Fruit and distal colon cancer.
Total fruit and distal colon cancer risk.
Data about the relation between total fruit and distal colon cancer risk was provided by a pooled analysis of 14 cohorts (Koushik A [29]),
and two additional cohorts, which were both of very large size.
A significant protective effect among women, but not men, was found in the pooled analysis (12 cohorts for women).
In addition, a nonsignificant protective effect was found in one cohort, but results were not stratified by gender (van Duijnhoven FJ [18]).
No association was found in the remaining cohort (Park Y [27]).
The average RR = 0.80, but since data from one cohort (Park Y [27]) with RRs of 0.97, and 1.14 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 was found in the pooled analysis at ≥ 400 g/day among women only (Koushik A [29]). No other (non)significant effects were
found at any level of consumption.
Conclusion: A significant protective effect among women was found in a pooled analysis of 12 cohorts, but no significant effects were found in any of the cohorts of very large size. Total fruit possibly protects against distal colon cancer risk among women. This effect was found at the level of consumption of ≥ 400 g/day.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 29) Koushik A (2007) | Pooled analysis of 14 cohorts. | 810 men, and 1,431 women | Men: RR = 0.94 (0.70-1.28; P = 0.82). Women: RR = 0.69 (0.55-0.87; P = 0.04). |
| 27) Park Y (2007) | The NIH-AARP Diet and Health Study | Not defined | Men: RR = 1.14 (0.89-1.48; P = 0.29). Women: RR = 0.97 (0.63-1.49; P = 0.90). |
| 18) van Duijnhoven FJ (2009) | The EPIC Study | 790 | HR = 0.84 (0.64-1.09; P = 0.08). |
| Total number of cases: 3,031 + X | Average RR = 0.80 |
| 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 | 2241 (1431 women, 810 men) | Distal colon cancer risk (tumors in the descending and sigmoid colon) | Total fruit (fruits and fruit juices) |
INCLUSION CRITERIA:
INCLUDED STUDIES (Follow-up years/No. of colon cancer cases). 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]) Distal 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. 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) 790 | Distal colon cancer incidence | (including the descending and sigmoid colon) 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 = 0.84 (0.64-1.09; P = 0.08) 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) 101 | Distal colon cancer risk | Fruit (including citrus fruit, fruit juice, bananas, apples, and pears) |
RR = 0.91 (0.53-1.55; P = 0.95) for the highest vs lowest quartile of consumption. | Amount specific data (servings/day): < 1.0: RR = 1. 1.0-1.5: RR = 0.54 (0.30-0.98). 1.5-2.0: RR = 0.86 (0.51-1.46). > 2.0: RR = 0.91 (0.53-1.55). 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) 160 men, 122 women | Distal 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) 120 | Distal 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 = 0.97 (0.58-1.61) for the highest vs lowest quartile of consumption. | Amount specific data (servings/week): < 7.5: RR = 1. 7.5-11.9: RR = 0.66 (0.39-1.14). 12.0-17.4: RR = 0.93 (0.57-1.52). > 17.4: RR = 0.97 (0.58-1.61). 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. |
|