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Fruits, vegetables and lung cancer: A pooled analysis of cohort studies
Author(s) -
SmithWarner Stephanie A.,
Spiegelman Donna,
Yaun ShiawShyuan,
Albanes Demetrius,
Beeson W. Lawrence,
van den Brandt Piet A.,
Feskanich Diane,
Folsom Aaron R.,
Fraser Gary E.,
Freudenheim Jo L.,
Giovannucci Edward,
Goldbohm R. Alexandra,
Graham Saxon,
Kushi Lawrence H.,
Miller Anthony B.,
Pietinen Pirjo,
Rohan Thomas E.,
Speizer Frank E.,
Willett Walter C.,
Hunter David J.
Publication year - 2003
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.11490
Subject(s) - medicine , lung cancer , relative risk , confounding , prospective cohort study , cohort study , cancer , cohort , environmental health , toxicology , confidence interval , biology
Inverse associations between fruit and vegetable consumption and lung cancer risk have been consistently reported. However, identifying the specific fruits and vegetables associated with lung cancer is difficult because the food groups and foods evaluated have varied across studies. We analyzed fruit and vegetable groups using standardized exposure and covariate definitions in 8 prospective studies. We combined study‐specific relative risks (RRs) using a random effects model. In the pooled database, 3,206 incident lung cancer cases occurred among 430,281 women and men followed for up to 6–16 years across studies. Controlling for smoking habits and other lung cancer risk factors, a 16–23% reduction in lung cancer risk was observed for quintiles 2 through 5 vs . the lowest quintile of consumption for total fruits (RR = 0.77; 95% CI = 0.67–0.87 for quintile 5; p ‐value, test for trend < 0.001) and for total fruits and vegetables (RR = 0.79; 95% CI = 0.69–0.90; p ‐value, test for trend = 0.001). For the same comparison, the association was weaker for total vegetable consumption (RR = 0.88; 95% CI = 0.78–1.00; p ‐value, test for trend = 0.12). Associations were similar between never, past, and current smokers. These results suggest that elevated fruit and vegetable consumption is associated with a modest reduction in lung cancer risk, which is mostly attributable to fruit, not vegetable, intake. However, we cannot rule out the possibility that our results are due to residual confounding by smoking. The primary focus for reducing lung cancer incidence should continue to be smoking prevention and cessation. © 2003 Wiley‐Liss, Inc.