Fruit and vegetable consumption and squamous cell carcinoma of the esophagus in Japan: The JPHC study

Authors

  • Taiki Yamaji,

    Corresponding author
    1. Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
    • Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
    Search for more papers by this author
    • Fax: +81-3-3547-8578.

  • Manami Inoue,

    1. Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
    Search for more papers by this author
  • Shizuka Sasazuki,

    1. Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
    Search for more papers by this author
  • Motoki Iwasaki,

    1. Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
    Search for more papers by this author
  • Norie Kurahashi,

    1. Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
    Search for more papers by this author
  • Taichi Shimazu,

    1. Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
    Search for more papers by this author
  • Shoichiro Tsugane,

    1. Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
    Search for more papers by this author
  • for the Japan Public Health Center-based Prospective Study Group

    Search for more papers by this author
    • Members of the Japan Public Health Center-based Prospective Study Group (principal investigator: S. Tsugane) are as follows: S. Tsugane, M. Inoue, T. Sobue and T. Hanaoka, National Cancer Center, Tokyo; J. Ogata, S. Baba, T. Mannami, A. Okayama and Y. Kokubo, National Cardiovascular Center, Osaka; K. Miyakawa, F. Saito, A. Koizumi, Y. Sano, I. Hashimoto and T. Ikuta, Iwate Prefectural Ninohe Public Health Center, Iwate; Y. Miyajima, N. Suzuki, S. Nagasawa, Y. Furusugi and N. Nagai, Akita Prefectural Yokote Public Health Center, Akita; H. Sanada, Y. Hatayama, F. Kobayashi, H. Uchino, Y. Shirai, T. Kondo, R. Sasaki, Y. Watanabe, Y. Miyagawa and Y. Kobayashi, Nagano Prefectural Saku Public Health Center, Nagano; Y. Kishimoto, E. Takara, T. Fukuyama, M. Kinjo, M. Irei and H. Sakiyama, Okinawa Prefectural Chubu Public Health Center, Okinawa; K. Imoto, H. Yazawa, T. Seo, A. Seiko, F. Ito and F. Shoji, Katsushika Public Health Center, Tokyo; A. Murata, K. Minato, K. Motegi and T. Fujieda, Ibaraki Prefectural Mito Public Health Center, Ibaraki; K. Matsui, T. Abe, M. Katagiri and M. Suzuki, Niigata Prefectural Kashiwazaki and Nagaoka Public Health Center, Niigata; M. Doi, A. Terao, Y. Ishikawa and T. Tagami, Kochi Prefectural Chuo-higashi Public Health Center, Kochi; H. Sueta, H. Doi, M. Urata, N. Okamoto and F. Ide, Nagasaki Prefectural Kamigoto Public Health Center, Nagasaki; H. Sakiyama, N. Onga, H. Takaesu and M. Uehara, Okinawa Prefectural Miyako Public Health Center, Okinawa; F. Horii, I. Asano, H. Yamaguchi, K. Aoki, S. Maruyama, M. Ichii and M. Takano, Osaka Prefectural Suita Public Health Center, Osaka; S. Matsushima and S. Natsukawa, Saku General Hospital, Nagano; K. Suzuki, Research Institute for Brain and Blood Vessels Akita, Akita; M. Kabuto, National Institute for Environmental Studies, Ibaraki; M. Yamaguchi, Y. Matsumura, S. Sasaki and S. Watanabe, National Institute of Health and Nutrition, Tokyo; M. Noda, International Medical Center of Japan, Tokyo; S. Tominaga, Aichi Cancer Center Research Institute, Aichi; H. Shimizu, Sakihae Institute, Gifu; M. Iida, W. Ajiki and A. Ioka, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka; S. Sato, Osaka Medical Center for Health Science and Promotion, Osaka; Y. Tsubono, Tohoku University, Miyagi; K. Nakamura, Niigata University, Niigata; Y. Honda, K. Yamagishi and S. Sakurai, Tsukuba University, Ibaraki; M. Akabane, Tokyo University of Agriculture, Tokyo; T. Kadowaki, Tokyo University, Tokyo; Y. Kawaguchi, Tokyo Medical and Dental University, Tokyo; Y. Takashima, Kyorin University, Tokyo; H. Sugimura, Hamamatsu University, Shizuoka; H. Iso, Osaka University, Osaka; E. Maruyama, Kobe University, Hyogo; M. Konishi, K. Okada and I. Saito, Ehime University, Ehime; N. Yasuda, Kochi University, Kochi; and S. Kono, Kyushu University, Fukuoka, Japan.


Abstract

Epidemiological studies have consistently demonstrated a decrease in the risk of esophageal squamous cell carcinoma (SCC) associated with higher fruit and vegetable intake, although the association has been examined predominantly in case–control studies. Here, we conducted a population-based prospective cohort study among middle-aged Japanese men. Lifestyle characteristics were investigated using a self-administered questionnaire, which included a validated food frequency questionnaire with 138 food and beverage items. We followed a total of 38,790 men aged 45–74 years. A Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for esophageal SCC, with adjustment for potential confounders. During 297,651 person–years of follow-up, a total of 116 men were newly diagnosed with esophageal SCC. An increase in consumption of total fruit and vegetables by 100 grams per day (g/day) was associated with an 11% decrease in the incidence of esophageal SCC (95% CI: 1–21%). In particular, a higher intake of cruciferous vegetables was associated with a significant decrease in risk (HR per 100 g/day: 0.44; 95% CI: 0.23–0.82). Stratified analyses revealed that the beneficial effect of fruits and vegetables was not able to completely offset the harmful effect of tobacco and alcohol. Our findings provide further evidence for the protective role of fruits and vegetables in the development of esophageal SCC. To effectively reduce the burden of this disease, however, priority should be placed on smoking and drinking cessation. Finally, cruciferous vegetables deserve further investigation as foods possibly effective in the prevention of esophageal SCC. © 2008 Wiley-Liss, Inc.

Ancillary