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Key words
Cohort studies, fruit, lung neoplasms, meta-analysis,
vegetables
Correspondence
Kenji Wakai, Department of Preventive Medicine, Nagoya
University Graduate School of Medicine, 65 Tsurumai-cho,
Showa-ku, Nagoya 466-8550, Japan.
Tel: +81-52-744-2132; Fax: +81-52-744-2971;
E-mail: wakai@med.nagoya-u.ac.jp
*Research group members are presented in Appendix 1.
Funding information
National Cancer Center Research and Development Fund
Grant-in-Aid for the Third-Term Comprehensive Ten-Year
Strategy for Cancer Control from the Ministry of Health,
Labour and Welfare of Japan
Received January 14, 2015; Revised May 4, 2015; Accepted
May 25, 2015
Cancer Sci 106 (2015) 10571065
doi: 10.1111/cas.12707
2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd
on behalf of Japanese Cancer Association.
This is an open access article under the terms of the Creative Commons
Attribution-NonCommercial License, which permits use, distribution and
reproduction in any medium, provided the original work is properly cited and is
not used for commercial purposes.
2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd
on behalf of Japanese Cancer Association.
at
110 792
83
registry
Cancer
4064
47 605
92
certificate
certificate
in Miyagi
Japan
Prefecture,
and death
municipalities
Cancer
registry
1990
14
Residents of
areas: 22)
and death
(selected
Japan
registry
Cancer
throughout
areas
Residents of 45
1990
certificate
areas in Japan
1988
80
and death
4079
78 825
health-center
1994
of 6 public
residents
Japanese
areas in Japan
1993
Cancer
certificate
82
naire
question-
follow up
Method of
and death
4069
for
baseline
health-center
61 595
size
Population
of 5 public
1990
survey
line
base-
registry
4059
(years)
line
base-
rate (%)
residents
Japanese
Population
of
Year
Response
4064
4079
4069
4059
year
range,
Age
2001
2008
2008
2008
up
follow
Last
Mean
11.0
15.8
14.7
17.8
year
period,
up
follow
95 235
22 234
23 815
29 008
20 178
Men
114 109
23 764
36 434
32 254
21 657
Women
Size of cohort
For mortality
1385
117
543
463
262
Men
401
33
179
123
66
Women
cancer cases
Number of
2003
2001
2006
2006
up
follow
Last
JACC, The Japan Collaborative Cohort Study; JPHC, Japan Public Health Center-based Prospective Study; MIYAGI, The Miyagi Cohort Study.
Total
MIYAGI
JACC
JPHC II
JPHC I
Study
range
Age
Mean
12.8
10.5
12.1
15.3
year
period,
up
follow
87 570
22 208
16 225
28 978
20 159
Men
103 370
23 756
25 719
32 241
21 654
Women
Size of cohort
For incidence
Table 1. Characteristics of the four cohort studies in the pooled analysis of the association between consumption of fruit and vegetables and lung cancer risk
Number of
1300
297
222
503
278
Men
442
98
74
152
118
Women
cancer cases
Original Article
Vegetables, fruit and lung cancer risk
www.wileyonlinelibrary.com/journal/cas
Original Article
Wakai et al.
www.wileyonlinelibrary.com/journal/cas
four studies that met these criteria: (1) the Japan Public Health
Center-based Prospective Study-I (JPHC-I);(11) (2) the Japan
Public Health Center-based Prospective Study-II (JPHC-II);(11)
(3) the Japan Collaborative Cohort Study (JACC);(12) and (4)
the Miyagi Cohort Study (MIYAGI).(13) Selected characteristics of these cohort studies are shown in Table 1.
We excluded data from participants with extreme energy
intakes (>3 SD from the mean loge-transformed energy intake
in each study), those with missing information on dietary
intake and those with a history of cancer at baseline. The relevant institutional review board approved each study. The
JPHC-I and JPHC-II have already published results on the
association of consumption of vegetables and fruit with
the risk of lung cancer.(14) In the current study, we reanalyzed
the updated dataset for JPHC-I and JPHC-II.
Assessment of consumption of fruit and vegetables. In each
study, dietary intake was assessed by means of self-administered FFQ. Although the FFQ differed by study, investigators
in each cohort estimated the consumption in grams for the following food groups, based on the frequency of intake: (1)
fruit; (2) total vegetables; (3) green-yellow vegetables; and (4)
vegetables and fruit. The details of the questionnaires have
been described previously.(15) In brief, the questionnaire contained questions asking about the average frequency of intake
of food items, including several vegetables and fruits. A portion size for each food item was determined in each cohort
based on the median values observed in 12-day or 28-day dietary records (DR) that were collected in the validation studies
for the FFQ.(1618) We computed daily intake of each food
Table 2. Summary hazard ratios for lung cancer mortality by level of consumption of vegetables and fruit
Men
Number of cases
Fruit
Vegetables
and fruit
Greenyellow
vegetables
Vegetables
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
344
261
231
271
278
P
298
258
263
289
277
P
279
265
255
286
300
P
258
265
263
292
307
P
Women
Multivariateadjusted
1.00
0.74 (0.630.87)
0.64 (0.540.75)
0.71 (0.610.84)
0.71 (0.600.83)
4 9 10 5
1.00
0.81 (0.690.96)
0.78 (0.660.93)
0.82 (0.690.96)
0.75 (0.640.89)
0.003
1.00
0.92 (0.771.09)
0.84 (0.710.99)
0.87 (0.731.02)
0.82 (0.700.97)
0.023
1.00
0.98 (0.831.17)
0.91 (0.761.08)
0.97 (0.821.14)
0.96 (0.811.13)
0.630
1.00
0.80 (0.680.94)
0.71 (0.600.84)
0.85 (0.721.00)
0.90 (0.761.06)
0.275
1.00
0.87 (0.741.03)
0.88 (0.751.04)
0.97 (0.821.14)
0.94 (0.791.11)
0.890
1.00
0.98 (0.821.15)
0.92 (0.781.09)
0.98 (0.831.16)
0.99 (0.841.17)
0.976
1.00
1.04 (0.871.23)
0.98 (0.821.16)
1.05 (0.891.24)
1.09 (0.921.29)
0.303
Number of cases
90
74
77
77
83
91
67
69
91
83
77
76
81
78
89
79
82
71
81
88
Multivariateadjusted
1.00
0.85 (0.621.16)
0.89 (0.651.21)
0.88 (0.641.20)
0.94 (0.691.27)
0.805
1.00
0.75 (0.551.04)
0.76 (0.561.05)
0.99 (0.741.33)
0.86 (0.631.16)
0.890
1.00
1.01 (0.731.39)
1.02 (0.751.40)
0.94 (0.681.29)
1.01 (0.741.38)
0.925
1.00
1.05 (0.771.43)
0.89 (0.641.23)
0.96 (0.701.32)
0.98 (0.721.33)
0.713
1.00
0.91 (0.661.24)
0.98 (0.721.34)
0.97 (0.701.32)
1.03 (0.761.41)
0.700
1.00
0.81 (0.591.11)
0.83 (0.601.14)
1.10 (0.821.49)
0.94 (0.691.27)
0.659
1.00
1.06 (0.771.46)
1.10 (0.801.51)
1.01 (0.731.39)
1.10 (0.801.50)
0.664
1.00
1.11 (0.811.51)
0.93 (0.671.29)
1.02 (0.741.40)
1.03 (0.751.40)
0.927
Adjusted for age, area, smoking and intake of total energy. CI, confidence interval; Q1Q5, quintiles 15.
2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd
on behalf of Japanese Cancer Association.
Original Article
Vegetables, fruit and lung cancer risk
www.wileyonlinelibrary.com/journal/cas
Table 3. Summary hazard ratios for lung cancer mortality by level of consumption of vegetables and fruit among never smokers
Men
Number of cases
Fruit
Vegetables
and fruit
Greenyellow
vegetables
Vegetables
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
96
97
81
89
112
P
91
91
80
108
105
P
90
82
101
101
101
P
88
91
91
97
108
P
Women
Multivariateadjusted
1.00
1.14 (0.532.45)
0.89 (0.411.96)
0.88 (0.401.92)
1.00 (0.472.15)
0.737
1.00
1.00 (0.482.09)
0.35 (0.130.92)
0.91 (0.441.87)
0.74 (0.361.52)
0.980
1.00
1.33 (0.563.19)
1.06 (0.432.63)
1.51 (0.683.39)
1.11 (0.492.54)
0.690
1.00
0.88 (0.411.92)
1.06 (0.512.21)
0.58 (0.241.37)
0.97 (0.491.90)
0.681
1.00
1.11 (0.512.40)
0.90 (0.411.97)
0.89 (0.411.94)
1.00 (0.472.16)
0.748
1.00
1.01 (0.482.11)
0.35 (0.130.93)
0.93 (0.451.91)
0.74 (0.361.53)
0.998
1.00
1.36 (0.573.26)
1.10 (0.442.72)
1.57 (0.703.52)
1.12 (0.492.54)
0.678
1.00
0.90 (0.411.95)
1.08 (0.522.25)
0.59 (0.251.40)
0.96 (0.491.89)
0.651
Number of cases
62
50
66
69
64
60
51
57
81
62
52
63
66
57
73
55
67
55
66
68
Multivariateadjusted
1.00
0.79 (0.541.16)
1.09 (0.771.55)
1.11 (0.781.57)
1.05 (0.731.50)
0.252
1.00
0.91 (0.631.33)
1.03 (0.711.49)
1.37 (0.971.93)
1.00 (0.691.44)
0.312
1.00
1.30 (0.891.88)
1.25 (0.861.81)
1.08 (0.741.59)
1.27 (0.881.84)
0.491
1.00
1.23 (0.861.77)
1.00 (0.691.46)
1.11 (0.771.59)
1.08 (0.751.55)
0.950
1.00
0.79 (0.541.15)
1.08 (0.761.53)
1.09 (0.771.55)
1.05 (0.741.51)
0.248
1.00
0.91 (0.621.33)
1.02 (0.701.48)
1.36 (0.961.92)
1.00 (0.691.44)
0.319
1.00
1.29 (0.891.88)
1.23 (0.851.80)
1.07 (0.731.58)
1.27 (0.881.84)
0.505
1.00
1.23 (0.851.76)
0.99 (0.681.45)
1.10 (0.761.58)
1.08 (0.751.55)
0.961
Adjusted for age, area and intake of total energy. CI, confidence interval; Q1Q5, quintiles 15.
2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd
on behalf of Japanese Cancer Association.
Original Article
Wakai et al.
www.wileyonlinelibrary.com/journal/cas
Table 4. Summary hazard ratios for lung cancer mortality by level of consumption of vegetables and fruit among ever smokers
Men
Summary hazard ratio (95% CI)
Number of cases
Fruit
Vegetables
and fruit
Greenyellow
vegetables
Vegetables
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
308
247
210
252
266
P
262
239
244
277
261
P
259
232
239
263
290
P
234
247
243
272
287
P
Women
Age and
area-adjusted
Multivariateadjusted
1.00
0.77 (0.650.91)
0.64 (0.530.76)
0.76 (0.640.90)
0.75 (0.630.88)
0.001
1.00
0.82 (0.690.98)
0.82 (0.690.98)
0.88 (0.741.04)
0.80 (0.670.95)
0.056
1.00
0.88 (0.741.05)
0.85 (0.721.02)
0.85 (0.711.01)
0.85 (0.721.01)
0.071
1.00
0.99 (0.831.18)
0.92 (0.771.11)
0.98 (0.821.17)
0.99 (0.831.18)
0.855
1.00
0.81 (0.680.95)
0.69 (0.580.82)
0.85 (0.721.01)
0.87 (0.741.04)
0.177
1.00
0.86 (0.721.02)
0.89 (0.751.05)
0.99 (0.831.17)
0.93 (0.781.10)
0.963
1.00
0.91 (0.771.09)
0.92 (0.771.10)
0.92 (0.771.10)
0.97 (0.821.15)
0.799
1.00
1.03 (0.861.23)
0.97 (0.811.17)
1.04 (0.871.24)
1.09 (0.921.30)
0.383
Number of cases
19
20
11
11
9
23
16
10
8
13
17
14
10
15
14
18
16
12
10
14
Multivariateadjusted
1.00
1.28 (0.712.31)
0.48 (0.201.14)
0.44 (0.181.07)
0.56 (0.251.27)
0.031
1.00
0.62 (0.321.18)
0.25 (0.100.65)
0.41 (0.170.95)
0.57 (0.291.13)
0.015
1.00
0.62 (0.291.32)
0.69 (0.321.48)
0.61 (0.291.28)
0.57 (0.271.18)
0.206
1.00
0.88 (0.451.73)
0.57 (0.261.26)
0.46 (0.201.06)
0.69 (0.351.39)
0.103
1.00
1.36 (0.752.48)
0.53 (0.221.25)
0.51 (0.211.26)
0.58 (0.251.32)
0.049
1.00
0.61 (0.321.18)
0.27 (0.100.71)
0.47 (0.201.10)
0.61 (0.311.22)
0.035
1.00
0.67 (0.321.45)
0.76 (0.361.64)
0.71 (0.331.50)
0.64 (0.311.33)
0.326
1.00
0.95 (0.481.86)
0.63 (0.291.40)
0.50 (0.221.17)
0.77 (0.391.56)
0.192
Adjusted for age, area, smoking and intake of total energy. CI, confidence interval; Q1Q5, quintiles 15.
20. We incorporated total energy intake because its inclusion may reduce the random error in the effect of vegetable
fruit intake if energy intake has an important association
with the outcome.(19) We also conducted subgroup analyses
in never smokers and ever smokers (ex-smokers and current
smokers), whereby we determined sex-specific and cohortspecific cutoff points for quintiles of vegetable and fruit
intakes separately for the two subgroups. SAS version 9.1
(SAS Institute, Cary, NC, USA) or STATA, version 10.1
(Stata Corporation, College Station, TX, USA) statistical
software was used for these estimations.
To obtain a single pooled estimate of the HR from the
individual studies for each quintile, we applied a fixed-effect
model. The pooled HR was statistically tested individually
for the second to the highest quintiles versus the lowest; the
null hypothesis was that the risk of lung cancer mortality or
incidence was not different between individuals with each of
the second to the highest quintile of vegetable fruit intakes
and those with the lowest quintile. We did not consider possible issues of multiple comparisons, as in the previous
analysis regarding the risk of stomach cancer and consumption of vegetables and fruit.(15) We tested heterogeneity
among studies for each category by using Cochrans Q statistic and found no apparent indication of heterogeneity
(P > 0.05 for all categories). The dose-response relationship
was examined by models in which the lowest to the top
quintiles were scored as 0, 1, 2, 3 and 4, respectively, and
were incorporated as explanatory variables in individual studies. Resultant HR from all of the four cohorts were combined
2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd
on behalf of Japanese Cancer Association.
Original Article
Vegetables, fruit and lung cancer risk
www.wileyonlinelibrary.com/journal/cas
Table 5. Summary hazard ratios for lung cancer incidence by level of consumption of vegetables and fruit
Men
Number of cases
Fruit
Vegetables
and fruit
Greenyellow
vegetables
Vegetables
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
301
254
233
248
264
P
253
264
237
278
268
P
253
235
244
279
289
P
221
243
275
266
295
P
Women
Multivariateadjusted
1.00
0.83 (0.700.98)
0.75 (0.630.89)
0.76 (0.640.90)
0.77 (0.650.91)
0.001
1.00
1.00 (0.841.19)
0.85 (0.711.02)
0.95 (0.801.12)
0.88 (0.741.05)
0.123
1.00
0.92 (0.771.10)
0.91 (0.771.09)
0.97 (0.821.15)
0.93 (0.781.10)
0.645
1.00
1.07 (0.891.29)
1.13 (0.951.35)
1.05 (0.881.26)
1.11 (0.931.33)
0.335
1.00
0.89 (0.751.06)
0.83 (0.700.98)
0.89 (0.751.05)
0.96 (0.811.14)
0.589
1.00
1.07 (0.901.28)
0.95 (0.791.14)
1.12 (0.941.33)
1.07 (0.901.28)
0.354
1.00
0.98 (0.821.18)
1.00 (0.841.19)
1.09 (0.921.29)
1.10 (0.931.31)
0.122
1.00
1.14 (0.951.37)
1.21 (1.011.45)
1.14 (0.951.37)
1.26 (1.051.50)
0.024
Number of cases
90
87
96
78
91
86
92
80
92
92
83
81
94
81
103
74
109
77
83
99
Multivariateadjusted
1.00
0.98 (0.731.31)
1.06 (0.791.43)
0.84 (0.621.15)
0.99 (0.741.34)
0.714
1.00
1.07 (0.791.44)
0.90 (0.661.23)
1.01 (0.751.37)
1.00 (0.741.35)
0.897
1.00
1.00 (0.741.37)
1.13 (0.841.52)
0.94 (0.691.28)
1.15 (0.851.54)
0.497
1.00
1.46 (1.091.97)
1.00 (0.721.38)
1.04 (0.751.42)
1.19 (0.881.61)
0.941
1.00
1.02 (0.751.37)
1.13 (0.841.52)
0.89 (0.651.22)
1.04 (0.771.41)
0.944
1.00
1.11 (0.821.49)
0.94 (0.691.28)
1.07 (0.801.45)
1.04 (0.771.41)
0.866
1.00
1.04 (0.761.41)
1.17 (0.871.58)
0.98 (0.721.34)
1.20 (0.891.61)
0.323
1.00
1.50 (1.122.02)
1.03 (0.751.42)
1.07 (0.781.47)
1.22 (0.901.65)
0.955
Adjusted for age, area, smoking and intake of total energy. CI, confidence interval; Q1Q5, quintiles 15.
2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd
on behalf of Japanese Cancer Association.
Original Article
Wakai et al.
www.wileyonlinelibrary.com/journal/cas
Table 6. Summary hazard ratios for lung cancer incidence by level of consumption of vegetables and fruit among never smokers
Men
Number of cases
Fruit
Greenyellow vegetables
Vegetables
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
21
14
17
19
15
P
22
16
11
19
18
P
12
21
14
18
21
P
17
15
18
16
20
P
Women
Multivariateadjusted
1.00
0.86 (0.421.77)
0.79 (0.371.66)
0.64 (0.301.35)
0.73 (0.351.51)
0.720
1.00
0.68 (0.341.37)
0.39 (0.180.87)
0.57 (0.281.20)
0.67 (0.341.30)
0.575
1.00
1.74 (0.803.81)
1.19 (0.512.79)
1.40 (0.613.21)
1.57 (0.743.33)
0.646
1.00
0.74 (0.321.73)
1.05 (0.532.07)
0.66 (0.311.42)
0.97 (0.491.90)
0.985
1.00
0.80 (0.391.65)
0.78 (0.371.65)
0.66 (0.311.40)
0.69 (0.331.44)
0.692
1.00
0.72 (0.361.46)
0.41 (0.180.91)
0.59 (0.281.24)
0.67 (0.341.30)
0.523
1.00
1.85 (0.844.06)
1.29 (0.553.02)
1.53 (0.663.52)
1.62 (0.763.44)
0.606
1.00
0.80 (0.341.87)
1.12 (0.562.20)
0.69 (0.321.49)
0.96 (0.491.89)
0.911
Number of cases
69
61
78
67
74
59
76
62
76
76
57
74
73
59
86
54
86
60
70
79
Multivariateadjusted
1.00
0.86 (0.601.22)
1.09 (0.781.52)
0.91 (0.641.29)
1.03 (0.731.44)
0.559
1.00
1.21 (0.851.72)
1.10 (0.771.57)
1.20 (0.841.70)
1.19 (0.841.69)
0.404
1.00
1.20 (0.841.72)
1.31 (0.921.85)
0.97 (0.671.41)
1.33 (0.951.88)
0.275
1.00
1.64 (1.162.32)
1.10 (0.761.61)
1.20 (0.841.73)
1.35 (0.941.92)
0.692
1.00
0.86 (0.601.22)
1.09 (0.781.53)
0.90 (0.641.28)
1.02 (0.731.44)
0.600
1.00
1.21 (0.851.72)
1.10 (0.771.57)
1.19 (0.841.69)
1.19 (0.841.68)
0.430
1.00
1.21 (0.851.73)
1.30 (0.921.84)
0.98 (0.681.42)
1.34 (0.951.88)
0.273
1.00
1.64 (1.162.32)
1.11 (0.761.61)
1.20 (0.841.73)
1.34 (0.941.91)
0.719
Adjusted for age, area and intake of total energy. CI, confidence interval; Q1Q5, quintiles 15.
2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd
on behalf of Japanese Cancer Association.
Original Article
Vegetables, fruit and lung cancer risk
www.wileyonlinelibrary.com/journal/cas
Table 7. Summary hazard ratios for lung cancer incidence by level of consumption of vegetables and fruit among ever smokers
Men
Number of cases
Fruit
Vegetables
and fruit
Greenyellow
vegetables
Vegetables
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
Q1
Q2
Q3
Q4
Q5
Trend
265
232
219
224
256
P
223
236
222
261
254
P
233
209
215
268
271
P
195
235
247
244
275
P
Women
Multivariateadjusted
1.00
0.86 (0.721.02)
0.77 (0.640.92)
0.81 (0.680.97)
0.83 (0.700.99)
0.028
1.00
1.01 (0.841.21)
0.91 (0.751.09)
1.02 (0.851.22)
0.95 (0.791.13)
0.602
1.00
0.89 (0.741.07)
0.90 (0.751.08)
0.99 (0.831.19)
0.94 (0.781.12)
0.927
1.00
1.14 (0.941.37)
1.15 (0.951.38)
1.10 (0.911.32)
1.18 (0.981.41)
0.229
1.00
0.90 (0.761.08)
0.83 (0.690.99)
0.90 (0.761.08)
0.97 (0.811.16)
0.648
1.00
1.05 (0.881.26)
0.97 (0.811.17)
1.13 (0.951.36)
1.08 (0.901.30)
0.282
1.00
0.93 (0.771.12)
0.96 (0.801.16)
1.07 (0.901.28)
1.06 (0.891.27)
0.209
1.00
1.18 (0.981.43)
1.20 (0.991.45)
1.15 (0.961.39)
1.28 (1.061.54)
0.039
Number of cases
10
21
8
14
8
15
16
8
14
8
13
12
9
15
12
14
16
10
9
12
Multivariateadjusted
1.00
2.00 (1.023.90)
1.31 (0.553.14)
1.01 (0.412.52)
0.81 (0.312.08)
0.420
1.00
0.92 (0.461.86)
0.46 (0.181.21)
1.12 (0.542.36)
0.54 (0.231.26)
0.149
1.00
0.75 (0.321.73)
1.15 (0.452.95)
1.08 (0.512.28)
0.75 (0.331.70)
0.658
1.00
1.16 (0.572.37)
0.75 (0.321.78)
0.90 (0.362.26)
0.82 (0.381.75)
0.242
1.00
2.06 (1.054.04)
1.37 (0.573.28)
1.05 (0.422.64)
0.79 (0.302.06)
0.464
1.00
0.93 (0.461.88)
0.47 (0.181.24)
1.24 (0.592.63)
0.56 (0.241.30)
0.201
1.00
0.79 (0.341.83)
1.20 (0.463.08)
1.14 (0.532.41)
0.78 (0.341.78)
0.702
1.00
1.22 (0.602.49)
0.76 (0.321.82)
0.95 (0.382.39)
0.86 (0.401.85)
0.285
Adjusted for age, area, smoking and intake of total energy. CI, confidence interval; Q1Q5, quintiles 15.
2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd
on behalf of Japanese Cancer Association.
Acknowledgments
This study was supported by the National Cancer Center Research and
Development Fund and a Grant-in-Aid for the Third-Term Comprehensive Ten-Year Strategy for Cancer Control from the Ministry of
Health, Labour and Welfare of Japan.
Disclosure Statement
The authors have no conflicts of interest.
Original Article
Wakai et al.
www.wileyonlinelibrary.com/journal/cas
References
1 International Agency for Research on Cancer, World Health Organization.
IARC Handbooks of Cancer Prevention, vol. 8: Fruit and Vegetables. Lyon:
IARC Press, 2003.
2 World Cancer Research Fund, American Institute for Cancer Research.
Foods and drinks: Vegetables, fruits, pulses (legumes), nuts, seeds, herbs,
spices. In: World Cancer Research Fund, American Institute for Cancer
Research, eds. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. Washington: American Institute for Cancer
Research, 2007; 75115.
3 World Cancer Research Fund, American Institute for Cancer Research. Dietary constituents and supplements. In: World Cancer Research Fund, American Institute for Cancer Research, eds. Food, Nutrition, Physical Activity,
and the Prevention of Cancer: A Global Perspective. Washington: American
Institute for Cancer Research, 2007; 17989.
4 Wakai K, Matsuo K, Nagata C et al. Lung cancer risk and consumption of
vegetables and fruit: an evaluation based on a systematic review of epidemiological evidence from Japan. Jpn J Clin Oncol 2011; 41: 693708.
5 Mizoue T, Inoue M, Wakai K et al. Alcohol drinking and colorectal cancer
in Japanese: a pooled analysis of results from five cohort studies. Am J Epidemiol 2008; 167: 1397406.
6 Inoue M, Sasazuki S, Wakai K et al. Green tea consumption and gastric cancer
in Japanese: a pooled analysis of six cohort studies. Gut 2009; 58: 132332.
7 Sasazuki S, Inoue M, Tsuji I et al. Body mass index and mortality from all
causes and major causes in Japanese: results of a pooled analysis of 7 largescale cohort studies. J Epidemiol 2011; 21: 41730.
8 Inoue M, Nagata C, Tsuji I et al. Impact of alcohol intake on total mortality
and mortality from major causes in Japan: a pooled analysis of six largescale cohort studies. J Epidemiol Community Health 2012; 66: 44856.
9 Matsuo K, Mizoue T, Tanaka K et al. Association between body mass index
and the colorectal cancer risk in Japan: pooled analysis of population-based
cohort studies in Japan. Ann Oncol 2012; 23: 47990.
10 Shimazu T, Sasazuki S, Wakai K et al. Alcohol drinking and primary liver
cancer: a pooled analysis of four Japanese cohort studies. Int J Cancer 2012;
130: 264553.
11 Tsugane S, Sobue T. Baseline survey of JPHC studydesign and participation rate. Japan Public Health Center-based Prospective Study on Cancer and
Cardiovascular Diseases. J Epidemiol 2001; 11: S249.
12 Tamakoshi A, Yoshimura T, Inaba Y et al. Profile of the JACC study. J Epidemiol 2005; 15(Suppl 1): S48.
13 Tsuji I, Nishino Y, Tsubono Y et al. Follow-up and mortality profiles in the
Miyagi Cohort Study. J Epidemiol 2004; 14(Suppl 1): S26.
14 Liu Y, Sobue T, Otani T, Tsugane S. Vegetables, fruit consumption and risk
of lung cancer among middle-aged Japanese men and women: JPHC study.
Cancer Causes Control 2004; 15: 34957.
15 Shimazu T, Wakai K, Tamakoshi A et al. Association of vegetable and fruit
intake with gastric cancer risk among Japanese: a pooled analysis of four
cohort studies. Ann Oncol 2014; 25: 122833.
16 Ogawa K, Tsubono Y, Nishino Y et al. Validation of a food-frequency questionnaire for cohort studies in rural Japan. Public Health Nutr 2003; 6: 14757.
Appendix 1
Research group members
Supporting Information
Additional supporting information may be found in the online version of this article:
Table S1. Cutoff points used for quintiles of vegetable and fruit intakes by sex and cohort.
Table S2. Summary hazard ratios for lung cancer mortality by level of consumption of vegetables and fruit among never smokers (men and
women combined).
Table S3. Summary hazard ratios for lung cancer incidence by level of consumption of vegetables and fruit among never smokers (men and
women combined).
2015 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd
on behalf of Japanese Cancer Association.