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Fruits, vegetables and lung cancer risk: a systematic review and meta-analysis.

Abstract

BACKGROUND

Lung cancer is the most common cause of cancer death. Fruits and vegetables containing carotenoids and other antioxidants have been hypothesized to decrease lung cancer risk. As part of the World Cancer Research Fund International Continuous Update Project, we conducted a systematic review and meta-analysis of prospective studies.

METHODS

We searched PubMed and several databases up to December 2014 for prospective studies. We conducted meta-analyses comparing the highest and lowest intakes and dose-response meta-analyses to estimate summary relative risks (RRs) and 95% confidence intervals (CIs), and examine possible non-linear associations. We combined results from the Pooling Project with the studies we identified to increase the statistical power of our analysis.

RESULTS

When comparing the highest with the lowest intakes, the summary RR estimates were 0.86 [95% CI 0.78-0.94; n (studies) = 18] for fruits and vegetables, 0.92 (95% CI 0.87-0.97; n = 25) for vegetables and 0.82 (95% CI 0.76-0.89; n = 29) for fruits. The association with fruit and vegetable intake was marginally significant in current smokers and inverse but not significant in former or never smokers. Significant inverse dose-response associations were observed for each 100 g/day increase: for fruits and vegetables [RR: 0.96; 95% CI 0.94-0.98, I(2) = 64%, n = 14, N (cases) = 9609], vegetables (RR: 0.94; 95% CI 0.89-0.98, I(2) = 48%, n = 20, N = 12 563) and fruits (RR: 0.92; 95% CI 0.89-0.95, I(2) = 57%, n = 23, N = 14 506). Our results were consistent among the different types of fruits and vegetables. The strength of the association differed across locations. There was evidence of a non-linear relationship (P < 0.01) between fruit and vegetable intake and lung cancer risk showing that no further benefit is obtained when increasing consumption above ∼400 g per day.

CONCLUSIONS

Eliminating tobacco smoking is the best strategy to prevent lung cancer. Although residual confounding by smoking cannot be ruled out, the current evidence from prospective studies is consistent with a protective role of fruit and vegetables in lung cancer aetiology.

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  • Authors+Show Affiliations

    ,

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

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    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

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    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

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    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

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    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

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    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

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    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

    ,

    Division of Biostatistics, University of Leeds, Leeds, UK.

    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

    Source

    MeSH

    Diet
    Fruit
    Humans
    Lung Neoplasms
    Prospective Studies
    Risk Factors
    Vegetables

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    26371287

    Citation

    Vieira, A R., et al. "Fruits, Vegetables and Lung Cancer Risk: a Systematic Review and Meta-analysis." Annals of Oncology : Official Journal of the European Society for Medical Oncology, vol. 27, no. 1, 2016, pp. 81-96.
    Vieira AR, Abar L, Vingeliene S, et al. Fruits, vegetables and lung cancer risk: a systematic review and meta-analysis. Ann Oncol. 2016;27(1):81-96.
    Vieira, A. R., Abar, L., Vingeliene, S., Chan, D. S., Aune, D., Navarro-Rosenblatt, D., ... Norat, T. (2016). Fruits, vegetables and lung cancer risk: a systematic review and meta-analysis. Annals of Oncology : Official Journal of the European Society for Medical Oncology, 27(1), pp. 81-96. doi:10.1093/annonc/mdv381.
    Vieira AR, et al. Fruits, Vegetables and Lung Cancer Risk: a Systematic Review and Meta-analysis. Ann Oncol. 2016;27(1):81-96. PubMed PMID: 26371287.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Fruits, vegetables and lung cancer risk: a systematic review and meta-analysis. AU - Vieira,A R, AU - Abar,L, AU - Vingeliene,S, AU - Chan,D S M, AU - Aune,D, AU - Navarro-Rosenblatt,D, AU - Stevens,C, AU - Greenwood,D, AU - Norat,T, Y1 - 2015/09/14/ PY - 2015/05/20/received PY - 2015/08/20/accepted PY - 2015/9/16/entrez PY - 2015/9/16/pubmed PY - 2016/9/23/medline KW - fruits KW - lung cancer KW - meta-analysis KW - review KW - smoking KW - vegetables SP - 81 EP - 96 JF - Annals of oncology : official journal of the European Society for Medical Oncology JO - Ann. Oncol. VL - 27 IS - 1 N2 - BACKGROUND: Lung cancer is the most common cause of cancer death. Fruits and vegetables containing carotenoids and other antioxidants have been hypothesized to decrease lung cancer risk. As part of the World Cancer Research Fund International Continuous Update Project, we conducted a systematic review and meta-analysis of prospective studies. METHODS: We searched PubMed and several databases up to December 2014 for prospective studies. We conducted meta-analyses comparing the highest and lowest intakes and dose-response meta-analyses to estimate summary relative risks (RRs) and 95% confidence intervals (CIs), and examine possible non-linear associations. We combined results from the Pooling Project with the studies we identified to increase the statistical power of our analysis. RESULTS: When comparing the highest with the lowest intakes, the summary RR estimates were 0.86 [95% CI 0.78-0.94; n (studies) = 18] for fruits and vegetables, 0.92 (95% CI 0.87-0.97; n = 25) for vegetables and 0.82 (95% CI 0.76-0.89; n = 29) for fruits. The association with fruit and vegetable intake was marginally significant in current smokers and inverse but not significant in former or never smokers. Significant inverse dose-response associations were observed for each 100 g/day increase: for fruits and vegetables [RR: 0.96; 95% CI 0.94-0.98, I(2) = 64%, n = 14, N (cases) = 9609], vegetables (RR: 0.94; 95% CI 0.89-0.98, I(2) = 48%, n = 20, N = 12 563) and fruits (RR: 0.92; 95% CI 0.89-0.95, I(2) = 57%, n = 23, N = 14 506). Our results were consistent among the different types of fruits and vegetables. The strength of the association differed across locations. There was evidence of a non-linear relationship (P < 0.01) between fruit and vegetable intake and lung cancer risk showing that no further benefit is obtained when increasing consumption above ∼400 g per day. CONCLUSIONS: Eliminating tobacco smoking is the best strategy to prevent lung cancer. Although residual confounding by smoking cannot be ruled out, the current evidence from prospective studies is consistent with a protective role of fruit and vegetables in lung cancer aetiology. SN - 1569-8041 UR - https://www.unboundmedicine.com/medline/citation/26371287/full_citation L2 - https://academic.oup.com/annonc/article-lookup/doi/10.1093/annonc/mdv381 DB - PRIME DP - Unbound Medicine ER -