Intake of fruits and vegetables and risk of cancer of the upper aero-digestive tract: The prospective EPIC-study

Heiner Boeing, Thomas Dietrich, Kurt Hoffmann, Tobias Pischon, Pietro Ferrari, Petra H. Lahmann, Marie Christine Boutron-Ruault, Francoise Clavel-Chapelon, Naomi Allen, Tim Key, Guri Skeie, Eiliv Lund, Anja Olsen, Anne Tjonneland, Kim Overvad, Majken K. Jensen, Sabine Rohrmann, Jakob Linseisen, Antonia Trichopoulou, Christina BamiaTheodora Psaltopoulou, Lars Weinehall, Ingegerd Johansson, Maria José Sánchez, Paula Jakszyn, Eva Ardanaz, Pilar Amiano, Maria Dolores Chirlaque, J. Ramón Quirós, Elisabet Wirfalt, Göran Berglund, Petra H. Peeters, Carla H. Van Gils, H. Bas Bueno-De-Mesquita, Frederike L. Büchner, Franco Berrino, Domenico Palli, Carlotta Sacerdote, Rosario Tumino, Salvatore Panico, Sheila Bingham, Kay Tee Khaw, Nadia Slimani, Teresa Norat, Mazda Jenab, Elio Riboli

Research output: Indexed journal article Articlepeer-review

100 Citations (Scopus)


Epidemiologic studies suggest that a high intake of fruits and vegetables is associated with decreased risk of cancers of the upper aero-digestive tract. We studied data from 345,904 subjects of the prospective European Investigation into Cancer and Nutrition (EPIC) recruited in seven European countries, who had completed a dietary questionnaire in 1992-1998. During 2,182,560 person years of observation 352 histologically verified incident squamous cell cancer (SCC) cases (255 males; 97 females) of the oral cavity, pharynx, larynx, and esophagus were identified. Linear and restricted cubic spline Cox regressions were fitted on variables of intake of fruits and vegetables and adjusted for potential confounders. We observed a significant inverse association with combined total fruits and vegetables intake (estimated relative risk (RR) = 0.91; 95% confidence interval (95% CI) 0.83-1.00 per 80 g/d of consumption), and nearly significant inverse associations in separate analyses with total fruits and total vegetables intake (RR: 0.97 (95% CI: 0.92-1.02) and RR = 0.89 (95% CI: 0.78-1.02) per 40 g/d of consumption). Overall, vegetable subgroups were not related to risk with the exception of intake of root vegetables in men. Restricted cubic spline regression did not improve the linear model fits except for total fruits and vegetables and total fruits with a significant decrease in risk at low intake levels (<120 g/d) for fruits. Dietary recommendations should consider the potential benefit of increasing fruits and vegetables consumption for reducing the risk of cancers of the upper aero-digestive tract, particularly at low intake.

Original languageEnglish
Pages (from-to)957-969
Number of pages13
JournalCancer Causes and Control
Issue number7
Publication statusPublished - Sept 2006
Externally publishedYes


  • EPIC
  • Fruits and vegetables
  • Prospective study
  • Relative risk
  • Root vegetables
  • Upper aero-digestive cancer


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