Variety in Fruit and Vegetable Consumption and the Risk of Lung Cancer in the European Prospective Investigation into Cancer and Nutrition

Abstract

Background: We investigated whether a varied consumption of vegetables and fruits is associated with lower lung cancer risk in the European Prospective Investigation into Cancer and Nutrition study.Methods: After a mean follow-up of 8.7 years, 1,613 of 452,187 participants with complete information were diagnosed with lung cancer. Diet diversity scores (DDS) were used to quantify the variety in fruit and vegetable consumption. Multivariable proportional hazards models were used to assess the associations between DDS and lung cancer risk. All models were adjusted for smoking behavior and the total consumption of fruit and vegetables.Results: With increasing variety in vegetable subgroups, risk of lung cancer decreases [hazard ratios (HR), 0.77; 95% confidence interval (CI), 0.64-0.94 highest versus lowest quartile; P trend = 0.02]. This inverse association is restricted to current smokers (HR, 0.73; 95% CI, 0.57-0.93 highest versus lowest quartile; P trend = 0.03). In continuous analyses, in current smokers, lower risks were observed for squamous cell carcinomas with more variety in fruit and vegetable products combined (HR/two products, 0.88; 95% CI, 0.82-0.95), vegetable subgroups (HR/subgroup, 0.88; 95% CI, 0.79-0.97), vegetable products (HR/two products, 0.87; 95% CI, 0.79-0.96), and fruit products (HR/two products, 0.84; 95% CI, 0.72-0.97).Conclusion: Variety in vegetable consumption was inversely associated with lung cancer risk among current smokers. Risk of squamous cell carcinomas was reduced with increasing variety in fruit and/or vegetable consumption, which was mainly driven by the effect in current smokers.Impact: Independent from quantity of consumption, variety in fruit and vegetable consumption may decrease lung cancer risk. Cancer Epidemiol Biomarkers Prev; 19(9); 2278-86. ©2010 AACR.

A review of the Hispanic paradox: time to spill the beans?

“…As stated above, the consumption of fruit and vegetables has been shown to be protective against COPD and lung cancer [5,6]. This has been attributed to an antioxidant or anti-inflammatory effect according to many epidemiological, animal and in vitro studies [5,6].…”

“…Interestingly, the risk variables of age and pack-years have been shown to have a strong interactive effect on disease risk, with an exponential rise in disease prevalence observed in smokers compared with nonsmokers, above the age of 45 years in COPD and 65 years in lung cancer [10,11]. While there is growing evidence that the genetic factors underlying susceptibility to COPD and lung cancer are overlapping [7,12,13], there is also evidence for both diseases that the consumption of fruit and vegetables is protective [5,6]. This raises the question: what mechanism that links susceptibility to COPD and lung cancer might also be influenced by diet?…”

“…This has been attributed to an antioxidant or anti-inflammatory effect according to many epidemiological, animal and in vitro studies [5,6]. However, the specific food group and biological mechanism underlying this effect has not yet been clearly identified.…”

“…Indeed, COPD and lung cancer are relatively rare in the absence of a smoking or alternate aero-pollutant exposure. Established risk factors underlying these diseases are age, degree of smoking exposure, family history and diet [1][2][3][4], where the regular consumption of fruit and vegetables has been shown to have a protective effect [5,6]. This protective effect is relatively strong, even after correction for other variables like smoke exposure, and suggests diet may modify, to some degree, the harmful effects of smoking.…”

“…This protective effect is relatively strong, even after correction for other variables like smoke exposure, and suggests diet may modify, to some degree, the harmful effects of smoking. Although the underlying basis of this protective effect is not known, it is believed to stem from the collective antioxidant effects derived through consuming a diet rich in fruit and vegetables [5,6].…”