Fruit and pancreatic cancer.
Pancreatic cancer risk: Data about total fruit was provided by 9 cohorts, including a total of 2,949 cases.
A significantly increased risk was found in one cohort (16), but a significant protective effect was found in another cohort, among men (17).
No other (non)significant associations were found. The average RR = 1.03 (excluding incomplete data from Michaud DS [12]).
Inclusion of intermediate levels of consumption:
Data from one cohort (16) could not be used in the following table, because RRs were presented in g/1000 kcal/d. Since men and women consume different amounts
of calories, no translation can be made to g/day.
(Non)significant effects at any level of consumption were restricted to findings from one cohort (George SM [17]). A significant protective effect was found at the level of
consumption of > 636 g/day, among men.
Pancreatic cancer mortality: Data about total fruit was provided by 5 cohorts, including a total of 510 cases.
A significant protective effect was found in one cohort among men (Lin Y [15]). No other (non)significant associations were found, but all RR's were < 1. The
average RR = 0.76.
Conclusion: Few associations were found. No evidence was found for an association between total fruits and pancreatic cancer risk, or pancreatic cancer death. But
the RR for pancreatic cancer death was well below 1.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 18) Vrieling A (2009) | The EPIC Study | 555 | HR = 1.02 (0.77-1.36; P = 0.93) |
| 17) George SM (2008) | The NIH-AARP Diet and Health Study | Men: 713. Women: 377. | Men: RR = 0.73 (0.57-0.95; P = 0.012). Women: RR = 1.21 (0.87-1.70; P = 0.173). |
| 16) Nöthlings U (2007) | The Multiethnic Cohort Study | 434 | RR = 1.42 (1.05-1.93; P = 0.03) |
| 14) Larsson SC (2006) | The Swedish Mammography Cohort & The Cohort of Swedish Men | 135 | HR = 1.10 (0.64-1.88; P = 0.66) |
| 12) Michaud DS (2005) | The Nurses' Health Study & The Health Professionals Follow-Up Study | 366 | No substantial increase in risk. |
| 6) Bobe G (2008) | The ATBC Study | 306 | HR = 0.95 (0.67-1.34; P = 0.82) |
| 4) Shibata A (1994) | The Leisure World Study | 63 | RR = 0.89 (0.49-1.62) |
| Total number of cases: 2,949 | Average RR = 1.03 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 15) Lin Y (2006) | The JACC Study | Men: 102. Women: 123. | Men: HR = 0.51 (0.27-0.97; P = 0.02). Women: HR = 0.86 (0.51-1.46; P = 0.82) |
| 11) Khan MM (2004) | No cohort name defined | 13 | RR = 0.6 (0.1-4.6) |
| 9) Sauvaget C (2003) | The Hiroshima/Nagasaki Life Span Study | 177 | RR = 0.85 (0.55-1.20; P = 0.23) |
| 8) Appleby PN (2002) | The Health Food Shoppers Study | 39 | RR = 0.74 (0.35-1.55) |
| 3) Zheng W (1993) | The Lutheran Broterhood Cohort | 56 | No clear association. |
| Total number of cases: 510 | Average RR = 0.76 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 18) Vrieling A (2009) | The EPIC Study | 478,400 subjects from 10 European countries. | 8.9 (1991-2000 to 2002-2007) | 555 | Invasive exocrine pancreatic cancer incidence | Total fruit (all fresh, dried, and canned fruits and nuts, seeds, and olives) |
HR = 1.02 (0.77-1.36; P = 0.93) for the highest vs lowest quartile of consumption. Amount specific data (g/day): < 112: HR = 1. 112-202: HR = 1.08 (0.85-1.38). 202-329: HR = 0.96 (0.74-1.24). > 329: HR = 1.02 (0.77-1.36). Results for fresh fruit were similar to those for total fruit (data not shown). | Stratified by age at entry, sex and center. Adjusted for energy from fat, energy from non-fat, weight, height, history of diabetes, and smoking status. Waist-to-hip ratio, alcohol, red meat and processed meat intake, and education did not markedly change the risk estimates. |
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| 17) 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 | 377 women, and 713 men | Pancreas cancer incidence | Fruit |
1 cup = 237 mL. One cup is 1 cup of raw/cooked fruit, 1 cup of 100% juice, or 0.5 cup of dried fruit. 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 vegetable intake. |
16) Nöthlings U (2007) | The Multiethnic Cohort Study | 162,150 subjects (72,966 men and 89,184 women) aged 45-75. | (Hawaii-Los Angeles) 8 | (1993-96 to 2002) 434 | Exocrine pancreatic cancer incidence | Fruit (not defined) |
RR = 1.42 (1.05-1.93; P = 0.03) for the highest vs lowest quartile of consumption. | Amount specific data (g/1000 kcal./d): < 53.3: RR = 1. 53.3-104.1: RR = 1.18 (0.89-1.58). 104.1-178.4: RR = 1.20 (0.90-1.62). ≥ 178.4: RR = 1.42 (1.05-1.93). The greater risk associated with fruit intake was most apparent among never smokers (data not shown). Controlled for sex and time on study. Adjusted for race-ethnicity, age at cohort entry, smoking status, pack-years of smoking, family history of pancreatic cancer, energy intake, intakes of red meat and processed meat, and BMI. |
16) Nöthlings U (2007) | The Multiethnic Cohort Study | 162,150 subjects (72,966 men and 89,184 women) aged 45-75. | (Hawaii-Los Angeles) 8 | (1993-96 to 2002) 434 | Exocrine pancreatic cancer incidence | Fruit and juices (not defined) |
RR = 1.37 (1.02-1.84; P = 0.04) for the highest vs lowest quartile of consumption. | Amount specific data (g/1000 kcal./d): < 77.4: RR = 1. 77.4-144.7: RR = 1.10 (0.83-1.47). 144.7-238.2: RR = 1.05 (0.78-1.40). ≥ 238.2: RR = 1.37 (1.02-1.84). -Among overweight or obese participants, total fruit and juice intake was associated with a 51% higher risk. -There was little evidence of effect modification by smoking status (never, former, or current). Controlled for sex and time on study. Adjusted for race-ethnicity, age at cohort entry, smoking status, pack-years of smoking, family history of pancreatic cancer, energy intake, intakes of red meat and processed meat, and BMI. |
14) Larsson SC (2006) | The Swedish Mammography Cohort | & The Cohort of Swedish Men 81,922 subjects (36,616 women and 45,306 men). | 6.8 | (1998-2004) 135 | (61 women and 74 men) Primary malignant neoplasm of the exocrine pancreas incidence | All fruits (apples, pears, bananas, oranges, grapefruit, orange/grapefruit juice, berries, and other fruits) |
HR = 1.10 (0.64-1.88; P = 0.66) for the highest vs lowest quartile of consumption. | Amount specific data (servings/d): < 1.0: HR = 1. 1.0-1.4: HR = 0.83 (0.48-1.41). 1.5-2.4: HR = 1.12 (0.70-1.80). ≥ 2.5: HR = 1.10 (0.64-1.88). Age, sex, education, BMI, physical activity, cigarette smoking status and pack-years of smoking, multivitamin supplement use, and intakes of total energy, alcohol, and all vegetables. |
12) Michaud DS (2005) | The Health Professionals Follow-Up Study | & The Nurses' Health Study 47,493 men and 77,179 women. | (USA) Women: 1984-2000. | Men: 1986-2000. 366? | (185 men, and 181 women) Pancreatic cancer incidence | Fruit (not defined) | No substantial increase in risk was found (no data shown). | Age, pack-years of smoking, BMI, physical activity, history of diabetes mellitus, caloric intake, height, and multivitamin use. |
6) Bobe G (2008) | The Alpha-Tocopherol, beta-Carotene Cancer Prevention Study (ATBC) | 27,111 healthy male smokers of ≥ 5 cigarettes/day aged 50-69. | (Finland) 16.1 | (1985-2004) 306 | Primary exocrine adenocarcinoma of the pancreas incidence | Fruit (not defined) |
HR = 0.95 (0.67-1.34; P = 0.82) for the highest vs lowest quintile of consumption. | Amount specific data (g/day): ≤ 52.33: HR = 1. 52.34-89.90: HR = 0.86 (0.61-1.22). > 89.90-131.9: HR = 0.80 (0.56-1.15). > 131.9-191.3: HR = 0.76 (0.53-1.10). > 191.3: HR = 0.95 (0.67-1.34). Effect modification: No significant interaction was found by intervention (any supplement [alpha-tocopherol, beta-carotene, or both] vs placebo). Age at randomization, years of smoking, total number of cigarettes per day, self-reported history of diabetes mellitus, and energy-adjusted saturated fat intake. |
6) Stolzenberg-Solomon RZ (2002) | The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC). | 27,111 male smokers of ≥ 5 cigarettes/day aged 50-69. | (Finland) 13 | (1985-88 to 1997) 163? | Primary malignant neoplasm of the exocrine pancreas incidence | All fruits and berries (not defined) |
HR = 0.85 (0.53-1.35; P = 0.52) for the highest vs lowest quintile of consumption. | Amount specific data (g/day): ≤ 25.9: HR = 1. > 25.9 and ≤ 54.3: HR = 0.81 (0.50-1.30). > 54.3 and ≤ 87.6: HR = 0.72 (0.44-1.17). > 87.6 and ≤ 133.9: HR = 0.85 (0.53-1.36). > 133.9: HR = 0.85 (0.53-1.35). Energy intake, age and years of smoking. |
Additional variables examined in the analyses included ATBC trial interventions; dietary folate, saturated fat, and carbohydrate intakes; history of diabetes mellitus; occupational physical activity; and education. 4) Shibata A (1994) | The Leisure World Study | 13,979 residents of a retirement community. | 9 | (1981-1990) 63 | Pancreatic cancer incidence | Fruits (not defined) |
RR = 0.89 (0.49-1.62) for the highest vs lowest tertile of consumption. | Amount specific data (servings per day): < 2.4: RR = 1. 2.4-3.5: RR = 0.90 (0.49-1.66). ≥ 3.6: RR = 0.89 (0.49-1.62). Sex, age and cigarette smoking. |
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