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Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies.

Abstract

BACKGROUND

Fruit and vegetable intakes have been associated with a reduced risk of colon cancer; however, in more recent studies associations have been less consistent. Statistical power to examine associations by colon site has been limited in previous studies.

METHODS

Fruit and vegetable intakes in relation to colon cancer risk were examined in the Pooling Project of Prospective Studies of Diet and Cancer. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated separately in 14 studies using Cox proportional hazards model and then pooled using a random-effects model. Intakes of total fruits and vegetables, total fruits, and total vegetables were categorized according to quintiles and absolute cutpoints. Analyses were conducted for colon cancer overall and for proximal and distal colon cancer separately. All statistical tests were two-sided.

RESULTS

Among 756,217 men and women followed for up to 6 to 20 years, depending on the study, 5838 were diagnosed with colon cancer. The pooled multivariable RRs (95% CIs) of colon cancer for the highest versus lowest quintiles of intake were 0.91 (0.82 to 1.01, P(trend) = .19) for total fruits and vegetables, 0.93 (0.85 to 1.02, P(trend) = .28) for total fruits, and 0.94 (0.86 to 1.02, P(trend) = .17) for total vegetables. Similar results were observed when intakes were categorized by identical absolute cut points across studies (pooled multivariable RR = 0.90, 95% CI = 0.77 to 1.05 for 800 or more versus <200 g/day of total fruits and vegetables, P(trend) = .06). The age-standardized incidence rates of colon cancer for these two intake categories were 54 and 61 per 100,000 person-years, respectively. When analyzed by colon site, the pooled multivariable RRs (95% CIs) comparing total fruit and vegetable intakes of 800 or more versus less than 200 g/day were 0.74 (0.57 to 0.95, P(trend) = .02) for distal colon cancers and 1.02 (0.82 to 1.27, P(trend) = .57) for proximal colon cancers. Similar site-specific associations were observed for total fruits and total vegetables.

CONCLUSION

Fruit and vegetable intakes were not strongly associated with colon cancer risk overall but may be associated with a lower risk of distal colon cancer.

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  • Authors+Show Affiliations

    ,

    Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. anita.koushik@umontreal.ca

    , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

    Source

    Journal of the National Cancer Institute 99:19 2007 Oct 03 pg 1471-83

    MeSH

    Adult
    Aged
    Colonic Neoplasms
    Europe
    Feeding Behavior
    Female
    Fruit
    Humans
    Male
    Middle Aged
    Multivariate Analysis
    North America
    Odds Ratio
    Prospective Studies
    Risk Assessment
    Risk Factors
    Risk Reduction Behavior
    Vegetables

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    17895473

    Citation

    Koushik, Anita, et al. "Fruits, Vegetables, and Colon Cancer Risk in a Pooled Analysis of 14 Cohort Studies." Journal of the National Cancer Institute, vol. 99, no. 19, 2007, pp. 1471-83.
    Koushik A, Hunter DJ, Spiegelman D, et al. Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies. J Natl Cancer Inst. 2007;99(19):1471-83.
    Koushik, A., Hunter, D. J., Spiegelman, D., Beeson, W. L., van den Brandt, P. A., Buring, J. E., ... Smith-Warner, S. A. (2007). Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies. Journal of the National Cancer Institute, 99(19), pp. 1471-83.
    Koushik A, et al. Fruits, Vegetables, and Colon Cancer Risk in a Pooled Analysis of 14 Cohort Studies. J Natl Cancer Inst. 2007 Oct 3;99(19):1471-83. PubMed PMID: 17895473.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies. AU - Koushik,Anita, AU - Hunter,David J, AU - Spiegelman,Donna, AU - Beeson,W Lawrence, AU - van den Brandt,Piet A, AU - Buring,Julie E, AU - Calle,Eugenia E, AU - Cho,Eunyoung, AU - Fraser,Gary E, AU - Freudenheim,Jo L, AU - Fuchs,Charles S, AU - Giovannucci,Edward L, AU - Goldbohm,R Alexandra, AU - Harnack,Lisa, AU - Jacobs,David R,Jr AU - Kato,Ikuko, AU - Krogh,Vittorio, AU - Larsson,Susanna C, AU - Leitzmann,Michael F, AU - Marshall,James R, AU - McCullough,Marjorie L, AU - Miller,Anthony B, AU - Pietinen,Pirjo, AU - Rohan,Thomas E, AU - Schatzkin,Arthur, AU - Sieri,Sabina, AU - Virtanen,Mikko J, AU - Wolk,Alicja, AU - Zeleniuch-Jacquotte,Anne, AU - Zhang,Shumin M, AU - Smith-Warner,Stephanie A, Y1 - 2007/09/25/ PY - 2007/9/27/pubmed PY - 2007/10/12/medline PY - 2007/9/27/entrez SP - 1471 EP - 83 JF - Journal of the National Cancer Institute JO - J. Natl. Cancer Inst. VL - 99 IS - 19 N2 - BACKGROUND: Fruit and vegetable intakes have been associated with a reduced risk of colon cancer; however, in more recent studies associations have been less consistent. Statistical power to examine associations by colon site has been limited in previous studies. METHODS: Fruit and vegetable intakes in relation to colon cancer risk were examined in the Pooling Project of Prospective Studies of Diet and Cancer. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated separately in 14 studies using Cox proportional hazards model and then pooled using a random-effects model. Intakes of total fruits and vegetables, total fruits, and total vegetables were categorized according to quintiles and absolute cutpoints. Analyses were conducted for colon cancer overall and for proximal and distal colon cancer separately. All statistical tests were two-sided. RESULTS: Among 756,217 men and women followed for up to 6 to 20 years, depending on the study, 5838 were diagnosed with colon cancer. The pooled multivariable RRs (95% CIs) of colon cancer for the highest versus lowest quintiles of intake were 0.91 (0.82 to 1.01, P(trend) = .19) for total fruits and vegetables, 0.93 (0.85 to 1.02, P(trend) = .28) for total fruits, and 0.94 (0.86 to 1.02, P(trend) = .17) for total vegetables. Similar results were observed when intakes were categorized by identical absolute cut points across studies (pooled multivariable RR = 0.90, 95% CI = 0.77 to 1.05 for 800 or more versus <200 g/day of total fruits and vegetables, P(trend) = .06). The age-standardized incidence rates of colon cancer for these two intake categories were 54 and 61 per 100,000 person-years, respectively. When analyzed by colon site, the pooled multivariable RRs (95% CIs) comparing total fruit and vegetable intakes of 800 or more versus less than 200 g/day were 0.74 (0.57 to 0.95, P(trend) = .02) for distal colon cancers and 1.02 (0.82 to 1.27, P(trend) = .57) for proximal colon cancers. Similar site-specific associations were observed for total fruits and total vegetables. CONCLUSION: Fruit and vegetable intakes were not strongly associated with colon cancer risk overall but may be associated with a lower risk of distal colon cancer. SN - 1460-2105 UR - https://www.unboundmedicine.com/medline/citation/17895473/Fruits_vegetables_and_colon_cancer_risk_in_a_pooled_analysis_of_14_cohort_studies_ L2 - https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djm155 DB - PRIME DP - Unbound Medicine ER -