Subtypes of fruit and vegetables, variety in consumption and risk of colon and rectal cancer in the European Prospective Investigation into Cancer and Nutrition

Max Leenders*, Peter D. Siersema, Kim Overvad, Anne Tjønneland, Anja Olsen, Marie Christine Boutron-Ruault, Nadia Bastide, Guy Fagherazzi, Verena Katzke, Tilman Kühn, Heiner Boeing, Krasimira Aleksandrova, Antonia Trichopoulou, Pagona Lagiou, Eleni Klinaki, Giovanna Masala, Sara Grioni, Maria Santucci De Magistris, Rosario Tumino, Fulvio RicceriPetra H.M. Peeters, Eiliv Lund, Guri Skeie, Elisabete Weiderpass, J. Ramõn Quirõs, Antonio Agudo, María José Sánchez, Miren Dorronsoro, Carmen Navarro, Eva Ardanaz, Bodil Ohlsson, Karin Jirström, Bethany Van Guelpen, Maria Wennberg, Kay Tee Khaw, Nick Wareham, Timothy J. Key, Isabelle Romieu, Inge Huybrechts, Amanda J. Cross, Neil Murphy, Elio Riboli, H. Bueno-De-Mesquita

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

42 Citations (Scopus)


Previously, a lower risk of colorectal cancer was observed with fruit and vegetable consumption in the European Prospective Investigation into Cancer and Nutrition within a follow-up period of 9 years which was not fully supported by a recent meta-analysis. Therefore, we were interested in the relation with extended follow-up, also focusing on single subtypes and a variety of intake of fruit and vegetables. Fruit and vegetable consumption was assessed at baseline. After an average of 13 years of follow-up, 3,370 participants were diagnosed with colon or rectal cancer. Diet diversity scores were constructed to quantify variety in fruit and vegetable consumption. A lower risk of colon cancer was observed with higher self-reported consumption of fruit and vegetable combined (HR Q4 vs. Q1 0.87, 95% CI 0.75-1.01, p for trend 0.02), but no consistent association was observed for separate consumption of fruits and vegetables. No associations with risk of rectal cancer were observed. The few observed associations for some fruit and vegetable subtypes with colon cancer risk may have been due to chance. Variety in consumption of fruits and vegetables was not associated with a lower risk of colon or rectal cancer. Although a lower risk of colon cancer is suggested with high consumption of fruit and vegetables, this study does not support a clear inverse association between fruit and vegetable consumption and colon or rectal cancer beyond a follow-up of more than 10 years. Attenuation of the risk estimates from dietary changes over time cannot be excluded, but appears unlikely. What's new? Eating a healthy diet loaded with fruits and vegetables will help you stave off cancer - that's the conventional wisdom. But the relationship between diet and cancer is complex. This study probed the effects of fruits and vegetables on colorectal cancer risk. The authors combed through data from the European Prospective Investigation into Cancer and Nutrition (EPIC) and analyzed total fruit and vegetable consumption as well as individual subtypes. Contrary to earlier results, they found no correlation between fruit and vegetable intake and colorectal cancer risk over a period of more than ten years.

Original languageEnglish
Pages (from-to)2705-2714
Number of pages10
JournalInternational Journal of Cancer
Issue number11
Publication statusPublished - 1 Dec 2015
Externally publishedYes


  • colorectal cancer
  • fruits and vegetables
  • variety


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