Smith-Warner Stephanie A, Spiegelman Donna, Yaun Shiaw-Shyuan, Albanes Demetrius, Beeson W Lawrence, van den Brandt Piet A, Feskanich Diane, Folsom Aaron R, Fraser Gary E, Freudenheim Jo L, Giovannucci Edward, Goldbohm R Alexandra, Graham Saxon, Kushi Lawrence H, Miller Anthony B, Pietinen Pirjo, Rohan Thomas E, Speizer Frank E, Willett Walter C, Hunter David J
Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
Int J Cancer. 2003 Dec 20;107(6):1001-11. doi: 10.1002/ijc.11490.
Inverse associations between fruit and vegetable consumption and lung cancer risk have been consistently reported. However, identifying the specific fruits and vegetables associated with lung cancer is difficult because the food groups and foods evaluated have varied across studies. We analyzed fruit and vegetable groups using standardized exposure and covariate definitions in 8 prospective studies. We combined study-specific relative risks (RRs) using a random effects model. In the pooled database, 3,206 incident lung cancer cases occurred among 430,281 women and men followed for up to 6-16 years across studies. Controlling for smoking habits and other lung cancer risk factors, a 16-23% reduction in lung cancer risk was observed for quintiles 2 through 5 vs. the lowest quintile of consumption for total fruits (RR = 0.77; 95% CI = 0.67-0.87 for quintile 5; p-value, test for trend < 0.001) and for total fruits and vegetables (RR = 0.79; 95% CI = 0.69-0.90; p-value, test for trend = 0.001). For the same comparison, the association was weaker for total vegetable consumption (RR = 0.88; 95% CI = 0.78-1.00; p-value, test for trend = 0.12). Associations were similar between never, past, and current smokers. These results suggest that elevated fruit and vegetable consumption is associated with a modest reduction in lung cancer risk, which is mostly attributable to fruit, not vegetable, intake. However, we cannot rule out the possibility that our results are due to residual confounding by smoking. The primary focus for reducing lung cancer incidence should continue to be smoking prevention and cessation.
水果和蔬菜摄入量与肺癌风险之间的负相关关系已得到一致报道。然而，由于不同研究中评估的食物类别和食物各不相同，确定与肺癌相关的具体水果和蔬菜很困难。我们在8项前瞻性研究中使用标准化的暴露和协变量定义分析了水果和蔬菜类别。我们使用随机效应模型合并了各研究的特定相对风险（RRs）。在汇总数据库中，430281名男性和女性在长达6至16年的研究随访中发生了3206例肺癌病例。在控制吸烟习惯和其他肺癌风险因素后，与水果摄入量最低的五分位数相比，水果摄入量第二至第五五分位数的肺癌风险降低了16%至23%（第五五分位数的RR = 0.77；95%CI = 0.67 - 0.87；趋势检验p值<0.001），水果和蔬菜总摄入量也有类似情况（RR = 0.79；95%CI = 0.69 - 0.90；趋势检验p值 = 0.001）。对于相同的比较，蔬菜总摄入量的关联较弱（RR = 0.88；95%CI = 0.78 - 1.00；趋势检验p值 = 0.12）。从不吸烟者、既往吸烟者和当前吸烟者之间的关联相似。这些结果表明，增加水果和蔬菜摄入量与肺癌风险适度降低相关，这主要归因于水果而非蔬菜的摄入。然而，我们不能排除我们的结果是由于吸烟残留混杂因素导致的可能性。降低肺癌发病率的主要重点应继续是预防和戒烟。
