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Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies.

Abstract

BACKGROUND & AIMS

The association between fruit and vegetable intake and colorectal cancer risk has been investigated by many studies but is controversial because of inconsistent results and weak observed associations. We summarized the evidence from cohort studies in categorical, linear, and nonlinear, dose-response meta-analyses.

METHODS

We searched PubMed for studies of fruit and vegetable intake and colorectal cancer risk that were published until the end of May 2010. We included 19 prospective studies that reported relative risk estimates and 95% confidence intervals (CIs) of colorectal cancer-associated with fruit and vegetable intake. Random effects models were used to estimate summary relative risks.

RESULTS

The summary relative risk for the highest vs the lowest intake was 0.92 (95% CI: 0.86-0.99) for fruit and vegetables combined, 0.90 (95% CI: 0.83-0.98) for fruit, and 0.91 (95% CI: 0.86-0.96) for vegetables (P for heterogeneity=.24, .05, and .54, respectively). The inverse associations appeared to be restricted to colon cancer. In linear dose-response analysis, only intake of vegetables was significantly associated with colorectal cancer risk (summary relative risk=0.98; 95% CI: 0.97-0.99), per 100 g/d. However, significant inverse associations emerged in nonlinear models for fruits (Pnonlinearity<.001) and vegetables (Pnonlinearity=.001). The greatest risk reduction was observed when intake increased from very low levels of intake. There was generally little evidence of heterogeneity in the analyses and there was no evidence of small-study bias.

CONCLUSIONS

Based on meta-analysis of prospective studies, there is a weak but statistically significant nonlinear inverse association between fruit and vegetable intake and colorectal cancer risk.

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  • Authors+Show Affiliations

    ,

    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK. d.aune@imperial.ac.uk

    , , , , ,

    Source

    Gastroenterology 141:1 2011 Jul pg 106-18

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Colorectal Neoplasms
    Diet
    Evidence-Based Medicine
    Female
    Fruit
    Humans
    Male
    Middle Aged
    Nonlinear Dynamics
    Prospective Studies
    Risk Assessment
    Risk Factors
    Vegetables
    Young Adult

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Video-Audio Media

    Language

    eng

    PubMed ID

    21600207

    Citation

    Aune, Dagfinn, et al. "Nonlinear Reduction in Risk for Colorectal Cancer By Fruit and Vegetable Intake Based On Meta-analysis of Prospective Studies." Gastroenterology, vol. 141, no. 1, 2011, pp. 106-18.
    Aune D, Lau R, Chan DS, et al. Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies. Gastroenterology. 2011;141(1):106-18.
    Aune, D., Lau, R., Chan, D. S., Vieira, R., Greenwood, D. C., Kampman, E., & Norat, T. (2011). Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies. Gastroenterology, 141(1), pp. 106-18. doi:10.1053/j.gastro.2011.04.013.
    Aune D, et al. Nonlinear Reduction in Risk for Colorectal Cancer By Fruit and Vegetable Intake Based On Meta-analysis of Prospective Studies. Gastroenterology. 2011;141(1):106-18. PubMed PMID: 21600207.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies. AU - Aune,Dagfinn, AU - Lau,Rosa, AU - Chan,Doris S M, AU - Vieira,Rui, AU - Greenwood,Darren C, AU - Kampman,Ellen, AU - Norat,Teresa, Y1 - 2011/04/16/ PY - 2011/01/17/received PY - 2011/03/23/revised PY - 2011/04/05/accepted PY - 2011/5/24/entrez PY - 2011/5/24/pubmed PY - 2011/9/8/medline SP - 106 EP - 18 JF - Gastroenterology JO - Gastroenterology VL - 141 IS - 1 N2 - BACKGROUND & AIMS: The association between fruit and vegetable intake and colorectal cancer risk has been investigated by many studies but is controversial because of inconsistent results and weak observed associations. We summarized the evidence from cohort studies in categorical, linear, and nonlinear, dose-response meta-analyses. METHODS: We searched PubMed for studies of fruit and vegetable intake and colorectal cancer risk that were published until the end of May 2010. We included 19 prospective studies that reported relative risk estimates and 95% confidence intervals (CIs) of colorectal cancer-associated with fruit and vegetable intake. Random effects models were used to estimate summary relative risks. RESULTS: The summary relative risk for the highest vs the lowest intake was 0.92 (95% CI: 0.86-0.99) for fruit and vegetables combined, 0.90 (95% CI: 0.83-0.98) for fruit, and 0.91 (95% CI: 0.86-0.96) for vegetables (P for heterogeneity=.24, .05, and .54, respectively). The inverse associations appeared to be restricted to colon cancer. In linear dose-response analysis, only intake of vegetables was significantly associated with colorectal cancer risk (summary relative risk=0.98; 95% CI: 0.97-0.99), per 100 g/d. However, significant inverse associations emerged in nonlinear models for fruits (Pnonlinearity<.001) and vegetables (Pnonlinearity=.001). The greatest risk reduction was observed when intake increased from very low levels of intake. There was generally little evidence of heterogeneity in the analyses and there was no evidence of small-study bias. CONCLUSIONS: Based on meta-analysis of prospective studies, there is a weak but statistically significant nonlinear inverse association between fruit and vegetable intake and colorectal cancer risk. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/21600207/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(11)00522-1 DB - PRIME DP - Unbound Medicine ER -