Fruit and vegetable intake and the risk of stomach and oesophagus adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition (EPIC–EURGAST)

Abstract

It is considered that fruit and vegetable (F&V) protect against oesophagus and gastric cancer (GC). However, 2 recent meta‐analyses suggest that the strength of association on GC seems to be weaker for vegetables than for fruit and weaker in cohort than in case‐control studies. No evidence exists from cohort studies about adenocarcinoma of oesophagus (ACO). In 521,457 men and women participating in the EPIC cohort in 10 European countries, information of diet and lifestyle was collected at baseline. After an average of 6.5 years of follow‐up, a total of 330 GC and 65 ACO, confirmed and classified by a panel of pathologists, was used for the analysis. We examined the relation between F&V intake and GC and ACO. A calibration study in a sub‐sample was used to control diet measurement errors. In a sub‐sample of cases and a random sample of controls, antibodies against Helicobacter pylori (Hp) were measured and interactions with F&V were examined in a nested case‐control study. We observed no association with total vegetable intake or specific groups of vegetables and GC risk, except for the intestinal type, where a negative association is possible regarding total vegetable (calibrated HR 0.66; 95% CI 0.35–1.22 per 100 g increase) and onion and garlic intake (calibrated HR 0.70; 95% CI 0.38–1.29 per 10 g increase). No evidence of association between fresh fruit intake and GC risk was observed. We found a negative but non significant association between citrus fruit intake and the cardia site (calibrated HR 0.77; 95% CI 0.47–1.22 per 100 g increase) while no association was observed with the non‐cardia site. Regarding ACO, we found a non significant negative association for vegetable intake and for citrus intake (calibrated HRs 0.72; 95% CI 0.32–1.64 and 0.77; 95% CI 0.46–1.28 per 100 and 50 g increase, respectively). It seems that Hp infection does not modify the effect of F&V intake. Our study supports a possible protective role of vegetable intake in the intestinal type of GC and the ACO. Citrus fruit consumption may have a role in the protection against cardia GC and ACO. © 2005 Wiley‐Liss, Inc.

Recent patterns in gastric cancer: A global overview

“…Primary prevention of stomach cancer by dietary means is feasible by encouraging high-risk populations to decrease consumption of cured meats and salt preserved foods, and increase the consumption of vegetables and fruit. [42][43][44][45][46][47] Prevention may also be feasible through eradication of H. pylori infection, particularly in childhood and adolescence.…”

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

“…Increasing fruit and vegetable consumption continues to be considered a factor capable of lowering the risk of developing gastric cancer, although recent prospective studies have not been able to confirm this effect (81,167) . Neither was vitamin supplementation in the diet also able to reduce the gastric cancer risk (6) .…”

Plasma and dietary carotenoid, retinol and tocopherol levels and the risk of gastric adenocarcinomas in the European prospective investigation into cancer and nutrition

“…The intake of some fruits and vegetables has been suggested to be inversely associated with the risk of GCs (World Cancer Research Fund, 1997;Riboli and Norat, 2003;Gonzalez et al, 2006), an effect that may be owing to the various carotenoids and antioxidant vitamins present in these foods (Donaldson, 2004). Several case -control studies have shown strong inverse associations between GC risk and higher consumption of some of these nutrients (Buiatti et al, 1990(Buiatti et al, , 1991Gonzalez et al, 1994;Hansson et al, 1994;Ekstrom et al, 2000).…”