Orange and/or grapefruit juice and lung cancer.

Lung cancer risk: Data about lung cancer risk was provided by a pooled analysis of 6 cohorts and 1 additional cohort including a total of 3,777 cases. A significant protective effect was found in the pooled analysis including 2,839 cases (24). No association was found in the single cohort, which was of very large size (19).

Inclusion of intermediate levels of consumption:
A significant protective effect at consumption of > 24 g/day was found in the pooled analysis. In addition, a significant protective effect at an intermediate level of consumption (14-55 g/day) was found in the single cohort. For this analysis, the average RR = 0.81

RRs for citrus fruit juice in g/day.
1 oz of citrus fruit juice was calculated to 28.35 g.

Lung cancer mortality: No data was found.

Conclusion: A significant protective effect of citrus fruit juice against lung cancer risk was found in a pooled analysis of 6 cohorts (including 75% of all cases). No (non)significantly increased risks were found in other studies. Citrus fruit juice possibly protects against lung cancer risk. The evidence was stronger for an intermediate level of consumption (24-55 g/day), at which citrus fruit juice probably protects against lung cancer risk (- 19%).

Author

Cohort name

Subjects

Years of follow-up

Cases

End point

Consumption of

Relative Risk (RR)

Adjustments

24) Smith-Warner SA (2003)

Pooled analysis of 6 prospective studies.

392,994

6-16

2,839

Lung cancer risk

Orange and grapefruit juice

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 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 = 0.82 (0.71-0.94; P = 0.01) for the highest vs lowest quartile of consumption.

Amount specific data (servings):
0: RR = 1.
> 0 to < 1/week: RR = 0.90 (0.79-1.02).
> 1/week to 1/2/day: RR = 0.82 (0.71-0.95).
≥ 1/2/day: RR = 0.82 (0.71-0.94).

One serving = 6 oz.

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: 0.27.
P for between-study heterogeneity due to sex: 0.11.

Adjusted for education, BMI, alcohol intake, calories, smoking status, smoking duration for past/current smokers, amount smoked for current smokers.

19) Linseisen J (2007)

The EPIC Study

478,590 individuals, mostly aged 25-70 from 10 European countries.

6.4
(1992-2000)

938 (653 current smokers, 217 former smokers, and 98 never smokers)

lung cancer risk

Citrus fruit juices

HR = 0.82 (0.65-1.03) for the highest vs lowest quintile of consumption.

Amount specific data (g/day):
0: HR = 1.
0-3.5: HR = 0.82 (0.66-1.02).
3.5-14.3: HR = 0.94 (0.74-1.20).
14.3-54.8: HR = 0.78 (0.61-0.99).
54.8-2632.0: HR = 0.82 (0.65-1.03).

**Stratified by smoking status:**
Current smokers	Former smokers	Never smokers
HR = 0.78 (0.59-1.02) for the highest vs lowest quintile of consumption. Amount specific data (g/day): 0: HR = 1. 0-3.5: HR = 0.81 (0.62-1.05). 3.5-14.3: HR = 1.00 (0.76-1.33). 14.3-54.8: HR = 0.66 (0.49-0.89). 54.8-2632.0: HR = 0.78 (0.59-1.02).	HR = 0.82 (0.52-1.30) for the highest vs lowest quintile of consumption. Amount specific data (g/day): 0: HR = 1. 0-3.5: HR = 0.75 (0.47-1.21). 3.5-14.3: HR = 0.70 (0.41-1.17). 14.3-54.8: HR = 0.98 (0.62-1.56). 54.8-2632.0: HR = 0.82 (0.52-1.30).	HR = 1.43 (0.61-3.33) for the highest vs lowest quintile of consumption. Amount specific data (g/day): 0: HR = 1. 0-3.5: HR = 1.66 (0.71-3.90). 3.5-14.3: HR = 1.63 (0.65-4.12). 14.3-54.8: HR = 1.29 (0.53-3.16). 54.8-2632.0: HR = 1.43 (0.61-3.33).

Since results were not significantly different between men and women, no sex-stratified results are presented.

adjusted for tobacco smoking (status and duration), education (5 categories), physical activity at work (5 categories), intake of red meat, intake of processed meat, height, weight, nonfat energy intake, energy intake from fat, ethanol intake at baseline

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

Orange juice

No significant association with risk (no data shown).

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.

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

Grapefruit juice

Women: A marginally significant lower risk: RR = 0.31 (0.31-1.01; 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.

14) Speizer FE (1999)

The Nurses' Health Study.

89,284 women aged 34-59 years.
(USA)

12
(1980-1992)

399?

Lung cancer risk

Orange juice

RR = 0.7 (No 95% CI; P = 0.17) for the highest vs the lowest quintile of consumption.

Amount specific data (Frequency of consumption):
Never: RR = 1.
1-3/mo: RR = 0.7.
2-4/wk: RR = 0.6.
5-6/wk: RR = 0.8.
≥ 1/day: RR = 0.7.

age, smoking (past, current, amount in 1980), and age of starting to smoke

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

Orange/grapefruit juice (processed)

RR = 0.9 (0.7-1.1; P = 0.06) for consumption 20 vs 0 g/day (Only measured in 2 units of consumption).

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.