Vegetables and rectal cancer.
Total vegetables and rectal cancer risk.
Data about the relation between total vegetables and rectal cancer risk was provided by 9 cohort studies, including 2,524 + X cases (no data about the
amount of cases was provided by one cohort (Park Y [27]).
A nonsignificantly increased risk among women (trend), but not men was found in one cohort (Voorrips LE [9]). No other associations were found. The average RR = 1.01 (excluding
incomplete data from Park Y [27]).
Inclusion of intermediate levels of consumption:
Though in one cohort, the trend increased nonsignificantly, no (non)significant effects were found at any level of consumption among both men and women:
Effect modification:
- No effect modification was found by alcohol consumption (15, 18, 25), meat consumption (18, 25), physical activity (25), and vitamin supplement use (25).
- One (18), but not the other (25) cohort showed an increased risk among current smokers only.
- Most (15, 25), but not all (18) cohorts showed no effect modification by BMI.
Conclusion: Few associations were found. No evidence was found for an association between total vegetables 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 = 0.97 (0.64-1.46; P = 0.586). Women: RR = 1.09 (0.67-1.77; P = 0.415). |
| 27) Park Y (2007) | The NIH-AARP Diet and Health Study | Not defined | Men: RR = 0.81 (0.62-1.05; P = 0.21). Women: RR = 1.21 (0.80-1.83; P = 0.59). |
| 25) Tsubono Y (2005) | The JPHC Study | 154 men, and 95 women | Men: RR = 1.06 (0.63-1.78; P = 0.81). Women: RR = 0.71 (0.36-1.38; P = 0.27). |
| 24) Sato Y (2005) | The Miyagi Cohort Study | 112 (not defined, stratified by gender) | Men: RR = 1.32 (0.67-2.60; P = 0.23). Women: RR = 0.99 (0.42-2.32; P = 0.73). |
| 18) van Duijnhoven FJ (2009) | The EPIC Study | 991 | HR = 1.04 (0.81-1.33; P = 0.80). |
| 15) Terry P (2001) | The Swedish Mammography Screening Cohort | 159 | RR = 0.71 (0.45-1.12; P = 0.29). |
| 9) Voorrips LE (2000) | The Netherlands Cohort Study | 199 men, and 115 women | Men: RR = 0.88 (0.55-1.41; P = 0.58). Women: RR = 1.78 (0.94-3.38; P = 0.09). |
| 6) Michels KB (2000) | The Health Professionals' Follow up Study & The Nurses' Health Study | 89 men, and 155 women | Men: RR = 1.24. Women: RR = 0.67. |
| Total number of cases: 2,524 + X | Average RR = 1.01 |
| 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) | Vegetables (not defined) |
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 | Vegetables (Not defined. Excluding potatoes except sweet potatoes) |
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One serving = 1 cup of leafy vegetables, 1/2 cup of other vegetables, 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 vegetables | Cohort I: five vegetables (green leafy, yellow, white, pickled, and vegetable juice). Cohort II: six vegetables (green vegetables, carrot, tomatoes, green pickled vegetables, other pickled vegetables, and vegetable juice)
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Stratified analyses by covariates included in multivariate models did not reveal remarkable effect modifications (no data shown). Analyses based on the octiles of total vegetable 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 | 112 | (No data about amount of male and female cases) Rectal cancer risk | Total vegetables (Green leafy vegetables, carrots and pumpkins, tomatoes, cabbage and lettuce, Chinese cabbage and tsukemono [pickles]) |
RR = 1.14 (0.67-1.93; P = 0.55) for the highest vs lowest quartile of consumption. | Amount specific data (g): ≤ 245: RR = 1. 246-277: RR = 0.87 (0.50-1.52). 278-312: RR = 0.96 (0.55-1.66). ≥ 313: RR = 1.14 (0.67-1.93).
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 vegetables (leafy vegetables, fruiting vegetables, root vegetables, cabbages, onions and garlic, mushrooms, grain and pod vegetables [e.g. peas], stalk vegetables and sprouts, mixed salads/mixed vegetables, and unclassified vegetables. | excluding legumes or potatoes and other tubers)
HR = 1.04 (0.81-1.33; P = 0.80) for the highest vs lowest quintile of consumption. | Amount specific data (g/d): < 95.1: HR = 1. 95.1-141.0: HR = 1.02 (0.84-1.25). 141.0-197.5: HR = 1.08 (0.88-1.33). 197.5-284.4: HR = 1.06 (0.85-1.33). > 284.4: HR = 1.04 (0.81-1.33).
Effect modification: Tertiles of red and processed meat or alcohol did not modify the association between vegetable consumption and the risk of cancer (no data shown). BMI modified the association: an inverse association was most apparent in the highest tertile of BMI (no data shown). 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 fruit. |
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 | Vegetables (such as cabbage, tomatoes, lettuce, spinach, potatoes, and carrots and beets) |
RR = 0.71 (0.45-1.12; P = 0.29) for the highest vs lowest quartile of consumption. | Amount specific data (servings/day): < 1.0: RR = 1. 1.0-1.5: RR = 0.84 (0.54-1.30). 1.5-2.0: RR = 1.05 (0.69-1.58). > 2.0: RR = 0.71 (0.45-1.12). 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) 314 | (199 men, 115 women) Rectal cancer risk | Total vegetables (Brussels sprouts, cauliflower, cabbage, spinach, cooked endive, beetroot, string beans, broad beans, kale, cooked carrots, sweet peppers, sauerkraut, rhubarb, mushrooms, gherkins, raw endive, raw carrots, lettuce, tomatoes) |
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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 vegetable was used in the definition "all vegetables" if it was included in at least 2 (out of 4) different FFQs of the NHS. | All Vegetables. (defined as: alfalfa sprouts, beets, broccoli, Brussels sprouts, cabbage, carrots, cauliflower, celery, chard greens, coleslaw, corn, eggplant, head lettuce, iceberg lettuce, kale, leaf lettuce, lima beans, mixed vegetables, mushrooms, mustard greens, peas, red chili sauce, romaine lettuce, soybeans, spinach, string beans, summer squash, sweet potatoes, tofu, tomato juice, tomato sauce, tomatoes, yams, yellow squash, winter squash, zucchini. Potatoes were not included)
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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. |
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