Prospective studies of apples/pears and lung cancer risk:
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 30) Wang L (2009) | The Women's Health Study | 38,408 female health professionals aged ≥ 45.
(USA) | 11.5
(1992-95 to 2007) | 241? | Lung cancer incidence | Apples | Risk did not materially change with intake (data not shown). | Age, race, total energy, randomized treatment assignment, smoking, alcohol use, physical activity, postmenopausal status, hormone replacement therapy use, multivitamin use, family history of colorectal cancer, ovary cancer, or breast cancer, and intake of fruit and vegetables, fiber, folate, and saturated fat. |
| 25) Liu Y (2004) | Cohort II of The JPHC Study | 51,114 (aged 40-69) subjects.
(Japan) | 7
(1993-1999) | 251? | lung cancer risk | Apple | Inverse associations between lung cancer and specific individual fruits were not observed (no data shown). | age, gender, area, sports, frequency of alcohol intake, BMI, vitamin supplement use, salted fish and meat, pickled vegetables, smoking duration, and number of cigarettes per day among ever smokers. |
| 24) Smith-Warner SA (2003) | Pooled analysis of 7 prospective studies. | 399,765 | 6-16 | 3,138 | Lung cancer risk | Apples, pears |
INCLUSION CRITERIA:
- At least 50 incident lung cancer cases.
- Assessment of usual diet.
- Conduct of a validation of the diet assessment method or a closely related instrument.
- Assessment of smoking habits.
INCLUDED STUDIES (Follow-up years/No. of lung cancer cases):
- The Alpha-tocopherol, Beta-carotene Cancer Prevention Study (Only the placebo group is included in this analysis). (1985-1996/298 men)
Albanes D, Heinonen OP, Taylor PR, Virtamo J, Edwards BK, Rautalahti. Alpha-Tocopherol and beta-carotene supplements and lung cancer incidence in the alpha-tocopherol, beta-carotene cancer prevention study: effects of base-line characteristics and study compliance. J Natl Cancer Inst. 1996 Nov 6;88(21):1560-70. Full text
- The Canadian National Breast Screening Study. (1980-1993/149 women)
Rohan TE, Jain M, Howe GR, Miller AB. A cohort study of dietary carotenoids and lung cancer risk in women (Canada). Cancer Causes Control. 2002 Apr;13(3):231-7. Abstract
- The Health Professionals' Follow-up Study. (1986-1996/244 men)
Feskanich D, Ziegler RG, Michaud DS, Giovannucci EL, Speizer FE, Willet WC. Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. J Natl Cancer Intst. 2000 Nov 15;92(22):1812-23. Full text
- The Iowa Women's Health Study. (1986-1996/433 women)
Steinmetz KA, Potter JD, Folsom AR. Vegetables, fruit, and lung cancer in the Iowa Women's Health Study. Cancer Res. 1993 Feb 1;53(3):536-43. Full text
- The Netherlands Cohort Study. (1986-1992/843 men, 131 women)
Voorrips LE, Goldbohm RA, Verhoeven DT, van Poppel GA, Sturmans F, Hermus RJ. Vegetable and fruit consumption and lung cancer risk in the Netherlands Cohort Study on diet and cancer. Cancer Causes Control. 2000 Feb;11(2):101-15. Abstract
- The New York State Cohort. (1980-1987/392 men, 130 women)
Bandera EV, Freudenheim JL, Marshall JR, Zielezny M, Priore RL, Basure 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 Nurses' Health Study. A + B (A = 1980-1986/156 women. B = 1986-1996/379 women)
Feskanich D, Ziegler RG, Michaud DS, Giovannucci EL, Speizer FE, Willet WC. Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. J Natl Cancer Intst. 2000 Nov 15;92(22):1812-23. Full text
RELATIVE RISK:
RR = 0.80 (0.68-0.94; P = 0.03) for the highest vs lowest quartile of consumption.
Amount specific data (servings):
0: RR = 1.
> 0 to < 1/week: RR = 0.89 (0.78-1.02).
> 1/week to 1/2/day: RR = 0.81 (0.69-0.94).
≥ 1/2/day: RR = 0.80 (0.68-0.94).
One serving = 1 apple.
There were inverse associations for apples and pears; oranges and tangerines; and orange and grapefruit juice. After further adjustment for total fruit consumption, only the association for oranges and tangerines remained statistically significant (results not shown).
P for between-study heterogeneity: 0.23.
P for between-study heterogeneity due to sex: 0.41.
| Adjusted for education, BMI, alcohol intake, calories, smoking status, smoking duration for past/current smokers, amount smoked for current smokers. |
| 14) Feskanich D (2000) | The Nurses' Health Study
&
The Health Professionals' Follow-up Study | 77,283 US women (38-63 years) and 47,778 men (40-75 years) | Women: 1984-1996.
Men: 1986-1996. | 516? women, and
258? men | Total lung cancer risk | Apples and pears | Women: A significantly lower risk: RR = 0.63 (0.43-0.91; No P-value) for increases of 1 serving/day.
Men: none of the individual fruits were significantly associated with the risk of lung cancer. | Not defined, but probably: age, follow-up cycle, smoking status,years since quitting among past smokers, cigarettes smoked/day among current smokers, age at start of smoking, total energy intake, and availability of diet data after baseline measure. |
| 11) Voorrips LE (2000) | The Netherlands Cohort Study | 62,573 women and 58,279 men aged 55-69. | 6.3
(1986-1992) | 963 | lung cancer risk | Apples and pears |
RR = 1.1 (0.7-1.7; P = 0.20) for the highest vs lowest quintile of consumption.
Amount specific data (g/day):
0: RR = 1.
45: RR = 0.8 (0.7-1.1).
80: RR = 0.8 (0.6-1.2).
116: RR = 0.8 (0.6-1.1).
232: RR = 1.1 (0.7-1.7).
Additional adjustment for total vegetable intake did not change results at all (No data shown). | age, sex, family history of lung cancer, highest educational level, current smoker, years of smoking, number of cigarettes/day and total fruit intake. |
| 10) Cutler GJ. (2008) | The Iowa Women's Health Study. | 34,708 postmenopausal women aged 55-69.
(USA) | 1986-2004 | 849? | Lung cancer risk | Apples and pears | Stratified by smoking history, intake of apples (> 3 vs < 1 times/wk) was not associated with risk of lung cancer (No data shown). | Age, energy, education, race, BMI, multivitamin use, activity level, and pack years. |
| 8) Knekt P. (2002) | The Finnish Mobile Clinic Health Examination Cohort. | 10,054 men and women. | 30
(1967-1996) | 169? | Lung cancer risk | Apples | RR = 0.40 (0.22-0.74; P = 0.001).
No data shown, but probably for the highest vs lowest quartile of consumption.
The inverse association remained after adjustment for intake of vegetables and fruit other than apples. | Sex, age, geographic area, occupation, smoking, and BMI. |
| 8) Knekt P. (1997) | The Finnish Mobile Clinic Health Examination Cohort. | 9,959 men and women aged 15-99.
(Finland) | 24
(1967-1991) | 151? | Lung cancer risk | Apples | RR = 0.42 (0.23-0.76; No P-value) for the highest vs lowest quartile of consumption (not defined). This association did not notably alter after adjustment for the intakes of vegetables and fruits other than apples: RR = 0.48 (0.27-0.85; No P-value). | Sex, age, geographic area, occupation, smoking, BMI, and intakes of energy, vitamin C, vitamin E, beta carotene, fiber, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, and cholesterol. |