Vegetables and lung cancer.
Total vegetables and lung cancer risk.
About the male analysis: In 2003 a pooled analysis of 8 prospective studies was published (Smith-Warner SA [24]). The analysis included data from a total of
1,808 men of which 298 were from The ATBC Study. In 2002 another publication about The ATBC Study included data from 1,644 men (Holick CN [18]), which is nearly as
much as the total amount of cases from the pooled analysis. A similar finding was done with The Netherlands Cohort Study. For this systematic review it was chosen not
to include data about men from the pooled analysis as a whole, but from the individual cohorts, because this allowed for a much larger amount of cases in the analysis.
As a consequence of this decision, data about men from The New York State Cohort (including 392 male cases) can not be included in these specific parts of the review,
since no article is published about this specific cohort.
Results:
- Men & women combined: 32 articles, providing information about 20 different cohorts were found, including 14,125 cases. Significant protective effects were found in 3 cohorts among men (Balder HF [11], Holick CN [18], George SM [29]) including 7,162 male cases. The average RR = 0.90 (excluding incomplete data from Shekelle RB [1], and Ratnasinghe D [15]).
- Men: Data about 11 cohorts including a total of 8,107 cases was found. A significant protective effect was found in 3 cohorts (Balder HF [11], Holick CN [18],
George SM [29]) including 7,162 cases (88% of all cases). No associations were found in the remaining 8 cohorts.
The average RR = 0.82 (excluding incomplete data from Shekelle RB [1], and Ratnasinghe D [15]). - Women: Data about 9 cohorts including a total of 3,863 cases was found. No significant associations were found. The average RR = 1.01
- In three other cohorts including a total of 2,294 cases, risk was not stratified by sex. No associations were found. The average RR = 0.98
Inclusion of intermediate levels of consumption:
(Non)significant effects at any level of consumption among men were as follows:
- Balder HF (11) At 294 g/day (highest quintile of consumption).
- Holick CN (18) At ≥ 110 g/day.
- George SM (29) At 170-235, and at ≥ 424 g/day (2nd and 5th quintile of consumption).
Among men, overlapping effects were found at the level of ≥ 170 g/day.
(Non)significant effects at any level of consumption among women were as follows:
- Smith-Warner SA [24] At the 3rd quintile of consumption. No level of consumption could be defined, because the pooled analysis included study-specific quintiles of consumption from the 6 cohorts.
Among women, the possibility of an association at an intermediate level of consumption can not be excluded, but is impossible to assess based on this data.
Effect modification by variables other than sex and smoking status:
A significant protective effect among cancer cases diagnosed at age < 65 years, but not ≥ 65 years was found in a pooled analysis of 8 cohorts (Smith-Warner [24]).
In the same analysis, no evidence of effect modification was found by the number of fruit and vegetable questions included on a study's FFQ.
No evidence of effect modification was found by alcohol intake or multivitamin use in two cohorts (Feskanich D [14]), or by use of beta carotene/vitamin A supplements
in another cohort (Neuhouser ML [22]).
Conclusion: For men, a significant protective effect was found in 3 cohorts of moderate-very large size, and no (non)significantly increased risks were found in
the remaining cohorts. Total vegetables possibly protect against lung cancer risk among men (- 18%). Levels of consumption for this effect were ≥ 170 g/day,
and the effect may be restricted to cancer cases diagnosed at age < 65 years. No associations were found among women.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 29) George SM (2008) | The NIH-AARP Diet and Health Study | 4,092 | RR = 0.87 (0.78-0.96; P = 0.024) |
| 27) Alavanja MC (2004) | The Agricultural Health Study | 206 | RR = 0.8 (0.5-1.2; P = 0.13) |
| 18) Holick CN (2002) | The ATBC Study | 1,644 | RR = 0.75 (0.63-0.88; P = < 0.001) |
| 15) Ratnasinghe D (2000) | No cohort name | 106 | No significant difference (P = 0.46) |
| 14) Feskanich D (2000) | The Health Professionals' Follow-up Study | 258 | RR = 1.04 (0.69-1.57) |
| 11) Balder HF (2005) | The Netherlands Cohort Study | 1,426 | RR = 0.66 (0.50-0.87; P = 0.008) |
| 8) Knekt P (1999) | The Finnish Mobile Clinic Health Cohort | 138 | RR = 0.83 (0.54-1.26) |
| 5) Jansen MC (2004) | The Zutphen Elderly Study | 42 | RR = 0.95 (0.44-2.07; P = 0.92) |
| 4) Shibata A (1992) | The Leisure World Study | 94 | RR = 1.37 (0.74-2.25) |
| 2) Kvale G (1983) | No cohort name | 68 | RO = 0.74 (P = 0.37) |
| 1) Shekelle RB (1981) | The Western Electric Study | 33 | A nonsignificant inverse association (P = 0.23) |
| Total number of cases: 8,107 | Average RR = 0.82 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 29) George SM (2008) | The NIH-AARP Diet and Health Study | 2,347 | RR = 1.08 (0.94-1.23; P = 0.219) |
| 27) Alavanja MC (2004) | The Agricultural Health Study | 48 | RR = 0.6 (0.2-1.7; P = 0.09) |
| 24) Smith-Warner SA (2003) | Pooled analysis of 6 studies | 1,398 | RR = 0.93 (0.78-1.12; P = 0.59) |
| 4) Shibata A (1992) | The Leisure World Study | 70 | RR = 0.58 (0.32-1.05) |
| Total number of cases: 3,863 | Average RR = 1.01 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 25) Liu Y (2004) | The JPHC Study | 428 | RR = 1.03 (0.81-1.30) |
| 22) Neuhouser ML (2003) | The CARET Study | 326 (placebo), and 414 (intervention) | Placebo arm: RR = 0.82 (0.59-1.14; P = 0.39). Intervention arm: RR = 0.81 (0.65-1.21; P = 0.46). |
| 19) Linseinen J (2007) | The EPIC Study | 1,126 | HR = 1.06 (0.83-1.36) |
| Total number of cases: 2,294 | Average RR = 0.98 |
Total vegetables and lung cancer risk. Stratified by smoking status.
Background:
About the analysis: For this systematic review, data is stratified by smoking status into current smokers, former smokers, and never smokers.
The JPHC Study (Liu Y [25]) and CARET Study (Neuhouser M [22]) provided data about "ever smokers" without stratifying into former vs current smokers. Likewise,
The Finnish Mobile clinic Health Cohort (Knekt P [8]) provided data about "current nonsmokers" without stratifying into nonsmokers vs former smokers. It was chosen not
to include this data in the following tables.
About the analysis of current smokers: In 2003 a pooled analysis of 8 prospective studies was published (Smith-Warner SA [24]). The analysis included data from a
total of 1,915 smoking cases of which 298 were from The ATBC Study. In 2002 another publication about The ATBC Study included data from 1,644 smoking cases (Holick CN [18]),
which is nearly as much as the total amount of cases from the pooled analysis. For the systematic review it was chosen not to include data about current smokers from
the pooled analysis as a whole, but from the individual cohorts, because this allowed for a much larger amount of cases in the analysis.
Results:
- Current smokers: Data about current smokers was provided by 8 cohorts, including 6,206 cases. Significant protective effects were found in 3 cohorts (Voorrips LE [11]), Feskanich D [14] among women, and Holick CN [18]), including 2,436 cases (39% of all cases). And a nonsignificant protective effect was found in a fourth cohort (Steinmetz KA [10]). No other (non)significant associations were found. The average RR = 0.85
- Former smokers: Data about former smokers was provided by a pooled analysis of 7 cohorts, and 2 additional cohorts which were both of very large size. The analysis included 4,217 cases. A significant protective effects was found in one cohort among men, while among women a nonsignificantly increased risk was found (Wright ME [29]). No other associations were found. The average RR = 1.01
- Never smokers: Data about never smokers was provided by a pooled analysis of 7 cohorts, and 3 additional cohorts, including 774 cases. No (non)significant effects were found. The average RR = 0.94
Conclusion: Significant protective effects among current smokers were found in 3 cohorts of moderate-large size, including 39% of all cases. Suggestive evidence was found for a protective effect of total vegetables against lung cancer risk among current smokers (- 15%). Few associations were found among former-, or never smokers, and no evidence was found for an association among these subgroups.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 29) Wright ME (2008) | The NIH-AARP Diet and Health Study | 1,583 men, and 1,196 women | Men: RR = 0.97 (0.81-1.16; P = 0.90). Women: RR = 1.01 (0.84-1.22; P = 0.75). |
| 19) Linheisen J (2007) | The EPIC Study | 731 | HR = 0.78 (0.54-1.13) |
| 18) Holick CN (2002) | The ATBC Study | 1,644 | RR = 0.75 (0.63-0.88; P = < 0.001). |
| 14) Feskanich D (2000) | The Nurses' Health Study & The Health Professionals' Follow-up Study | 86 men, and 269 women | Men: RR = 0.95 (0.45-2.03).. Women: RR = 0.59 (0.39-0.89). |
| 11) Voorrips LE (2000) | The Netherlands Cohort Study | 523 | RR = 0.7 (0.5-1.0; P = 0.003). |
| 10) Steinmetz KA (1993) | The Iowa Women's Health Study | 81 | OR = 0.63 (0.30-1.33; P = 0.08). |
| 8) Knekt P (1991) | The Finnish Mobile Clinic Health Cohort | 93 | RR = 0.98 (P = 0.81) for low vs high consumption. |
| Total number of cases: 6,206 | Average RR = 0.85 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 29) Wright ME (2008) | The NIH-AARP Diet and Health Study | 2,110 men, and 835 women | Men: RR = 0.88 (0.77-1.01; P = 0.01). Women: RR = 1.26 (1.01-1.58; P = 0.07). |
| 24) Smith-Warner SA (2003) | Pooled analysis of 7 studies | 981 | RR = 0.97 (0.76-1.24; P = 0.83) |
| 19) Linheisen J (2007) | The EPIC Study | 291 | HR = 1.33 (0.85-2.08) |
| Total number of cases: 4,217 | Average RR = 1.01 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 29) Wright ME (2008) | The NIH-AARP Diet and Health Study | 141 men, and 170 women | Men: RR = 0.94 (0.56-1.59; P = 0.99). Women: RR = 0.72 (0.42-1.22; P = 0.27). |
| 25) Liu Y (2004) | The JPHC Study | 106 | RR = 1.37 (0.79-2.37; P = 0.20) |
| 24) Smith-Warner SA (2003) | Pooled analysis of 7 studies | 259 | RR = 0.90 (0.58-1.40; P = 0.75) |
| 19) Linheisen J (2007) | The EPIC Study | 98 | HR = 0.97 (0.46-2.04) |
| Total number of cases: 774 | Average RR = 0.94 |
Total vegetables and lung cancer mortality.
Data about lung cancer mortality is provided by 4 cohorts. Three of these cohorts measured food intake prior to cancer diagnosis (5, 9, 16), and another one
following diagnosis (19). No associations were found. The average RR = 1.02 (excluding incomplete data from Skuladottir H [19]).
Conclusion: No associations were found. No evidence was found for an association between total vegetables and lung cancer mortality.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 19) Skuladottir H (2006) | The Danish Diet, Cancer and Health Study | Not defined | HR = 0.84 (0.59-1.21) |
| 16) Breslow RA (2000) | The NIHS | 158 | RR = 0.9 (0.5-1.5; P = 0.786) |
| 9) Chow WH (1992) | The Lutheran Brotherhood Cohort | 219 | RR = 1.2 (0.6-2.3) |
| 5) Jansen MC (2001) | The Seven Countries Study | 149 | RR = 0.90 (0.61-1.33; P = 0.59) |
| Total number of cases: 526 + X | Average RR = 1.02 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 29) George SM (2008) | The National Institutes of Health-AARP Diet and Health Study. | 195,229 women and 288,109 men aged 50-71. (USA) | 1995-2003 | 2,347 women, and 4,092 men | Lung cancer incidence | Vegetables (excluding potatoes) |
1 cup = 237 mL. One cup is 1 cup of raw/cooked vegetable, 1 cup of 100% juice, or 2 cups of raw leafy greens. Age, smoking (smoking status, time since quitting, and smoking dose), energy intake, BMI, alcohol, physical activity, education , race, marital status, family history, menopausal hormone therapy (women), and fruit intake. |
29) Wright ME (2008) | The NIH-AARP Diet and Health Study | 472,081 subjects (281,288 men and 190,793 women) aged 50-71. | (USA) 8 | (1995-2003) See variables | Lung cancer risk | Total vegetables (Spinach, turnip, collard greens, mustard, kale, cole slaw, cabbage, sauerkraut, carrots, string beans, green beans, peas, corn, broccoli, cauliflower, Brussel sprouts, mixed vegetables, tomatoes, sweet peppers, lettuce salad, sweet potatoes, yams, tomato juice, tomato sauce, chili, and salsa. Excluding potatoes.) |
All men (3,834 cases): | RR = 0.93 (0.83-1.03; P = 0.08) for the highest vs lowest quintile of consumption. Amount specific data (servings per 1000 kcal per day): < 0.87: RR = 1. 0.87-1.22: RR = 0.98 (0.89-1.07). 1.23-1.61: RR = 0.96 (0.87-1.05). 1.62-2.20: RR = 0.91 (0.82-1.01). > 2.20: RR = 0.93 (0.83-1.03).
All women (2,201 cases): RR = 1.05 (0.92-1.21; P = 0.23) for the highest vs lowest quintile of consumption. Amount specific data (servings per 1000 kcal per day): < 1.11: RR = 1. 1.11-1.56: RR = 0.94 (0.83-1.07). 1.57-2.08: RR = 0.99 (0.87-1.13). 2.09-2.86: RR = 1.03 (0.91-1.18). > 2.86: RR = 1.05 (0.92-1.21).
One serving of vegetables = 1 cup of raw, leafy vegetables, 1/2 cup of other vegetables, or 6 ounces of juice. Adjustment for fruits did not alter the associations. There were no differences when vegetable intake was examined with respect to the different histological types of lung cancer in either sex. Age, energy intake, race, education, BMI, smoking status, time since quitting, past smoking dose (former smokers only), current smoking dose (current smokers only), alcohol intake, physical activity, and family history of any cancer. |
27) Alavanja MC (2004) | The Agricultural Health Study Cohort. | 57,284 pesticide applicators and 32,333 spouses of farmer applicators from Iowa and North Carolina. | 6.2 | (1993-97 to 2001) See variables | Lung cancer incidence | Vegetables (not defined) |
|
Age, smoking status, sex, race, state of residence, education, pneumonia, other chronic lung disease (bronchitis and emphysema), asthma, family history of lung cancer, fruits, alcohol intake. |
25) Liu Y (2004) | The JPHC Study | 2 cohorts with 42,224 (aged 40-59) and 51,114 (aged 40-69) subjects. | (Japan) Cohort I: 10 (1990-1999). | Cohort II: 7 (1993-1999) 428 | (329 men, 99 women) (198 adenocarcinomas, 176 non-adenocarcinomas) (106 never smokers, 317 ever smokers) lung cancer risk | Vegetables excluding tofu, beans, and potatoes (Cohort I: green leafy vegetables, such as spinach; yellow vegetables, such as carrot or pumpkin; white vegetables, such as Chinese cabbage, radish, tomato or cucumber. | Cohort II: green vegetables; carrots; tomatoes)
RR = 1.03 (0.81-1.30; No P-value) for the highest vs lowest tertile of consumption. | Amount specific data (pooled tertiles not defined): T1 RR = 1. T2: RR = 0.96 (0.76-1.23). T3 RR = 1.03 (0.81-1.30). Very high vs very low consumption: No association was found when vegetables were categorized into six groups of consumption (no data shown).
Findings did not differ when analysis were limited to men (data not 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 8 prospective studies. | 430,281 (280.419 women and 149.862 men) | 6-16 | 3,206? | (1,398 women and 1,808 men) (259 never smokers, 981 past smokers, 1,915 current smokers) (956 adenocarcinomas [581 women, 375 men], 538 small cell carcinomas [256 women, 282 men], 901 squamous cell carcinomas [242 women, 659 men]) Lung cancer risk | Total vegetables (Vegetables and vegetable juice. Potatoes and mature beans were not classified as vegetables. The number of items varied from 6 to 38 across studies.) |
INCLUSION CRITERIA:
|
INCLUDED STUDIES (Follow-up years/No. of lung cancer cases):
RELATIVE RISK:
RR categorized into deciles: 0.89 (0.75-1.06; No P-value). RR using identical absolute cutpoints across studies: 0.90 (0.71-1.12; No P-value) for intakes of ≥ 400 vs < 100 g/day.
The test for heterogeneity among studies was not significant for total fruits, total vegetables or total fruits and vegetables, indicating that the differences in relative risks across the studies were compatible with random variation. There was no evidence of effect modification by the number of fruit and vegetable questions included on a study's food frequency questionnaire. Adjusted for education, BMI, alcohol intake, calories, smoking status, smoking duration for past/current smokers, amount smoked for current smokers. Results were similar after further adjustment for multivitamin use. Simultaneous adjustment for total fruit and total vegetable intakes did not materially alter the results observed when each group was analyzed separately. |
22) Neuhouser ML (2003) | The Beta-carotene And Retinol Efficacy Trial (CARET) (2003) | 14,120 current or former heavy smokers (male/female) and asbestos-exposted workers (male) aged 50-69. | 12 | (1989-2001) 742? | (326 in placebo arm, and 414 in intervention arm) Primary lung cancer risk | Total vegetables (broccoli, cauliflower, Brussels sprouts, cole slaw, cabbage, sauerkraut, mustard greens, turnip greens, collards, carrots, carrot juice, and mixed foods with carrots, potatoes [including French fries; boiled, mashed, and baked potatoes], tomatoes, tomato juice, and mixed foods and condiments with tomatoes, peas, green beans, other beans [e.g., pinto, lima], tofu, peanuts, and mixed foods with beans, squash, pumpkin, watermelon, cantaloupe, corn, onions, and sweet potatoes) |
|
Sex, age, smoking status, total pack-years of smoking, asbestos exposure, race-ethnicity, and enrollment center. |
19) Raaschou-Nielsen O (2008) | The Danish Diet, Cancer and Health Study (DCH) | 56,488 individuals aged 50-64. | 1994-97 to 2003 | 430 | Lung cancer risk | Vegetables (not defined) | The median dietary intake of vegetables was lower among cases (126 g/day) than among sub-cohort members (164 g/day). | Unadjusted. |
19) Linseisen J (2007) | The EPIC Study | 478,590 individuals, mostly aged 25-70 from 10 European countries. | 6.4 | (1992-2000) 1,126 (608 men, 518 women), of which 731 current smokers, 291 former smokers, and 98 never smokers) | lung cancer risk | Vegetables (excluding potatoes and legumes) |
HR = 1.06 (0.83-1.36) for the highest vs lowest quintile of consumption. | Amount specific data (g/day): 0-97.3: HR = 1. 97.3-146.0: HR = 0.96 (0.81-1.14). 146.0-207.9: HR = 1.01 (0.84-1.21). 207.9-306.8: HR = 0.98 (0.80-1.21). 306.8-2979.3: HR = 1.06 (0.83-1.36).
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. Further adjustment for fruit intake did not modify the estimates. |
19) Sorensen M (2007) | The Danish Diet, Cancer and Health Study (DCH). | 56,488 subjects aged 50-64. | 1994-97 to 2003 | 430 | Lung cancer incidence | All vegetables (e.g. carrots, peas, leeks, cauliflower and broccoli) | Cases consumed less vegetables (126 g/day) than sub-cohort members (163 g/day; P = < 0.001). | Unadjusted. |
19) Sorensen M (2006) | The Danish Diet, Cancer and Health Study. | 56,488 individuals aged 50-64. | 1994-97 to 2003 | 431 | Lung cancer incidence | Vegetables (e.g. carrots, peas, leeks, cauliflower and broccoli) | The median dietary intake of vegetables was lower among cases (125 g/day) than among sub-cohort members (164 g/day). | Age. |
19) Skuladottir H (2004) | The Danish Diet, Cancer and Health Study. | 54,158 (aged 50-64) | 1993-2001 | 247 | (142 men and 105 women) (43 small cell carcinoma, 79 adenocarcinoma, 49 squamous cell carcinoma) lung cancer risk | Vegetables (31 varieties of vegetables [Not defined]. The most frequently consumed vegetables were carrots, tomatoes and onion. Excluding vegetable juice and potatoes) |
RR = 0.67 (0.46-0.97; No P-value) for the higest vs lowest quartile of consumption. | Amount specific data (g): 17-68: RR = 1. 69-120: RR = 0.78 (0.54-1.11). 121-170: RR = 0.99 (0.68-1.42). 171-479: RR = 0.67 (0.46-0.97).
Age, smoking status, duration of smoking, number of cigarettes/day and occupation. |
19) Miller AB (2004) | The EPIC Study. | 335,376 individuals, mostly aged 25-70 from 7 European countries (excluding Germany, France and Greece) | 1992-98 to 1998-2002 | 860 (532 smokers, 236 ex-smokers, and 88 never smokers) | lung cancer risk | Total vegetables (defined as: spinach, lettuce [all variants], [swiss] chard, chicory, wine leaf, beet leaves, turnip tops, borage, seaweed, thistle, watercress; Avocado, pepper [sweet, chilli], courgette, tomato, pumpkin, eggplant, artichoke, cucumber/gherkin, french bean, sugar pea, caper, okra; Beetroot, swede, carrot, turnip, parsnip, celeriac, radish, salsify; Cabbage [white, red, curly, chinese, sauerkraut, savoy], cauliflower, brussels sprouts, broccoli; All types of mushrooms; [Sweet] corn, broad bean, pea; Onion, garlic, shalott; Blanched celery, leek, fennel, asparagus, sprouts [alfalfa, mungbean, bamboo, other beans]; Mixed salad/vegetables; Unclassified) |
RR = 1.00 (0.76-1.30; P = 0.8528) for the highest vs the lowest quintile of consumption. | Amount specific data (Quintiles not defined): Q1: RR = 1. Q2: RR = 0.99 (0.81-1.23). Q3: RR = 1.08 (0.87-1.34). Q4: RR = 0.98 (0.77-1.23). Q5: RR = 1.00 (0.76-1.30). There was no evidence of an inverse association for vegetable intake, either for men or women, or for both together. There remained no association for vegetable intake after adjusting for fruit intake.
Smoking, height and stratified by sex and centre. |
19) Miller AB (2002) | The EPIC Study | 127,892 men and 289,946 women. | 4 | 247? men and 245? women | Lung cancer incidence | All vegetables (not defined) |
HR = 0.96 (0.72-1.28) for the highest vs lowest quartile of consumption. | Amount specific data (Quartiles not defined): Q1: HR = 1. Q2: HR = 0.82 (0.63-1.06). Q3: HR = 0.80 (0.60-1.05). Q4: HR = 0.96 (0.72-1.28). 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 | Vegetables (not defined) |
RR = 0.75 (0.63-0.88; P = < 0.001) for the highest vs lowest quintile of consumption. | Amount specific data (g per day): < 52: RR = 1. 52-79: RR = 1.00 (0.87-1.16). 80-109: RR = 0.93 (0.80-1.08). 110-156: RR = 0.83 (0.71-0.96). > 156: RR = 0.75 (0.63-0.88). 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. |
18) Hirvonen T. (2001) | The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. | 27,110 male smokers aged 50-69. | (Finland) mean 6.1 | (1985-1993) 791 | Lung cancer risk | Vegetables (not defined) |
RR = 0.67 (0.55-0.83; P = 0.0002) for the highest vs lowest quartile of consumption. | Amount specific data (g/day): < 59: RR = 1. 59-94: RR = 0.99 (0.82-1.2). 95-142: RR = 0.88 (0.73-1.1). > 142: RR = 0.67 (0.55-0.83). Age, supplementation group, years of smoking, and number of cigarettes/day. |
15) Ratnasinghe D (2000) | Cohort name not defined. | 9,142 men aged 41-79 who were miners in the Yunnan Tin Corporation. | (China) 6 | (1992-1997) 108 | (of which 2 women) Lung cancer risk | Total vegetables (not defined) | Lung cancer cases did not consume significantly less vegetables (227 g/day) than controls (260 g/day; P = 0.46). | Unadjusted. |
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 (54 never smokers, 193 past smokers, 269 current smokers/ 179 Kreyberg I, 232 Kreyberg II), and | 258 men (24 never smokers, 148 past smokers, 86 current smokers/ 120 Kreyberg I, 93 Kreyberg II) Total lung cancer risk | Total vegetables (tomatoes; tomato juice; tomato sauce; string beans; broccoli; cabbage/cole slaw/sauerkraut; cauliflower; Brussels sprouts; carrots; mixed vegetables; corn; peas/lima beans; winter squash; eggplant/summer squash; yams/sweet potatoes; beets; spinach, cooked; spinach, raw; kale/mustard or chard greens; iceberg lettuce; romaine lettuce; celery; alfalfa sprouts) |
MEN: | RR = 1.04 (0.69-1.57) for the highest vs lowest quintile of consumption. Amount specific data (servings/day): < 1.7: RR = 1. 1.7-2.3: RR = 1.18 (0.82-1.72). 2.4-3.0: RR = 0.97 (0.65-1.44). 3.1-4.1: RR = 1.10 (0.75-1.63). > 4.1: RR = 1.04 (0.69-1.57).
WOMEN: A significantly lower risk: RR = 0.68 (0.51-0.90) for the highest vs lowest quintile of consumption. Amount specific data (servings/day): < 1.9: RR = 1. 1.9-2.5: RR = 0.73 (0.56-0.95). 2.6-3.2: RR = 0.73 (0.55-0.95). 3.3-4.3: RR = 0.86 (0.66-1.12). > 4.3: RR = 0.68 (0.51-0.90). Variety: There was no lower risk associated with variety of vegetables.
MEN & WOMEN: It is possible that earlier diet plays a more critical role in the etiology of lung cancer. To examine this possibility, we used various lag times between the diet measure and follow-up. For both fruits and vegetables, a higher intake was not associated with a lower risk of lung cancer in men and was only weakly associated with a lower risk in women when diet was measured within 4 years of diagnosis. However, when a longer lag time was applied, inverse associations became apparent in both cohorts:
Effect modification: Other analyses stratified by age, alcohol intake, and multivitamin use provided no evidence of a modification of effect. In both cohorts, associations between intake of fruits and vegetables and the risk of lung cancer were similar for participants over 65 years old and those 65 years old or younger, for abstainers and for drinkers of one or more drinks per day, and for current users and nonusers of multivitamins. Risks for never smokers are adjusted for age, follow-up cycle, total energy intake, and availability of diet data after baseline. In addition, risks for past smokers are adjusted for years since quitting, risks for current smokers are adjusted for cigaretts smoked/day, and risks for both past and current smokers are adjusted for age at start of smoking. |
Other covariates (i.e., BMI, physical activity, alcohol consumption, and use of multivitamin supplements) did not remain in the final models because they did not affect the RRs. 11) Hogervorst JG (2009) | The Netherlands Cohort Study on Diet and Cancer | 58,279 men and 62,573 women aged 55-69. | 13,3 | (1986-2000) 2649? | Lung cancer incidence | Vegetables (not defined) |
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Unadjusted. |
11) Balder HF (2005) | The Netherlands Cohort Study | 58,279 men aged 55-69. | 9.3 | (1986-1995) 1,426 | Lung cancer risk | Total vegetables (not defined, but including legumes, cabbages, leafy vegetables, allium vegetables, carrots, tomatoes, mushrooms) |
RR = 0.66 (0.50-0.87; P = 0.008) for the highest vs lowest quintile of consumption. | Amount specific data (g/d): 102: RR = 1. 144: RR = 0.97 (0.74-1.26). 177: RR = 0.99 (0.76-1.30). 218: RR = 0.92 (0.70.1.21). 294: RR = 0.66 (0.50-0.87). Adjusted for age at baseline, total energy intake, current cigarette smoker, number of cigarettes smoked per day, years of smoking cigarettes, higher vocational or university education, family history of lung cancer, physical activity, and BMI |
11) Voorrips LE (2000) | The Netherlands Cohort Study | 62,573 women and 58,279 men aged 55-69. | 6.3 | (1986-1992) 910 | (57 never smokers, 321 former smokers, 532 current smokers) (575 male Kreyberg I, 146 male Kreyberg II, 68 female Kreyberg I, and 44 female Kreyberg II) lung cancer risk | All vegetables (defined as: Brussels sprouts; cauliflower; cabbage [white/green]; kale; string beans; broad beans; spinach; cooked endive; raw endive; lettuce; cooked carrots; raw carrots; sweet peppers; sauerkraut; tomatoes; beetroot; mushrooms; gherkins; rhubarb) |
RR = 0.7 (0.5-1.0; P = 0.001) for the highest vs lowest quintile of consumption. | Amount specific data (g/day): 103: RR = 1. 145: RR = 1.1 (0.8-1.5). 178: RR = 1.0 (0.7-1.3). 217: RR = 1.0 (0.7-1.3). 286: RR = 0.7 (0.5-1.0).
Age, sex, family history of lung cancer, highest educational level, current smoker, years of smoking, number of cigarettes/day |
10) Hayes JH (2006) | The Iowa Women's Health Study. | 27,162 women ages 61-75. | 1992-2002 | 403? | Lung cancer incidence | Total vegetables (not defined) | HR = 0.88 (0.72-1.07; P = 0.19) for ≥ 22.5 servings/week (median). | Unadjusted. |
10) Olson JE (2002) | The Iowa Women's Health Study. | 38,006 women aged 55-69. | 1986-1998 | 596? | Lung cancer incidence | Vegetables (not defined) | No association with risk (no data shown). | Age, smoking status, and pack-years of smoking. |
10) Steinmetz KA (1993) | The Iowa Women's Health Study. | 35,115 women aged 55-69. | 4 | (1986-1989) 138? | Lung cancer incidence | All vegetabes (Tomatoes; tomato sauce; string beans; broccoli; cabbage or coleslaw; cauliflower; Brussels sprouts; carrots; corn; peas or lima beans; mixed vegetables; yellow (winter) squash; eggplant, zucchini, or other summer squash; yams or sweet potatoes; spinach; kale, mustard, or chard greens; iceberg or head lettuce; romaine or leaf lettuce; celery; mushrooms; beets; alfalfa sprouts; garlic; green or chili peppers; potatoes; artichokes; asparagus; avocado; bean sprouts; chicory; chili peppers; daikon radish; endive, escarole; Jerusalem artichokes; turnips; kohlrabi; leeks; okra; oriental vegetables; parsley; parsnips; peapods; radishes; rhubarb; rutabagas; scallions; and water chestnuts) |
OR = 0.50 (0.29-0.87; P = 0.01) for the highest vs lowest quartile of consumption. | Amount specific data (servings/wk): ≤ 14: OR = 1. 15-21: OR = 0.65 (0.40-1.06). 22-30: OR = 0.53 (0.31-0.90). ≥ 31: OR = 0.50 (0.29-0.87). Additional adjustment for smoking status, alcohol intake, education, physical activity, and family history of cancer resulted in a OR of 0.68 (0.34-1.21).
Age, energy intake, and pack-years of smoking. |
8) Knekt P (1999) | The Finnish Mobile Clinic Health Examination Survey. | 4545 men aged 20-69. | 25 | (1967-72 to 1991) 138? | Lung cancer risk | Vegetables (not defined) |
RR = 0.83 (0.54-1.26; P = 0.20) for the highest vs lowest tertile of consumption. | Amount specific data (Tertiles): T1: RR = 1. T2: RR = 0.90 (0.61-1.34). T3: RR = 0.83 (0.54-1.26). Tertiles are defined as "Low" (61 g/day) and "High" (118 g/day). Age and smoking status. |
8) Knekt P (1991) | The Finnish Mobile Clinic Health Cohort | 4,538 men aged 20-69 (2,121 nonsmokers, and 2,417 smokers). | 20 | (1966-72 to 1986) Non/ex-smokers: 24? | Current smokers: 93? Lung cancer risk | Vegetables (not defined) |
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Age. |
Results were not changed after adjustment for social class, geographic area, energy and fat intake, BMI, height, or all other foodstuffs. 5) Jansen MC. (2004) | The Zutphen Elderly Study | (Part of The Seven Countries Study). 730 men aged 65-84. | (The Netherlands) 10 | (1985-1995) 42 | Lung cancer risk | Vegetables (not defined, 27 items excluding potatoes) |
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Age, smoking-status, pack-years of cigarette smoking, total energy intake, physical activity, BMI, alcohol intake, fruit intake, and vegetable intake when variety studied. |
5) Ocké MC (1997) | The Zutphen Study | (the Dutch contribution to The Seven Countries Study) 561 men. | 20 | (1971-1990) 54? | Lung cancer incidence | Vegetables (boiled and raw. Excluding potatoes) |
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Age, pack-years of cigarettes, and energy intake. |
4) Shibata A (1992) | The Leisure World Study. | 5,080 elderly men. | (USA) 8 | (1981-1989) 97 | Lung cancer risk | All vegetables (defined as: leafy green lettuce [romaine, boston, bibb, butterhead, endive, escarole, salad bowl, red leafy lettuce]; other leafy greens [spinach, chard, beet greens, turnip greens, mustard greens, collards, kale, dandelion greens]; iceberg or head lettuce; cabbage [include sauerkraut and coleslaw]; white potatoes or turnips; sweet potatoes, yams, pumpkin [include use in pie or soup]; carrots; winter squash [butternut, hubbard, acorn squash-include use in pie or soup]; summer squash [zucchini, yellow crookneck, yellow straightneck, cocozelle, scallop squash]; broccoli; tomatoes [fresh or cooked, including tomatoes in a sauce such as spaghetti sauce or tomato soup]; green peas [include snow peas and Chinese pea pods]; green beans or string beans; lima beans or blackey beans; corn; asparagus; sweet green peppers; sweet red peppers; hot chili peppers [include hot pepper sauce, chili powder, cayanne pepper, tabasco sauce]; Brussels sprouts; cauliflower) |
RR = 1.36 (0.81-2.27;No P-value) for the highest vs the lowest tertile of consumption. | Amount specific data (Tertiles not defined): T1: RR = 1. T2: RR = 1.35 (0.81-2.25). T3: RR = 1.36 (0.81-2.27). age, personal, and wife's smoking-adjusted |
4) Shibata A. (1992) | The Leisure World Study. | 11,580 residents of a retirement community. | (USA) 1981-1989 | 164 (94 men, 70 women) | Lung cancer risk | Vegetables (Leafy green lettuce [Romaine, Boston, bibb, butterhead, endive, escarole, salad bowl, red leafy lettuce], other leafy greens [spinach, chard, beet greens, turnip greens, mustard greens, collards, kale, dandelion greens], iceberg or head lettuce, cabbage [incude sauerkraut and coleslaw], white potatoes or turnips, sweet potatoes, yams, pumpkin [including in pie or soup], carrots, winter squash [butternut, hubbard, acorn squash [including in pie or soup], summer squash [zucchini, yellow crookneck, yellow straightneck, cocozelle, scallop squash, broccoli, tomatoes [fresh or cooked, including tomatoes in a sauce such as spaghetti or tomato soup], green peas [including snow peas and Chines pea pods], green beans or string beans, lima beans or blackeye beans, corn, asparagus, sweet green peppers, sweet red peppers, hot red chili peppers [including hot pepper sauce, chili powder, cayenne pepper, tobasco sauce, Brussels sprouts, cauliflower) |
Age and smoking. |
Adjustment for BMI or physical activity did not materially alter the results (data not shown). 2) Kvale G (1983) | No cohort name. | 10,602 men. | (Norway) 11.5 | (1967-1978) All: 68. | Squamous and small cell: 40. Lung cancer risk | Vegetables (Not defined. Excluding potatoes) |
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Age, cigarette smoking, region and urban/rural place of residence. |
1) Shekelle RB (1981) | The Western Electric Study. | 1954 men aged 40-55. | 19 | (1957-?) 33? | Lung cancer incidence | Vegetables (not defined) | Vegetables tended to be inversely related to the risk of lung cancer (P = 0.225). | Unadjusted. |
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