Fruit and esophageal cancer.
Esophageal cancer risk: Data about the relation with total fruit was provided by 5 cohorts, including a total of 2,865 cases. Two articles about
The EPIC Study were found, and since the articles published data about different histologic types of cancer, they were both included.
Significant protective effects were found in 2 cohorts, including 2,059 cases (Tran G [2], Fan Y [9]). In addition, nonsignificant protective effect were found in
1 cohort (Fan Y [9]), and in another cohort among men only (George SM [7]), including another 579 cases. The average RR = 0.78 (excluding incomplete data from
Boeing H [5]).
Inclusion of intermediate levels of consumption:
Data about results published in grams, servings, or cups was restricted to findings from 2 cohorts. Though trends were nonsignificantly protective in both cohorts among men,
no (non)significant effects were related to any level of consumption.
Effect modification: (Non)significant protective effects were found in all 3 Asian cohorts (2, 8, 9), but protective effects among the Western cohorts
(5, 7) were restricted to a nonsignificant protective effect in only one of these cohorts, and among men only. Average RR's were 0.78, and 0.81 for Asian, and Western
cohorts, respectively.
Esophageal cancer mortality: Data about the relation with total fruit was provided by 1 cohort, including 80 cases (4). A nonsignificant protective
effect was found.
Conclusion: Significant protective effects of total fruit against esophageal cancer risk were found in 2 cohorts of moderate size, including 72% of all cases.
In addition, nonsignificant protective effects were found in 2 other cohorts, including another 20% of all cases. Total fruit possibly protects against esophageal
cancer risk (- 22%). No level of consumption could be defined for this effect. Though the evidence was restricted to findings among Asian cohorts - according to the
methodology used - effect sizes were similar between Asian and Western cohorts. Data about cancer mortality was restricted to findings from one cohort. No evidence was found
for an association between total fruits and esophageal cancer mortality.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 9) Fan Y (2008) | The Shanghai Cohort Study | 101 | HR = 0.46 (0.25-0.88; P = 0.01) |
| 8) Yamaji T (2008) | The JPHC Study | 116 | HR = 0.65 (0.39-1.08; P = 0.09) |
| 7) George SM (2008) | The NIH-AARP Diet and Health Study | Men: 463. Women: 78. | Men: RR = 0.74 (0.53-1.02; P = 0.084). Women: RR = 1.09 (0.54-2.2; P = 0.706) |
| 5) González CA (2006) | The EPIC Study | 65 | HR = 0.94 (0.49-1.80) |
| 5) Boeing H (2006) | The EPIC Study | 84 | The RR was below 1 (no data shown) |
| 2) Tran GD (2005) | The Linxian General Population Trial | 1,958 | RR = 0.80 (0.70-0.91; P = 0.002) |
| Total number of cases: 2,865 | Average RR = 0.78 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 4) Sauvaget C (2003 | The Hiroshima/Nagasaki Life Span Study | 80 | RR = 0.57 (0.31-1.04; P = 0.0714) |
| Total number of cases: 80 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 9) Fan Y (2008) | The Shanghai Cohort Study | 18,244 men aged 45-64 from Shanghai City. | 20 (1986-89 to 2006) | 101? | Esophageal cancer incidence | Fresh fruits (not defined) |
HR = 0.46 (0.25-0.88; P = 0.01) for the highest vs lowest tertile of consumption. Amount specific data (Tertiles not defined): T1: HR = 1. T2: HR = 0.70 (0.45-1.09). T3: HR = 0.46 (0.25-0.88). After further adjustment for seafood, vegetables, meat, eggs, milk, and preserved foods the association remained borderline significant (P = 0.06). Dietary effects on ESCC (68 cases) were similar to those found for all esophageal cancer cases. | Age at interview, year of interview, neighborhood residence, level of education, BMI, number of years of smoking, number of drinks consumed per day, and number of years of drinking. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 8) Yamaji T (2008) | The JPHC Study | 38,790 men aged 45-74. (Japan) | 7.7 (1995-98 to 2004) | 116 | Esophageal SCC risk | Total fruits (not defined) |
HR = 0.65 (0.39-1.08; P = 0.09) for the highest vs lowest tertile of consumption. Amount specific data (g/day): 47: HR = 1. 137: HR = 0.80 (0.52-1.23). 280: HR = 0.65 (0.39-1.08). | Age, PHC area, cigarette smoking and alcohol drinking. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 7) 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 | 78 women, and 463 men | Esophagus 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. |
7) Freedman ND (2007) | The NIH-AARP Diet and Health Study | 490,802 (292,898 men and 197,904 women). | (USA) 5 | (1995-96 to 2000) ESCC: 103. | EAC: 213. Esophageal cancer incidence | Total fruit (Whole fruits: apples, apple sauce, pears, bananas, dried fruit excluding apricots, peaches, nectarines, plums, cantaloupe, other melons, strawberries, oranges, tangerines, tangelos, grapefruit and grapes; Fruit Juice: orange and grapefruit juice, and other fruit juices and drinks) |
|
1 fruit serving equaled one medium sized fresh fruit, [1/2] cup cut fruit, or 6 oz juice. Sex, age at entry into cohort, BMI, education, alcohol intake, vegetables intake, cigarette-smoke-dose, vigorous physical activity, usual activity throughout the day and total energy. |
Whole fruits is additionally adjusted for fruit juice intake. 5) González CA (2006) | The EPIC Study | 481,518 men and women aged 35-70 from 9 European countries (excluding Norway). | 6.5 | (1992-98 to 1999-2002) 65 | Oesophagus adenocarcinoma incidence | Total fresh fruit (not defined, excluding dried fruits and juices) |
HR = 0.94 (0.49-1.80; P = 0.75) for the highest vs lowest tertile of consumption. | Amount specific data (Tertiles): T1: HR = 1. T2: HR = 0.67 (0.37-1.22). T3: HR = 0.94 (0.49-1.80). Cut-points for tertiles of consumption differed among men and women. For men: 102.09-157.22. For women: 234.29-292.36. Both in g/day.
Stratified by center and age. Adjusted by sex, height, weight, education, tobacco smoking, cigarette smoking intensity, work and leisure physical activity, alcohol intakt, energy intake, red meat intake and processed meat intake. |
5) Boeing H (2006) | The EPIC Study | 345,904 subjects (130,633 men and 215,271 women) from seven European countries (Excluding Norway, Greece, and France). | 5.8 | (1992-98 to 1999-2004) 84? | Primary carcinomas [SCC] of the esophagus | Total fruits (fresh fruits including citrus fruits, nuts and seeds, mixed fruits, olives) | The RR was below 1 (no data shown). | Age, gender, center, BMI, energy from fat sources, energy from non-fat sources, education, smoking status, duration of smoking, alcohol drinking, lifetime alcohol drinking, non-consumer status. |
2) Tran GD. (2005) | The Linxian General Population Trial | 29.584 individuals 40-69 years who were randomly assigned to 1 of 8 vitamin/mineral combinations. | (China) 15 | (1986-2001) 1.958? | Esophageal squamous cell carcinoma risk | Fresh fruits (not defined) |
RR = 0.80 (0.70-0.91; P = 0.002) for the highest vs lowest quartile of consumption. | Amount specific data (Frequency of consumption [times/year??]): ≤ 1: RR = 1. >1-5: RR = 0.84 (0.74-0.95). 5-13: RR = 0.89 (0.79-1.00). > 13: RR = 0.80 (0.70-0.91). age, gender. Adjustment for smoking (ever vs never use of any tobacco product), or education did not substantially alter the risk estimates for any of the dietary variables. |
The food questionnaire was not validated. 2) Guo W (1994) | The Linxian Nutrition Intervention Trial. | 29,584 Chinese adults aged 40-69. | (Nested case-control) 1986-1991 | 639 | Oesophageal cancer risk | (nearly all were squamous cell carcinomas) Fresh fruits (not defined) | OR = 0.9 (0.8-1.1) for ≥ 1 vs 0 times/month. | Years of smoking and cancer history in first degree relatives. |
|