supported by the European Commission: Public Health and Consumer Protection Directorate 1993-2004, Research Directorate-General 2005-, Ligue Contre le Cancer, Societé 3M, and Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (France); German Cancer Aid, German Cancer Research Center, and Federal Ministry of Education and Research (Germany); Danish Cancer Society and the ISAFRUIT project funded by the European Commission under the Thematic Priority 5–Food Quality and Safety of the 6th Framework Programme of RTD (contract no. FP6-FOOD–CT-2006-016279) (Denmark); Health Research Fund of the Spanish Ministry of Health and the participating regional governments and institutions (Spain); Cancer Research UK, Medical Research Council, Stroke Association, British Heart Foundation, Department of Health, Food Standards Agency, and the Wellcome Trust (United Kingdom); Greek Ministry of Health, the Greek Ministry of Education and the Stavros Foundation (Greece); Italian Association for Research on Cancer, and the National Research Council (Italy); the Dutch Ministry of Public Health, Welfare and Sports, Dutch Ministry of Health, Dutch Prevention Funds, LK Research Funds, Dutch ZON (Zorg Ondk Nederland), and World Cancer Research Fund (Netherlands); Swedish Cancer Society, Swedish Scientific Council, and Regional Government of Skane (Sweden); and Norwegian Cancer Society (Norway).

⁴ Reprints not available. Address correspondence to FJB van Duijnhoven, Centre for Nutrition and Health, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands. E-mail: franzel.van.duijnhoven{at}rivm.nl.

ABSTRACT

Background: A high consumption of fruit and vegetables is possibly associated with a decreased risk of colorectal cancer (CRC). However, the findings to date are inconsistent.

Objective: We examined the relation between self-reported usual consumption of fruit and vegetables and the incidence of CRC.

Design: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 452,755 subjects (131,985 men and 320,770 women) completed a dietary questionnaire in 1992–2000 and were followed up for cancer incidence and mortality until 2006. A multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HRs) and 95% CIs.

Results: After an average follow-up of 8.8 y, 2,819 incident CRC cases were reported. Consumption of fruit and vegetables was inversely associated with CRC in a comparison of the highest with the lowest EPIC-wide quintile of consumption (HR: 0.86; 95% CI: 0.75, 1.00; P for trend = 0.04), particularly with colon cancer risk (HR: 0.76; 95% CI: 0.63, 0.91; P for trend < 0.01). Only after exclusion of the first 2 y of follow-up were these findings corroborated by calibrated continuous analyses for a 100-g increase in consumption: HRs of 0.95 (95% CI: 0.91, 1.00; P = 0.04) and 0.94 (95% CI: 0.89, 0.99; P = 0.02), respectively. The association between fruit and vegetable consumption and CRC risk was inverse in never and former smokers, but positive in current smokers. This modifying effect was found for fruit and vegetables combined and for vegetables alone (P for interaction < 0.01 for both).

Conclusions: These findings suggest that a high consumption of fruit and vegetables is associated with a reduced risk of CRC, especially of colon cancer. This effect may depend on smoking status.

Received for publication October 17, 2008. Accepted for publication February 23, 2009.

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