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

Anita Koushik, David J. Hunter, Donna Spiegelman, W. Lawrence Beeson, Piet A. Van Den Brandt, Julie E. Buring, Eugenia E. Calle, Eunyoung Cho, Gary E. Fraser, Jo L. Freudenheim, Charles S. Fuchs, Edward L. Giovannucci, R. Alexandra Goldbohm, Lisa Harnack, David R. Jacobs, Ikuko Kato, Vittorio Krogh, Susanna C. Larsson, Michael F. Leitzmann, James R. MarshallMarjorie L. McCullough, Anthony B. Miller, Pirjo Pietinen, Thomas E. Rohan, Arthur Schatzkin, Sabina Sieri, Mikko J. Virtanen, Alicja Wolk, Anne Zeleniuch-Jacquotte, Shumin M. Zhang, Stephanie A. Smith-Warner

Research output: Contribution to journalArticle

185 Citations (Scopus)

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 t rend =.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 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 multivari- able 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 t rend =.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.

Original languageEnglish
Pages (from-to)1471-1483
Number of pages13
JournalJournal of the National Cancer Institute
Volume99
Issue number19
DOIs
Publication statusPublished - Oct 2007

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Vegetables
Colonic Neoplasms
Fruit
Cohort Studies
Confidence Intervals
Colon
Proportional Hazards Models
Prospective Studies
Diet
Incidence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

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), 1471-1483. https://doi.org/10.1093/jnci/djm155

Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies. / Koushik, Anita; Hunter, David J.; Spiegelman, Donna; Beeson, W. Lawrence; Van Den Brandt, Piet A.; Buring, Julie E.; Calle, Eugenia E.; Cho, Eunyoung; Fraser, Gary E.; Freudenheim, Jo L.; Fuchs, Charles S.; Giovannucci, Edward L.; Goldbohm, R. Alexandra; Harnack, Lisa; Jacobs, David R.; Kato, Ikuko; Krogh, Vittorio; Larsson, Susanna C.; Leitzmann, Michael F.; Marshall, James R.; McCullough, Marjorie L.; Miller, Anthony B.; Pietinen, Pirjo; Rohan, Thomas E.; Schatzkin, Arthur; Sieri, Sabina; Virtanen, Mikko J.; Wolk, Alicja; Zeleniuch-Jacquotte, Anne; Zhang, Shumin M.; Smith-Warner, Stephanie A.

In: Journal of the National Cancer Institute, Vol. 99, No. 19, 10.2007, p. 1471-1483.

Research output: Contribution to journalArticle

Koushik, A, Hunter, DJ, Spiegelman, D, Beeson, WL, Van Den Brandt, PA, Buring, JE, Calle, EE, Cho, E, Fraser, GE, Freudenheim, JL, Fuchs, CS, Giovannucci, EL, Goldbohm, RA, Harnack, L, Jacobs, DR, Kato, I, Krogh, V, Larsson, SC, Leitzmann, MF, Marshall, JR, McCullough, ML, Miller, AB, Pietinen, P, Rohan, TE, Schatzkin, A, Sieri, S, Virtanen, MJ, Wolk, A, Zeleniuch-Jacquotte, A, Zhang, SM & Smith-Warner, SA 2007, 'Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies', Journal of the National Cancer Institute, vol. 99, no. 19, pp. 1471-1483. https://doi.org/10.1093/jnci/djm155
Koushik A, Hunter DJ, Spiegelman D, Beeson WL, Van Den Brandt PA, Buring JE et al. Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies. Journal of the National Cancer Institute. 2007 Oct;99(19):1471-1483. https://doi.org/10.1093/jnci/djm155
Koushik, Anita ; Hunter, David J. ; Spiegelman, Donna ; Beeson, W. Lawrence ; Van Den Brandt, Piet A. ; Buring, Julie E. ; Calle, Eugenia E. ; Cho, Eunyoung ; Fraser, Gary E. ; Freudenheim, Jo L. ; Fuchs, Charles S. ; Giovannucci, Edward L. ; Goldbohm, R. Alexandra ; Harnack, Lisa ; Jacobs, David R. ; Kato, Ikuko ; Krogh, Vittorio ; Larsson, Susanna C. ; Leitzmann, Michael F. ; Marshall, James R. ; McCullough, Marjorie L. ; Miller, Anthony B. ; Pietinen, Pirjo ; Rohan, Thomas E. ; Schatzkin, Arthur ; Sieri, Sabina ; Virtanen, Mikko J. ; Wolk, Alicja ; Zeleniuch-Jacquotte, Anne ; Zhang, Shumin M. ; Smith-Warner, Stephanie A. / Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies. In: Journal of the National Cancer Institute. 2007 ; Vol. 99, No. 19. pp. 1471-1483.
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title = "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 t rend =.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 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 multivari- able 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 t rend =.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.",
author = "Anita Koushik and Hunter, {David J.} and Donna Spiegelman and Beeson, {W. Lawrence} and {Van Den Brandt}, {Piet A.} and Buring, {Julie E.} and Calle, {Eugenia E.} and Eunyoung Cho and Fraser, {Gary E.} and Freudenheim, {Jo L.} and Fuchs, {Charles S.} and Giovannucci, {Edward L.} and Goldbohm, {R. Alexandra} and Lisa Harnack and Jacobs, {David R.} and Ikuko Kato and Vittorio Krogh and Larsson, {Susanna C.} and Leitzmann, {Michael F.} and Marshall, {James R.} and McCullough, {Marjorie L.} and Miller, {Anthony B.} and Pirjo Pietinen and Rohan, {Thomas E.} and Arthur Schatzkin and Sabina Sieri and Virtanen, {Mikko J.} and Alicja Wolk and Anne Zeleniuch-Jacquotte and Zhang, {Shumin M.} and Smith-Warner, {Stephanie A.}",
year = "2007",
month = "10",
doi = "10.1093/jnci/djm155",
language = "English",
volume = "99",
pages = "1471--1483",
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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.

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.

PY - 2007/10

Y1 - 2007/10

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 t rend =.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 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 multivari- able 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 t rend =.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.

AB - 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 t rend =.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 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 multivari- able 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 t rend =.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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