Fruit and rectal cancer.
Total fruit and rectal cancer risk.
Data about the relation between total fruits and rectal cancer risk was provided by 9 cohort studies, including 2,542 + X cases (no amount of cases
was provided by one cohort (Park Y [27]).
The average RR = 0.96 (excluding incomplete data from Park Y [27]).
Women: A significant protective effect was found in one cohort examining women only (Terry P [15]), but a significantly increased risk was found in one other cohort
among women, but not men (Park Y [27]). No other associations were found.
Men: No associations were found.
Inclusion of intermediate levels of consumption:
Among men, significant protective effects were found in one cohort (Nomura AM [30]) at the 3rd and 4th quintile of consumption (median intakes 298, and 450 g/day).
Among women, significant protective effects were found in one cohort (Nomura AM [30] at the 2nd quintile of consumption (median intake 217 g/d), and in another
cohort at > 160 g/day (Terry P [15]). But a significantly increased risk was found in a third cohort (Park Y [27]) at the 4th and 5th quintile of consumption
(median intakes 368, and 560 g/day):
Effect modification:
- No effect modification was found by alcohol consumption (15, 18, 25), BMI (15, 18, 25), smoking status (18, 25), physical activity (25), and vitamin supplement use (25).
- One (25), but not the other (18) cohort showed no effect modification by meat consumption.
Conclusion: Inconsistent findings were done among women only, but no evidence was found for an association between total fruit and rectal cancer risk. No evidence was found for effect modification.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 30) Nomura AM (2008) | The Multiethnic Cohort Study | 276 men, and 179 women | Men: RR = 0.80 (0.53-1.21; P = 0.219). Women: RR = 0.77 (0.46-1.27; P = 0.609). |
| 27) Park Y (2007) | The NIH-AARP Diet and Health Study | Not defined | Men: RR = 0.99 (0.75-1.30; P = 0.89). Women: RR = 1.59 (1.04-2.44; P = 0.01). |
| 25) Tsubono Y (2005) | The JPHC Study | 154 men, and 95 women | Men: RR = 1.19 (0.59-2.36; P = 0.42). Women: RR = 0.84 (0.43-1.65; P = 0.77). |
| 24) Sato Y (2005) | The Miyagi Cohort Study | 110 (not defined, stratified by gender) | Men: RR = 0.28 (0.04-2.09; P = 0.75). Women: RR = 1.53 (0.68-3.45; P = 0.23). |
| 18) van Duijnhoven FJ (2009) | The EPIC Study | 991 | HR = 0.96 (0.76-1.21; P = 0.92). |
| 15) Terry P (2001) | The Swedish Mammography Screening Cohort | 159 | RR = 0.54 (0.33-0.89; P = 0.01). |
| 9) Voorrips LE (2000) | The Netherlands Cohort Study | 215 men, and 119 women | Men: RR = 0.85 (0.55-1.32; P = 0.29). Women: RR = 0.67 (0.34-1.33). |
| 6) Michels KB (2000) | The Health Professionals' Follow-up Study & The Nurses' Health Study | 89 men, and 155 women | Men: RR = 0.66. Women: RR = 2.04. |
| Total number of cases: 2,542 + X | Average RR = 0.96 |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 30) Nomura AM (2008) | The Multiethnic Cohort Study. | 85,903 men and 105,108 women aged 45-75. (Hawaii and California) | 7.3 (1993-96 to 2001) | 276 men, and 179 women | Rectum cancer risk (only invasive adenocarcinoma) | Fruit (not defined. including fruit juices) |
Age, family history of colorectal cancer, history of colorectal polyp, pack-years of cigarette smoking, BMI, hours of vigorous activity, aspirin use, multivitamin use, replacement hormone use, log energy intake, alcohol, red meat, folate, vitamin D, and calcium. |
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]) Rectal 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. 25) Tsubono Y. (2005) | The JPHC Study. | A pooled analysis of 2 prospective studies with 88,658 Japanese men and women. | Cohort I included 40,106 subjects 40-59 years (19,345 men and 20,761 women). Cohort II included 48,552 subjects 40-69 years (23,180 men and 25,372 women). Cohort I: 9 (1990-99). | Cohort II: 6 (1993-99) 249 | (154 men, 95 women) Rectum cancer risk | Total fruit | Cohort I: two fruits (fruit and fruit juice). Cohort II: three fruits (apples, oranges, and fruit juice)
|
Stratified analyses by covariates included in multivariate models did not reveal remarkable effect modifications (no data shown). Analyses based on the octiles of total fruit consumption did not show significant associations (no data shown). sex, age, public health centre area, BMI, frequency of sports, smoking, alcohol consumption, vitamin supplement use, energy, cereals, meat, and fish by each cohort. |
24) Sato Y. (2005) | The Miyagi Cohort Study. | 47,605 subjects (22,836 men and 24,769 women) aged 40-64. | (Japan) 1990-1997 | 110 | (No data about amount of male and female cases) Rectal cancer risk | Total fruit (orange, other fruits and fresh fruit juices) |
RR = 1.41 (0.73-2.73; P = 0.30) for the highest vs lowest quartile of consumption. | Amount specific data (g): ≤ 95: RR = 1. 96-169: RR = 1.26 (0.74-2.15). 170-241: RR = 1.36 (0.75-2.47). ≥ 242: RR = 1.41 (0.73-2.73).
Sex, age, smoking status, alcohol consumption, BMI, education, family history of cancer, walking time, and meat consumption. |
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) 991 | Rectal cancer incidence | (including tumors occurring at the rectosigmoid junction and rectum. excluding anal canal tumors) 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 = 0.96 (0.76-1.21; P = 0.92) for the highest vs lowest quintile of consumption. | Amount specific data (g/d): < 92.8: HR = 1. 92.8-156.0: HR = 0.87 (0.71-1.06). 156.0-235.3: HR = 0.98 (0.80-1.20). 235.3-342.7: HR = 0.97 (0.78-1.20). > 342.7: HR = 0.96 (0.76-1.21).
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) 159 | Rectal cancer risk | Fruit (including citrus fruit, fruit juice, bananas, apples, and pears) |
RR = 0.54 (0.33-0.89; P = 0.01) for the highest vs lowest quartile of consumption. | Amount specific data (servings/day): < 1.0: RR = 1. 1.0-1.5: RR = 0.95 (0.63-1.43). 1.5-2.0: RR = 0.79 (0.51-1.22). > 2.0: RR = 0.54 (0.33-0.89). The relationships between fruit and vegetable consumption and colon and rectal cancer risk were similar across different strata of alcohol consumption and body mass index. 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) 334 | (215 men, 119 women) Rectal 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. |
6) Michels KB. (2000) | The Nurses' Health Study | & The Health Professionals' Follow-up Study. 88,764 women aged 34-59 and 47,325 men aged 40-75. | (USA) Women: 16 | (1980-1996). Men: 10 (1986-1996) 244 (89 men, 155 women) | rectal cancer risk | A fruit was used in the definition "all fruit" if it was included in at least 2 (out of 4) different FFQs of the NHS. | All fruit (defined as: apples, applesauce, apricots, bananas, blueberries, cantaloupe, grapefruit, grapes, oranges, peaches, pears, plums, prunes, raisins, strawberries, watermelon, apple cider, apple juice, grapefruit juice, orange juice, other fruit juices)
|
age, family history of colorectal cancer, sigmoidoscopy, height, body mass index, pack-years of smoking, alcohol intake, physical activity, (women: menopausal status, postmenopausal hormone use,) aspirin use, vitamin supplement intake (ever use of multivitamins or vitamins A, C, or E), total caloric intake, and red meat consumption. |
|