| 30) Nomura AM (2008) | The Multiethnic Cohort Study. | 85,903 men and 105,108 women aged 45-75.
(Hawaii and California) | 7.3
(1993-96 to 2001) | 1138? men, and 972? women | Colorectal cancer risk
(only invasive adenocarcinoma of the large bowel) | Citrus fruit (not defined. excluding fruit juices) |
| Men: | Women: |
RR = 0.85 (0.70-1.04; P = 0.082) for the highest vs lowest quintile of consumption.
Amount specific data (quintiles not defined):
Q1: RR = 1.
Q2: RR = 0.91 (0.75-1.10).
Q3: RR = 0.96 (0.80-1.16).
Q4: RR = 0.72 (0.59-0.89).
Q5: RR = 0.85 (0.70-1.04).
|
RR = 1.04 (0.83-1.30; P = 0.368) for the highest vs lowest quintile of consumption.
Amount specific data (quintiles not defined):
Q1: RR = 1.
Q2: RR = 0.95 (0.75-1.19).
Q3: RR = 0.90 (0.71-1.13).
Q4: RR = 1.08 (0.86-1.34).
Q5: RR = 1.04 (0.83-1.30).
|
Age, family history of colorectal cancer, history of colorectal polyp, pack-years of cigarette smoking, BMI, hours of vigorous activity, aspirin use, multivitamin use, replacement hormone use, log energy intake, alcohol, red meat, folate, vitamin D, and calcium. |
| 29) Koushik A. (2007) | Pooled Analysis of 14 Cohort Studies. | 756,217 subjects (242,362 men and 513,855 women) | 6-20 years | 5,838? (1,890 men and 3,948 women). 3,063 proximal colon and 2,313 distal colon (data of colon site missing for 462 subjects) | Colon cancer risk | Rutaceae |
INCLUSION CRITERIA:
- Publication of a diet and cancer association.
- Diagnosis of at least 50 incident colorectal cancer cases.
- Assessment of usual diet.
- Conduct of a validation study of the dietary assessment method or a closely related instrument.
INCLUDED STUDIES (Follow-up years/No. of colon cancer cases).
In the analysis, an extended follow-up period for most of the studies was included:
- The Adventist Health Study. (1976-1982/52 men, 67 women)
Singh PN, Fraser GE. Dietary risk factors for colon cancer in a low-risk population. Am J Epidemiol. 1998 Oct 15;148(8):761-74. Full text
- The Alpha-Tocopherol Beta-Carotene Cancer Prevention Study. (1984-1999/187 men)
Pietinen P, Malila N, Virtanen M, Hartman TJ, Tangrea JA, Albanes D. Diet and risk of colorectal cancer in a cohort of Finnish men. Cancer Causes Control. 1999 Oct;10(5):387-96. Abstract
- The Cancer Prevention Study II Nutrition Cohort. (1992-1999/467 men, 349 women)
McCullough ML, Robertson AS, Chao A, Jacobs EJ, Stampfer MJ, Jacobs DR. A prospective study of whole grains, fruits, vegetables, and colon cancer risk. Cancer Causes Control. 2003 Dec;14(10):959-70. Abstract
- The Health Professionals Follow-up Study. (1986-2000/456 men)
Michels KB, Edward Giovannucci, Joshipura KJ, Rosner BA, Stampfer MJ, Fuchs CS. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst. 2000 Nov 1;92(21):1740-52. Full text
- The Netherlands Cohort Study. (1986-1993/393 men, 353 women)
Voorrips LE, Goldbohm RA, van Poppel G, Sturmans F, Hermus RJ, van den Brandt PA. Vegetable and fruit consumption and risks of colon and rectal cancer in a prospective cohort study: The Netherlands Cohort Study on diet and cancer. Am J Epidemiol. 2000 Dec 1;152(11):1081-92. Full text
- The New York State Cohort. (1980-1987/335 men, 223 women)
Bandera EV, Freudenheim JL, Marshall JR, Zielezny M, Priore RL, Brasure J. Diet and alcohol consumption and lung cancer risk in the New York State Cohort (United States). Cancer Causes Control. 1997 Nov;8(6):828-40. Abstract
- The Breast Cancer Detection Demonstration Project Follow-up Study. (1987-1999/349 women)
Flood A, Velie EM, Chaterjee N, Subar AF, Thompson FE, Lacey JV Jr. Fruit and vegetable intakes and the risk of colorectal cancer in the Breast Cancer Detection Demonstration Project follow-up cohort. Am J Clin Nutr. 2002 May;75(5):936-43. Full text
- The Canadian National Breast Screening Study. (1980-2000/431 women)
Terry P, Jain M, Miller AB, Howe GR, Rohan TE. Dietary intake of folic acid and colorectal cancer risk in a cohort of women. Int J Cancer. 2002 Feb 20;97(6):864-7. Abstract
- The Iowa Women's Health Study. (1986-2001/799 women)
Steinmetz KA, Kushi LH, Bostick RM, Folsom AR, Potter JD. Vegetables, and fruit colon cancer in the Iowa Women's Health Study. Am J Epidemiol. 1994 Jan 1;139(1):1-15. Abstract
- The New York University Women's Health Study. (1985-1998/96 women)
Kato I, Akhmedkhanov A, Koenig K, Toniolo PG, Shore RE, Riboli E. Prospective study of diet and female colorectal cancer: the New York University Women's Health Study. Nutr Cancer. 1997;28(3):276-81. Abstract
- The Nurses' Health Study A + B. (A = 1980-1986/162 women. B = 1986-2000/429 women)
Michels KB, Edward Giovannucci, Joshipura KJ, Rosner BA, Stampfer MJ, Fuchs CS. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst. 2000 Nov 1;92(21):1740-52. Full text
- The Prospective Study on Hormones, Diet and Breast Cancer. (1987-2001/ 43 women)
Sieri S, Krogh V, Muti P, Micheli A, Pala V, Crosignani P. Fat and protein intake and subsequent breast cancer risk in postmenopausal women. Nutr Cancer. 2002;42(1):10-7. Abstract
- The Swedish Mammography Cohort. (1987-2003/484 women)
Terry P, Giovannucci E, Michels KB, Bergkvist L, Hansen H, Holmberg L. Fruit, vegetables, dietary fiber, and risk of colorectal cancer. J Natl Cancer Inst. 2001 Apr 4;93(7):525-33. Full text
- The Women's Health Study. (1993-2003/163 women)
Lin J, Zhang SM, Cook NR, Rexrode KM, Liu S, Manson JE. Dietary intakes of fruit, vegetables, and fiber, and risk of colorectal cancer in a prospective cohort of women (United States). Cancer Causes Control. 2005 Apr;16(3):225-33. Abstract
RELATIVE RISK:
RR = 0.94 (0.88-1.01; No P-value) for the highest vs lowest tertile of consumption. | BMI; height; education; physical activity; family history of colorectal cancer; postmenopausal hormone use; oral contraceptive use; use of nonsteroidal anti-inflammatory drugs; multivitamin use; smoking habits (never/past/current + amount); red meat; total milk; alcohol; and total energy. Age in years and year of questionnaire return were included as stratification variables. |
| 27) Park Y. (2007) | The NIH-AARP Diet And Health Study. | 488,043 (291,094 men and 196,949 women) aged 50-71.
(USA) | 4,3
(1996-2000) | 2,972? (2,048 men and 924 women) | colorectal cancer risk | Citrus fruit (included orange, orange juice, and grapefruit) |
| Men: | Women: |
RR = 0.89 (0.77-1.03; P = 0.27) for the highest vs lowest quintile of consumption.
Amount specific data (median intake in servings/1,000 kcal/day):
0.04: RR = 1.
0.19: RR = 0.93 (0.81-1.06).
0.43: RR = 0.96 (0.84-1.10).
0.73: RR = 0.99 (0.86-1.13).
1.36: RR = 0.89 (0.77-1.03).
|
RR = 1.09 (0.88-1.35; P = 0.98) for the highest vs lowest quintile of consumption.
Amount specific data (median intake in servings/1,000 kcal/day):
0.05: RR = 1.
0.21: RR = 1.14 (0.93-1.40).
0.50: RR = 1.20 (0.98-1.48).
0.84: RR = 0.99 (0.80-1.23).
1.51: RR = 1.09 (0.88-1.35). |
One serving = 1 medium-sized piece of fruit, 1/2 cup of cut fruit, or 6 ounces of juice (1 cup = 237 mL, 1 ounce = 29.6 mL).education, physical activity, smoking (smoking/past/current. And < or = 20 vs > 20 cigarettes/day), alcohol, red meat, dietary calcium, total energy |
| 23) Lin J. (2005) | The Women's Health Study. | 36,976 women aged > or = 45 years.
(USA) | 10 | Colorectal: 222.
Proximal: 91? | colorectal cancer risk | Citrus fruit (grapefruit, oranges, grapefruit juice, orange juice) |
RR = 1.11 (0.71-1.74; P = 0.61) for the highest vs lowest quintile of consumption.
Amount specific data (servings/day):
0.1: RR = 1.
0.3: RR = 1.09 (0.72-1.65).
0.6: RR = 1.06 (0.67-1.66).
1.0: RR = 0.78 (0.49-1.24).
1.6: RR = 1.11 (0.71-1.74).
No association with proximal colon cancer risk.
No relationship with rectal cancer was assessed due to the small number of cases. | age, randomized treatment assignment, BMI, family history of colorectal cancer, history of colon polyps, physical activity, smoking status, baseline aspirin use, red meat intake, alcohol consumption, total energy intake, menopausal status, baseline post-menopausal HT use, folate intake and multivitamin use. Glycemic load in the multivariate model did not change the overall results. |
| 9) Voorrips LE. (2000) | The Netherlands Cohort Study. | 62,573 women and 58,279 men aged 55-69.
(The Netherlands) | 6.3
(1986-1992) | 611? colon (331 men, 280 women), and 334? rectal (215 men, 119 women) | Colorectal cancer risk | Citrus fruit (mandarins, oranges and fresh orange juice, grapefruits and fresh grapefruit juice, processed orange/grapefruit juice) |
Colon cancer risk:
| Men | Women |
RR = 1.09 (0.75-1.59; P = 0.44) for the highest vs lowest quintile of consumption.
Amount specific data (g/day):
0: RR = 1.
17: RR = 0.95 (0.64-1.41).
41: RR = 0.95 (0.64-1.40).
83: RR = 1.08 (0.74-1.58).
167: RR = 1.09 (0.75-1.59).
|
RR = 1.00 (0.66-1.52; P = 0.99) for the highest vs lowest quintile of consumption.
Amount specific data (g/day):
8: RR = 1.
38: RR = 0.95 (0.62-1.45).
79: RR = 1.22 (0.82-1.81).
111: RR = 0.94 (0.62-1.45).
187: RR = 1.00 (0.66-1.52).
|
Rectal cancer risk:
| Men | Women |
RR = 0.77 (0.49-1.20; P = 0.33) for the highest vs lowest quintile of consumption.
Amount specific data (g/day):
0: RR = 1.
17: RR = 0.74 (0.47-1.18).
41: RR = 1.00 (0.65-1.54).
83: RR = 0.81 (0.52-1.27).
167: RR = 0.77 (0.49-1.20).
|
RR = 1.16 (0.63-2.12; P = 0.38) for the highest vs lowest quintile of consumption.
Amount specific data (g/day):
8: RR = 1.
38: RR = 0.96 (0.51-1.79).
79: RR = 1.08 (0.59-1.97).
111: RR = 1.27 (0.70-2.30).
187: RR = 1.16 (0.63-2.12).
|
Age, family history of colorectal cancer, and alcohol. Total energy intake, smoking, physical activity, and BMI were evaluated as potential confounders. |
| 7) McCullough ML (2003) | The Cancer Prevention Study II Nutrition Cohort. | 62,609 men and 70,554 women aged 50-74. (The Nutrition Cohort is a subgroup of the approx. 1.2 million participants in CPS II) | 1992-93 to 1997 | 508 (298 men, 210 women) | colon cancer risk (fatal and nonfatal) | Citrus (defined as: Oranges. Grapefruit. Orange juice or grapefruit juice) |
| Men: | Women: |
RR = 0.85 (0.58-1.26; P = 0.94) for the highest vs lowest quintile of consumption.
Amount specific data (servings/day):
< 0.2: RR = 1.
0.2-< 1.0: RR = 0.88 (0.61-1.26).
1.0-< 2.1: RR = 0.92 (0.64-1.33).
2.1-< 4.6: RR = 1.14 (0.80-1.62).
≥ 4.6: RR = 0.85 (0.58-1.26).
|
RR = 0.71 (0.47-1.07; P = 0.40) for the highest vs lowest quintile of consumption.
Amount specific data (servings/day):
< 0.2: RR = 1.
0.2-< 0.9: RR = 0.73 (0.48-1.10).
0.9-< 1.8: RR = 0.66 (0.42-1.02).
1.8-< 4.5: RR = 0.82 (0.53-1.28).
≥ 4.5: RR = 0.71 (0.47-1.07).
|
age, exercise, METs, aspirin, smoking, family history of colorectal cancer, BMI, education, energy, multivitamin use, total calcium and red meat intake. Alcohol intake was not included because it did not influence the effect estimates when entered in the multivariate models. |
| 6) Michels KB. (2000) | The Nurses' Health Study
&
The Health Professionals' Follow-up Study. | 88,764 women aged 34-59 and 47,325 men aged 40-75.
(USA) | Women: 16
(1980-1996).
Men: 10
(1986-1996) | Colon cancer: 937 (368 men, 569 women).
Rectal cancer: 244 (89 men, 155 women) | Colorectal cancer risk | Total citrus fruit
(defined as: grapefruit, oranges, grapefruit juice, orange juice) FFq |
Colon cancer risk:
| Women | Men |
RR = 0.97 (No 95% CI; No P-value) for the highest vs lowest quintile of consumption
Amount specific data (servings):
≤ 1/wk: RR = 1.
2-4/wk: RR = 1.07.
5-6/wk: RR = 0.93.
1/day: RR = 0.81.
≥ 2/day: RR = 0.97.
|
RR = 1.19 (No 95% CI; No P-value) for the highest vs lowest quintile of consumption
Amount specific data (servings):
≤ 1/wk: RR = 1.
2-4/wk: RR = 1.09.
5-6/wk: RR = 1.07.
1/day: RR = 1.31.
≥ 2/day: RR = 1.19.
|
men + women combined (colon cancer):
| No vitamin supplement users | Vitamin supplement users |
| RR = 0.97 (0.83-1.13) for 1 additional serving/day. | RR = 1.02 (0.92-1.13) for 1 additional serving/day. |
men + women combined (colon cancer):
| Never smokers | Ever smokers |
| RR = 1.01 (0.88-1.16) for 1 additional serving/day. | RR = 1.01 (0.90-1.14) for 1 additional serving/day. |
Rectal cancer risk:
| Women: | Men: |
RR = 0.72 (No 95% CI; No P-value) for the highest vs lowest quintile of consumption
Amount specific data (servings):
≤ 1/wk: RR = 1.
2-4/wk: RR = 0.55.
5-6/wk: RR = 0.79.
1/day: RR = 0.73.
≥ 2/day: RR = 0.72.
|
RR = 1.50 (No 95% CI; No P-value) for the highest vs lowest quintile of consumption
Amount specific data (servings):
≤ 1/wk: RR = 1.
2-4/wk: RR = 1.22.
5-6/wk: RR = 0.89.
1/day: RR = 0.92.
≥ 2/day: RR = 1.50.
|
age, family history of colorectal cancer, sigmoidoscopy, height, body mass index, pack-years of smoking, alcohol intake, physical activity, (women: menopausal status, postmenopausal hormone use,) aspirin use, vitamin supplement intake (ever use of multivitamins or vitamins A, C, or E), total caloric intake, and red meat consumption. |
Prospective studies of citrus fruit and colorectal cancer mortality:
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 22) Iso H (2007) | The JACC Study. | 43,011 men, and 59,504 women.
(Japan) | Not defined. | 198 men, and
199 women. | Colon cancer mortality | Citrus fruits (not defined) |
| Men: | Women: |
HR = 1.44 (0.97-2.13; P = < 0.01) for the highest vs lowest tertile of consumption.
Amount specific data:
< 3/w: HR = 1.
3-4/w: HR = 1.39 (0.93-2.08).
≥ 5/w: HR = 1.44 (0.97-2.13).
|
HR = 0.98 (0.68-1.42) for the highest vs lowest tertile of consumption.
Amount specific data:
< 3/w: HR = 1.
3-4/w: HR = 1.19 (0.80-1.77).
≥ 5/w: HR = 0.98 (0.68-1.42).
|
Age and study area. |
| 22) Iso H (2007) | The JACC Study. | 43,011 men, and 59,504 women.
(Japan) | Not defined. | 150 men, and
81 women. | Rectal cancer mortality | Citrus fruits (not defined) |
| Men: | Women: |
HR = 1.24 (0.80-1.94) for the highest vs lowest tertile of consumption.
Amount specific data:
< 3/w: HR = 1.
3-4/w: HR = 0.92 (0.56-1.51).
≥ 5/w: HR = 1.24 (0.80-1.94).
|
HR = 0.97 (0.53-1.77) for the highest vs lowest tertile of consumption.
Amount specific data:
< 3/w: HR = 1.
3-4/w: HR = 0.79 (0.39-1.59).
≥ 5/w: HR = 0.97 (0.53-1.77).
|
Age and study area. |
| | | | | | |