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Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC).

  • Paolo Boffetta
  • Elisabeth Couto
  • Janine Wichmann
  • Pietro Ferrari
  • Dimitrios Trichopoulos
  • H Bas Bueno-de-Mesquita
  • Fränzel J B van Duijnhoven
  • Frederike L Büchner
  • Tim Key
  • Heiner Boeing
  • Ute Nöthlings
  • Jakob Linseisen
  • Carlos A Gonzalez
  • Kim Overvad
  • Michael R S Nielsen
  • Anne Tjønneland
  • Anja Olsen
  • Françoise Clavel-Chapelon
  • Marie-Christine Boutron-Ruault
  • Sophie Morois
  • Pagona Lagiou
  • Androniki Naska
  • Vassiliki Benetou
  • Rudolf Kaaks
  • Sabine Rohrmann
  • Salvatore Panico
  • Sabina Sieri
  • Paolo Vineis
  • Domenico Palli
  • Carla H van Gils
  • Petra H Peeters
  • Eiliv Lund
  • Magritt Brustad
  • Dagrun Engeset
  • José María Huerta
  • Laudina Rodríguez
  • Maria-José Sánchez
  • Miren Dorronsoro
  • Aurelio Barricarte
  • Göran Hallmans
  • Ingegerd Johansson
  • Jonas Manjer
  • Emily Sonestedt
  • Naomi E Allen
  • Sheila Bingham
  • Kay-Tee Khaw
  • Nadia Slimani
  • Mazda Jenab
  • Traci Mouw
  • Teresa Norat
  • Elio Riboli
  • Antonia Trichopoulou
Publishing year: 2010
Language: English
Pages: 529-537
Publication/Series: Journal of the National Cancer Institute
Volume: 102
Issue: 8
Document type: Journal article
Publisher: Oxford University Press
Additional info: The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Surgery Research Unit (013242220), Unit on Vascular Diabetic Complications (013241510), Emergency medicine/Medicine/Surgery (013240200)

Abstract english

BACKGROUND: It is widely believed that cancer can be prevented by high intake of fruits and vegetables. However, inconsistent results from many studies have not been able to conclusively establish an inverse association between fruit and vegetable intake and overall cancer risk. METHODS: We conducted a prospective analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort to assess relationships between intake of total fruits, total vegetables, and total fruits and vegetables combined and cancer risk during 1992-2000. Detailed information on the dietary habit and lifestyle variables of the cohort was obtained. Cancer incidence and mortality data were ascertained, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression models. Analyses were also conducted for cancers associated with tobacco and alcohol after stratification for tobacco smoking and alcohol drinking. RESULTS: Of the initial 142 605 men and 335 873 women included in the study, 9604 men and 21 000 women were identified with cancer after a median follow-up of 8.7 years. The crude cancer incidence rates were 7.9 per 1000 person-years in men and 7.1 per 1000 person-years in women. Associations between reduced cancer risk and increased intake of total fruits and vegetables combined and total vegetables for the entire cohort were similar (200 g/d increased intake of fruits and vegetables combined, HR = 0.97, 95% CI = 0.96 to 0.99; 100 g/d increased intake of total vegetables, HR = 0.98, 95% CI = 0.97 to 0.99); intake of fruits showed a weaker inverse association (100 g/d increased intake of total fruits, HR = 0.99, 95% CI = 0.98 to 1.00). The reduced risk of cancer associated with high vegetable intake was restricted to women (HR = 0.98, 95% CI = 0.97 to 0.99). Stratification by alcohol intake suggested a stronger reduction in risk in heavy drinkers and was confined to cancers caused by smoking and alcohol. CONCLUSIONS: A very small inverse association between intake of total fruits and vegetables and cancer risk was observed in this study. Given the small magnitude of the observed associations, caution should be applied in their interpretation.


  • Cancer and Oncology
  • Neoplasms: epidemiology
  • Alcohol Drinking: adverse effects
  • Europe: epidemiology
  • Neoplasms: prevention & control
  • Neoplasms: etiology


  • Surgery
  • ISSN: 1460-2105
Emily Sonestedt
E-mail: emily [dot] sonestedt [at] med [dot] lu [dot] se

Associate senior lecturer

Nutrition Epidemiology

+46 40 39 13 25

+46 73 700 71 45


Jan Waldenströms gata 35, CRC 60:13, Malmö


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Lund University Diabetes Centre, CRC, SUS Malmö, Jan Waldenströms gata 35, House 91:12. SE-214 28 Malmö. Telephone: +46 40 39 10 00