Fruit and proximal colon cancer.
Total fruit and proximal colon cancer risk.
Data about the relation between total fruit and proximal colon cancer risk was provided by a pooled analysis of 14 cohorts,
and two additional cohorts, which were both of very large size. No (non)significant associations were found in any cohort.
The average RR = 0.88, but since data from one cohort (Park Y [27]) with RRs of 1.04, and 0.99 could not be included - because no amounts of cases were provided -
the true effect size will be smaller.
Inclusion of intermediate levels of consumption:
A significant protective effect at an intermediate level of consumption (200- < 300 g/day) was found among women in the pooled analysis
(12 cohorts for women). No other associations were found among men or women.
Conclusion: A significant protective effect at an intermediate level of fruit consumption was found among women in a pooled analysis of 12 cohorts. No other associations were found. Total fruit possibly protects against proximal colon cancer risk among women at the level of consumption of 200- < 300 g/day.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 29) Koushik A (2007) | Pooled analysis of 14 cohorts | 912 men, and 2,065 women | Men: RR = 0.89 (0.66-1.20; P = 0.22). Women: RR = 0.91 (0.76-1.10; P = 0.53). |
| 27) Park Y (2007) | The NIH-AARP Diet and Health Study | Not defined | Men: RR = 1.04 (0.81-1.34). Women: RR = 0.99 (0.72-1.36). |
| 18) van Duijnhoven FJ (2009) | The EPIC Study | 783 | HR = 0.81 (0.62-1.05; P = 0.19). |
| Total number of cases: 3,760 + X | Average RR = 0.88 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 29) Koushik A. (2007) | Pooled Analysis of 14 Cohort Studies. | 756,217 subjects (242,362 men and 513,855 women) | 6-20 years | 2977 (2065 women, 912 men) | Proximal colon cancer risk (tumors from the cecum to the splenic flexure) | Total fruit (fruits and fruit juices) |
INCLUSION CRITERIA:
In the analysis, an extended follow-up period for most of the studies was included:
RELATIVE RISK:
BMI; height; education; physical activity; family history of colorectal cancer; postmenopausal hormone use; oral contraceptive use; use of nonsteroidal anti-inflammatory drugs; multivitamin use; smoking habits (never/past/current + amount); red meat; total milk; alcohol; and total energy. Age in years and year of questionnaire return were included as stratification variables. |
27) Park Y. (2007) | The NIH-AARP Diet And Health Study. | 488,043 (291,094 men and 196,949 women) aged 50-71. | (USA) 4,3 | (1996-2000) No data shown. | (2,972 for total colorectal cancer risk ([2,048 men and 924 women]) Proximal colon cancer risk | Fruit (not defined) |
|
One serving = 1 medium-sized piece of fruit, 1/2 cup of cut fruit, or 6 ounces of juice (1 cup = 237 mL, 1 ounce = 29.6 mL). education, physical activity, smoking (smoking/past/current. And < or = 20 vs > 20 cigarettes/day), alcohol, red meat, dietary calcium, total energy. |
Additional adjustment for race; BMI; family history of colorectal cancer; colorectal cancer screening; use of multivitamins, NSAID's, and menopausal hormone therapy in women; and vitamin D intake showed similar results. Mutual adjustment for intakes of fruits and vegetables did not change the results. Adjustment for dietary fiber did not change the results. 23) Lin J. (2005) | The Women's Health Study. | 36,976 women aged > or = 45 years. | (USA) 10 | 91? | Proximal colon cancer risk | Fruits (apples, apple juice, avocado, banana, blue berries, cantaloupe, grape fruit juice, grape fruit, orange juice, oranges, other juice, peaches, prunes, raisins, and strawberries) |
No association with proximal colon cancer risk (no data shown). | age, randomized treatment assignment, BMI, family history of colorectal cancer, history of colon polyps, physical activity, smoking status, baseline aspirin use, red meat intake, alcohol consumption, total energy intake, menopausal status, baseline post-menopausal HT use, folate intake and multivitamin use. Glycemic load in the multivariate model did not change the overall results. |
18) van Duijnhoven FJ (2009) | The EPIC Study | 452,755 subjects (131,985 men and 320,770 women) from 10 European countries. | 8.7-8.8 | (1992-2000 to 2006) 783 | Proximal colon cancer incidence | (including the cecum, appendix, ascending colon, hepatic flexure, transverse colon, and splenic flexure) All fruit (fresh fruit [ie, citrus fruit, hard fruit, stone fruit, grapes, berries and other fruit], mixed fruit [ie, fresh and canned fruit], olives, and nuts and seeds. | excluding fruit juices)
HR = 0.81 (0.62-1.05; P = 0.19) for the highest vs lowest quintile of consumption. | Effect modification: No effect modification by smoking status, alcohol, or BMI was shown, but red and processed meat did modify the association with fruit (No data shown, but an inverse association was apparent among individuals in the highest tertile of red and processed meat consumption). Stratified by age at entry, sex, and center. Adjusted for energy from fat, energy from nonfat, weight, height, physical activity, smoking status, alcohol consumption, red and processed meat consumption, fish consumption, dietary fiber from cereal sources, and consumption of vegetables. |
15) Terry P (2001) | The Swedish Mammography Screening Cohort. | 61,463 women aged 40-74. | 9.6 | (1987-90 to 1998) 118 | Proximal colon cancer risk | Fruit (including citrus fruit, fruit juice, bananas, apples, and pears) |
RR = 0.97 (0.57-1.64; P = 0.99) for the highest vs lowest quartile of consumption. | Amount specific data (servings/day): < 1.0: RR = 1. 1.0-1.5: RR = 0.77 (0.47-1.28). 1.5-2.0: RR = 0.89 (0.54-1.48). > 2.0: RR = 0.97 (0.57-1.64). Age, consumption of red meat and dairy products, and total calories. |
9) Voorrips LE. (2000) | The Netherlands Cohort Study. | 62,573 women and 58,279 men aged 55-69. | (The Netherlands) 6.3 | (1986-1992) 159 men, 144 women | Proximal colon cancer risk | Total fruit (Mandarins, oranges/fresh orange juice, grapefruits/fresh grapefruit juice, grapes, bananas, appels/pears, strawberries, processed orange/grapefruit juice, other fruit juices) |
|
Age, family history of colorectal cancer, and alcohol. Total energy intake, smoking, physical activity, and BMI were evaluated as potential confounders. |
8) Steinmetz KA. (1994) | The Iowa Women's Health Study. | 35,216 women aged 55-69. | (USA) 5 | (1986-1990) 86 | Proximal colon cancer risk | Fruit (Apples/pears, applesauce, bananas, blackberries, blueberries, cantaloupe, cherries, crenshaw melon, currants, dates, dried apples, dried apricots, dried currants, dried figs, dried papaya, dried peaches, dried pineapple, fruit cocktail, grapefruit, guavas, honeydew melon, kiwi fruit, lemons, limes, mangoes, nectarines, oranges, papaya, peaches/apricots/plums, persimmons, pineapple, plaintains, pomegranates, prunes, quince, raisins/grapes, raspberries, strawberries, tangerines, watermelon) |
RR = 0.80 (0.40-1.59) for the highest vs lowest quartile of consumption. | Amount specific data (servings/week): < 7.5: RR = 1. 7.5-11.9: RR = 1.32 (0.74-2.35). 12.0-17.4: RR = 1.12 (0.61-2.04). > 17.4: RR = 0.80 (0.40-1.59). Age, energy. The effect of adjustment of the vegetable and fruit associations for the following factors was negligible: BMI, parity, age at first live birth, physical activity, smoking, education, history of polyps or colitis, and alcohol intake. |
|