Abstract
Objective: We have examined the role of dietary patterns and specific dietary nutrients in the etiology of lung cancer among non-smokers using a multicenter case–control study.
Methods: 506 non-smoking incident lung cancer cases were identified in the eight centers along with 1045 non-smoking controls. Dietary habits were assessed using a quantitative food-frequency questionnaire administered by personal interview. Based on this information, measures of total carotenoids, beta-carotene and retinol nutrient intake were estimated.
Results: Protective effects against lung cancer were observed for high consumption of tomatoes, (odds ratio (OR) = 0.5; 95% confidence interval (CI) 0.4–0.6), lettuce (OR = 0.6; 95% CI 0.3–1.2), carrots (OR = 0.8; 95% CI 0.5–1.1), margarine (OR = 0.7; 95% CI 0.5–0.8) and cheese (OR = 0.7; 95% CI 0.5–1.0). Only weak protective effects were observed for high consumption of all carotenoids (OR = 0.8; 95% CI 0.6–1.0), beta-carotene (OR=0.8; 95% CI 0.6–1.1) and retinol (OR = 0.9; 95% CI 0.7–1.1). Protective effects for high levels of fruit consumption were restricted to squamous cell carcinoma (OR = 0.7; 95% CI 0.4–1.2) and small cell carcinoma (OR = 0.7; 95% CI 0.4–1.2), and were not apparent for adenocarcinoma (OR = 0.9; 95% CI 0.6–1.3). Similarly, any excess risk associated with meat, butter and egg consumption was restricted to squamous and small cell carcinomas, but was not detected for adenocarcinomas.
Conclusions: This evidence suggests that the public health significance of increasing vegetable consumption among the bottom third of the population would include a reduction in the incidence of lung cancer among lifetime non-smokers by at least 25%, and possibly more. A similar protective effect for increased fruit consumption may be present for squamous cell and small cell lung carcinomas.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Parkin DM, Sasco AJ (1993) Lung cancer: worldwide variation in occurrence and proportion attributable to tobacco use. Lung Cancer 9: 1–16.
Pisani P, Parkin DM, Muñoz N, et al. (1997) Cancer and infection: estimates of the attributable fraction in 1990. Cancer Epidemiol Biomarkers Prev 6: 387–400.
World Cancer Research Fund (1997) Food, Nutrition and the Prevention of Cancer: a Global Perspective. Washington, DC: American Institute for Cancer Research.
IARC (1998) Carotenoids. IARC Handbooks of Cancer Prevention, Vol. 2. Lyon: International Agency for Research on Cancer.
Boffetta P, Agudo A, Ahrens W, et al. (1998) Multicenter case-control study of exposure to environmental tobacco smoke and lung cancer in Europe. J Natl Cancer Inst 90: 1440–1450.
Mangels AR, Holden JM, Beecher GR, et al. (1993) Carotenoid content of fruits and vegetables: an evaluation of analytic data. J Am Diet Assoc 93: 284–296.
McCance RA, Widdowson EM (1985) The Composition of Foods (MRC Special Report No. 297). Fourth revised and extended edition. London: Her Majesty's Stationery Office.
White H (1982) Maximum likelihood estimation of mis-specified models. Econometrica 50: 1–25.
Nyberg F, Agrenius V, Svartengren K, et al. (1998) Dietary factors and risk of lung cancer in never-smokers. Int J Cancer, 78: 430–436.
Jöckel K-H, Pohlabeln H, Ahrens W, et al. (1998) Environmental tobacco smoke and lung cancer. Epidemiology 9: 672–675.
Armstrong BK, White E, Saracci R (1992) Principles of Exposure Measurement in Epidemiology. New York: Oxford University Press.
Nyberg F, Agudo A, Boffetta P, et al. (1998) A European validation study of smoking and environmental tobacco smoke exposure in nonsmoking lung cancer cases and controls. Cancer Causes Control 9: 173–182.
Brownson RC, Alavanja MCR, Caporaso N, Simoes EJ, Chang JC (1998) Epidemiology and prevention of lung cancer in nonsmokers. Epidemiol Rev 20: 218–236.
Peto R, Doll R, Buckley JD, et al. (1981) Can dietary beta-carotene materially reduce human cancer rates? Nature 290: 201–208.
Omenn GS, Goodman GE, Thornquist MD, et al. (1996) Effects of combination of beta-carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 334: 1150–1155.
Hennekens CH, Buring JE, Manson JE, et al. (1996) Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med 334: 1145–1149.
The Alpha-Tocopherol Beta Carotene Cancer Prevention Study Group (1994) The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 330: 1029.
Mayne ST, Janerich DT, Greenwald P, et al. (1994) Dietary beta carotene and lung cancer risk in U.S. nonsmokers. J Natl Cancer Inst 86: 33–38.
Steinmetz KA, Potter JD (1991) Vegetables, fruit, and cancer. II. Mechanisms. Cancer Causes Control 2: 427–442.
IARC (1998) Vitamin A. IARC Handbooks of Cancer Prevention, Vol. 3. Lyon: International Agency for Research on Cancer.
Alavanja MCR, Brown CC, Swanson C, et al. (1993) Saturated fat intake and lung cancer risk among nonsmoking women in Missouri. J Natl Cancer Inst 85: 1906–1916.
Swanson CA, Brown CC, Brownson RC, et al. (1997) Re: saturated fat intake and lung cancer risk among nonsmoking women in Missouri. J Natl Cancer Inst 89: 1724–1725.
Swanson CA, Brown CC, Sinha R, et al. (1997) Dietary fats and lung cancer risk among women: the Missouri Women's Health Study (United States). Cancer Causes Control 8: 883–893.
Sinha R, Kulldor. M, Curtin J, et al. (1998) Fried, well-done red meat and risk of lung cancer in women. Cancer Causes Control 9: 621–630.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Brennan, P., Fortes, C., Butler, J. et al. A multicenter case–control study of diet and lung cancer among non-smokers. Cancer Causes Control 11, 49–58 (2000). https://doi.org/10.1023/A:1008909519435
Issue Date:
DOI: https://doi.org/10.1023/A:1008909519435