Salads and lung cancer.

Lung cancer risk: Data about lung cancer risk was provided by 3 cohorts. A significant protective effect of mixed salads was found in one cohort (18), but no associations with mixed (19), or green salads (7) were found in the remaining cohorts.
Lung cancer mortality: Data about lung cancer mortality was provided by 2 cohorts. A protective effect of green salad was found in one cohort, but results were unadjusted (3). No association with raw vegetable salads was found in the other cohort (20).

Conclusion: A significant protective effect of mixed salads against lung cancer risk was found in one cohort, and a significant protective effect of green salad against lung cancer mortality was found in another cohort, but no adjustments were made for possible confounders. Given the differences in salad definitions and end points, evidence was judged inconclusive for an association between salad consumption and lung cancer.

**Prospective studies of salads and lung cancer risk:**
Author	Cohort name	Subjects	Years of follow-up	Cases	End point	Consumption of	Relative Risk (RR)	Adjustments
19) Miller AB (2002)	The EPIC Study	127,892 men and 289,946 women.	4	247? men and 245? women	Lung cancer incidence	Mixed salads (not defined)	No significant association with lung cancer (no data shown).	Stratified by centre and gender and adjusted for time of follow-up and smoking.
18) Holick CN (2002)	The Alpha-tocopherol, Beta-carotene Cancer Prevention Study (ATBC).	27,084 white male smokers (≥ 5 cigarettes/day) aged 50-69. (Finland)	14 (1985-1998)	1,644?	Lung cancer incidence	Salads	Low intake of lettuce-cucumber-tomato salad or Chinese cabbage-cucumber-tomato salad was associated with lung cancer (No data shown; P = < 0.05).	Age, years smoked, cigarettes per day, intervention (alpha-tocopherol, and beta-carotene supplements), supplement use (beta-carotene and vitamin A), energy intake, cholesterol and fat.
7) Fraser GE (1991)	The Adventist Health Study	34,198 white California seventh-day adventists. (USA)	6 (1977-1982)	56	Lung cancer risk	Green salads (not defined)	RR = 0.65 (0.29-1.47; P = 0.52) for the highest vs lowest tertile of consumption. Amount specific data (times/week): < 3: RR = 1. 3-6: RR = 0.81 (0.38-1.72). ≥ 7: RR = 0.65 (0.29-1.47).	Age, sex, and smoking history

Prospective studies of salads and lung cancer mortality:

Author

Cohort name

Subjects

Years of follow-up

Cases

End point

Consumption of

Relative Risk (RR)

Adjustments

20) Appleby PN. (2002)

The Health Food Shoppers Study.

10,741 subjects, aged 16-89 (4,325 men, 6,416 women. 8,675 non-smokers).
(UK)

1973-79 to 1997

81 (51 men, and 30 women. 37 non-smokers)?

Lung cancer mortality

Raw vegetable salads (not defined)

RR = 1.03 (0.60-1.76; No P-value) for daily consumption vs less frequent consumption.

Age at recruitment, sex, smoking, and each other food (fresh fruit, wholemeal bread, nuts/dried fruit, raw vegetable salads, and bran cereals).

20) Key TJ. (1996)

The Health Food Shoppers Study.

10.771 (4.336 men and 6.435 women) aged > or = 16, recruited through health food shops, vegeterian societies, and magazines.
(UK)

16.8
(1973-79 to 1995)

59? (37 men, 22 women)

lung cancer mortality

raw salad (not defined)

RR = 0.90 (0.51-1.58; No P-value) for consumption at least daily vs < daily.

age, sex, and smoking

3) Wang LD (1985)

Not defined (The American Cancer Society)

? white men aged 40-74.

1959-60 to 1970

2,952 (for age group 45-74)

Lung cancer death

Green salad

Mortality ratio = 1.30 for the lowest vs highest tertile of consumption.

Amount specific data (days per week):
0-2: MR = 1.30.
3-4: MR = 1.14.
5-7: MR = 1.

**Stratified by age group:**
45-49 (225 cases)	50-54 (501 cases)	55-59 (671 cases)	60-64 (702 cases)	65-69 (542 cases)	70-74 (311 cases)
Mortality ratio = 1.16 for the lowest vs highest tertile of consumption. Amount specific data (days per week): 0-2: MR = 1.16. 3-4: MR = 1.05. 5-7: MR = 1.	Mortality ratio = 1.48 for the lowest vs highest tertile of consumption. Amount specific data (days per week): 0-2: MR = 1.48. 3-4: MR = 1.48. 5-7: MR = 1.	Mortality ratio = 1.35 for the lowest vs highest tertile of consumption. Amount specific data (days per week): 0-2: MR = 1.35. 3-4: MR = 1.22. 5-7: MR = 1.	Mortality ratio = 1.33 for the lowest vs highest tertile of consumption. Amount specific data (days per week): 0-2: MR = 1.33. 3-4: MR = 0.91. 5-7: MR = 1.	Mortality ratio = 1.24 for the lowest vs highest tertile of consumption. Amount specific data (days per week): 0-2: MR = 1.24. 3-4: MR = 1.10. 5-7: MR = 1.	Mortality ratio = 1.08 for the lowest vs highest tertile of consumption. Amount specific data (days per week): 0-2: MR = 1,08. 3-4: MR = 1.09. 5-7: MR = 1.

Not defined, probably unadjusted.

Cancer & Diet. A systematic review.

Literature review.

Relating various aspects of our diet
to lung cancer risk & mortality.

Salads and lung cancer.

Cancer & Diet. A systematic review.

Literature review.

Relating various aspects of our dietto lung cancer risk & mortality.

Salads and lung cancer.

Relating various aspects of our diet
to lung cancer risk & mortality.