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Nutrition in acute and chronic diseases

Vegetable and fruit intake and colorectal cancer risk by smoking status in adults: The Japan Public Health Center-based Prospective Study



Cigarette smoke contains many oxidants and free radicals which may affect the association between vegetable and fruit intake and colorectal cancer (CRC) risk. However, this relationship remains unclear.


This study aimed to investigate the associations between vegetable and fruit intake and CRC risk by smoking status.


The Japan Public Health Center-based Prospective Study is a population-based prospective cohort study. Participants completed a self-administered questionnaire in 1995–1999 (baseline survey) and were followed through to 2013. At the baseline survey, 89,283 residents (41,797 men and 47,486 women) aged 45–74 years were included. Participants were asked about their lifestyle and dietary habits. To investigate the association of vegetable and fruit intake with risk of CRC, Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). We analyzed the relationship between vegetable and fruit intake and CRC risk stratified by sex and smoking status.


During follow-up, 2261 participants were diagnosed with CRC. Overall, vegetable and fruit intake were not associated with CRC risk in either sex. When stratified by sex and smoking status, CRC risk among male never smokers was inversely associated with intake of vegetables and fruit combined (HR: 0.72; 95% CI: 0.53, 0.98; highest vs lowest quartile p trend = 0.01) and fruit alone (HR: 0.62; 95% CI: 0.45, 0.86; p trend < 0.01).


Cigarette smoking may affect the association between vegetable and fruit intake and CRC risk among men.

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  1. Steinmetz KA, Potter JD. Vegetables, fruit, and cancer. II. Mechanisms. Cancer Causes Control. 1991;2:427–42.

    Article  CAS  Google Scholar 

  2. World Cancer Research Fund/American Institute for Cancer Research. Diet, nutrition, physical activity and cancer: a global perspective. Continuous Update Project Expert Report 2018.

  3. Tayyem RF, Shehadah I, Abu-Mweis SS, Bawadi HA, Bani-Hani KE, Al-Jaberi T, et al. Fruit and vegetable intake among Jordanians: results from a case-control study of colorectal cancer. Cancer Control. 2014;21:350–60.

    Article  Google Scholar 

  4. Luo WP, Fang YJ, Lu MS, Zhong X, Chen YM, Zhang CX. High consumption of vegetable and fruit colour groups is inversely associated with the risk of colorectal cancer: a case-control study. Br J Nutr. 2015;113:1129–38.

    Article  CAS  Google Scholar 

  5. Terry P, Terry JB, Wolk A. Fruit and vegetable consumption in the prevention of cancer: an update. J Intern Med. 2001;250:280–90.

    Article  CAS  Google Scholar 

  6. Flood A, Velie EM, Chaterjee N, Subar AF, Thompson FE, Lacey JV Jr, et al. Fruit and vegetable intakes and the risk of colorectal cancer in the Breast Cancer Detection Demonstration Project follow-up cohort. Am J Clin Nutr. 2002;75:936–43.

    Article  CAS  Google Scholar 

  7. Sato Y, Tsubono Y, Nakaya N, Ogawa K, Kurashima K, Kuriyama S, et al. Fruit and vegetable consumption and risk of colorectal cancer in Japan: The Miyagi Cohort Study. Public Health Nutr. 2005;8:309–14.

    Article  Google Scholar 

  8. Lin J, Zhang SM, Cook NR, Rexrode KM, Liu S, Manson JE, et al. Dietary intakes of fruit, vegetables, and fiber, and risk of colorectal cancer in a prospective cohort of women (United States). Cancer Causes Control. 2005;16:225–33.

    Article  Google Scholar 

  9. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum. 2004;83:1–1438.

    Google Scholar 

  10. Karademirci M, Kutlu R, Kilinc I. Relationship between smoking and total antioxidant status, total oxidant status, oxidative stress index, vit C, vit E. Clin Respir J. 2018;12:2006–12.

    Article  CAS  Google Scholar 

  11. Drope J, Schluger N, Cahn Z, Drope J, Hamill S, Islami F, et al. The Tobacco Atlas. 6th ed. American Cancer Society and Vital Strategies, Atlanta; 2018:1–20.

  12. Tsubono Y, Otani T, Kobayashi M, Yamamoto S, Sobue T, Tsugane S, et al. No association between fruit or vegetable consumption and the risk of colorectal cancer in Japan. Br J Cancer. 2005;92:1782–4.

    Article  CAS  Google Scholar 

  13. Tsugane S, Sobue T. Baseline survey of JPHC study-design and participation rate. Japan Public Health Center-based Prospective Study on Cancer and Cardiovascular Diseases. J Epidemiol. 2001;11:S24–9.

    Article  CAS  Google Scholar 

  14. Tsugane S, Sawada N. The JPHC study: design and some findings on the typical Japanese diet. Jpn J Clin Oncol. 2014;44:777–82.

    Article  Google Scholar 

  15. Mori N, Sawada N, Shimazu T, Yamaji T, Goto A, Takachi R, et al. Cruciferous vegetable intake and colorectal cancer risk: Japan public health center-based prospective study. Eur J Cancer Prev. 2019;28:420–7.

    Article  Google Scholar 

  16. Ministry of Education, Sports, Science, and Technology. Standard Tables of Food Composition in Japan. The 7th Revised Version. 2015. [Internet]. Available from: (accessed 12 December, 2020).

  17. Sasaki S, Kobayashi M, Tsugane S. Validity of a self-administered food frequency questionnaire used in the 5-year follow-up survey of the JPHC Study Cohort I: comparison with dietary records for food groups. J Epidemiol. 2003;13:S57–63.

    Article  Google Scholar 

  18. Ishihara J, Sobue T, Yamamoto S, Yoshimi I, Sasaki S, Kobayashi M, et al. Validity and reproducibility of a self-administered food frequency questionnaire in the JPHC Study Cohort II: study design, participant profile and results in comparison with Cohort I. J Epidemiol. 2003;13:S134–47.

    Article  Google Scholar 

  19. Leung CY, Abe SK, Sawada N, Ishihara J, Takachi R, Yamaji T, et al. Sugary drink consumption and subsequent colorectal cancer risk: The Japan Public Health Center-Based Prospective Cohort Study. Cancer Epidemiol Biomark Prev. 2021;30:782–8.

    Article  Google Scholar 

  20. Vogtmann E, Xiang YB, Li HL, Levitan EB, Yang G, Waterbor JW, et al. Fruit and vegetable intake and the risk of colorectal cancer: results from the Shanghai Men’s Health Study. Cancer Causes Control. 2013;24:1935–45.

    Article  Google Scholar 

  21. Wie GA, Cho YA, Kang HH, Ryu KA, Yoo MK, Kim YA, et al. Red meat consumption is associated with an increased overall cancer risk: a prospective cohort study in Korea. Br J Nutr. 2014;112:238–47.

    Article  CAS  Google Scholar 

  22. van Duijnhoven FJ, Bueno-De-Mesquita HB, Ferrari P, Jenab M, Boshuizen HC, Ros MM, et al. Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr. 2009;89:1441–52.

    Article  Google Scholar 

  23. Michels KB, Giovannucci E, Joshipura KJ, Rosner BA, Stampfer MJ, Fuchs CS, et al. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst. 2000;92:1740–52.

    Article  CAS  Google Scholar 

  24. Makarem N, Lin Y, Bandera EV, Jacques PF, Parekh N. Concordance with World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines for cancer prevention and obesity-related cancer risk in the Framingham Offspring cohort (1991-2008). Cancer Causes Control. 2015;26:277–86.

    Article  Google Scholar 

  25. Lee SA, Shu XO, Yang G, Li H, Gao YT, Zheng W. Animal origin foods and colorectal cancer risk: a report from the Shanghai Women’s Health Study. Nutr Cancer. 2009;61:194–205.

    Article  Google Scholar 

  26. Nomura AM, Wilkens LR, Murphy SP, Hankin JH, Henderson BE, Pike MC, et al. Association of vegetable, fruit, and grain intakes with colorectal cancer: the Multiethnic Cohort Study. Am J Clin Nutr. 2008;88:730–7.

    Article  CAS  Google Scholar 

  27. Park Y, Subar AF, Kipnis V, Thompson FE, Mouw T, Hollenbeck A, et al. Fruit and vegetable intakes and risk of colorectal cancer in the NIH-AARP diet and health study. Am J Epidemiol. 2007;166:170–80.

    Article  Google Scholar 

  28. McCarl M, Harnack L, Limburg PJ, Anderson KE, Folsom AR. Incidence of colorectal cancer in relation to glycemic index and load in a cohort of women. Cancer Epidemiol Biomark Prev. 2006;15:892–6.

    Article  CAS  Google Scholar 

  29. Terry P, Giovannucci E, Michels KB, Bergkvist L, Hansen H, Holmberg L, et al. Fruit, vegetables, dietary fiber and risk of colorectal cancer. J Natl Cancer Inst. 2001;93:525–33.

    Article  CAS  Google Scholar 

  30. Shibata A, Paganini-Hill A, Ross RK, Henderson BE. Intake of vegetables, fruits, beta-carotene, vitamin C and vitamin supplements and cancer incidence among the elderly: a prospective study. Br J Cancer. 1992;66:673–9.

    Article  CAS  Google Scholar 

  31. Zheng W, Anderson KE, Kushi LH, Sellers TA, Greenstein J, Hong CP, et al. A prospective cohort study of intake of calcium, vitamin D, and other micronutrients in relation to incidence of rectal cancer among postmenopausal women. Cancer Epidemiol Biomark Prev. 1998;7:221–5.

    CAS  Google Scholar 

  32. Steinmetz KA, Kushi LH, Bostick RM, Folsom AR, Potter JD. Vegetables, fruit, and colon cancer in the Iowa Women’s Health Study. Am J Epidemiol. 1994;139:1–15.

    Article  CAS  Google Scholar 

  33. Voorrips LE, Goldbohm RA, van Poppel G, Sturmans F, Hermus RJ, van den Brandt PA. Vegetable and fruit consumption and risks of colon and rectal cancer in a prospective cohort study: The Netherlands Cohort Study on Diet and Cancer. Am J Epidemiol. 2000;152:1081–92.

    Article  CAS  Google Scholar 

  34. Aoyama N, Kawado M, Yamada H, Hashimoto S, Suzuki K, Wakai K, et al. Low intake of vegetables and fruits and risk of colorectal cancer: the Japan Collaborative Cohort Study. J Epidemiol. 2014;24:353–60.

    Article  Google Scholar 

  35. Aune D, Lau R, Chan DS, Vieira R, Greenwood DC, Kampman E, et al. Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies. Gastroenterology. 2011;141:106–18.

    Article  Google Scholar 

  36. Leenders M, Leufkens AM, Siersema PD, van Duijnhoven FJ, Vrieling A, Hulshof PJ, et al. Plasma and dietary carotenoids and vitamins A, C and E and risk of colon and rectal cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2014;135:2930–9.

    Article  CAS  Google Scholar 

  37. Frei B, Stocker R, Ames BN. Antioxidant defenses and lipid peroxidation in human blood plasma. Proc Natl Acad Sci USA. 1988;85:9748–52.

    Article  CAS  Google Scholar 

  38. Koushik A, Hunter DJ, Spiegelman D, Beeson WL, van den Brandt PA, Buring JE, et al. Fruits, vegetables, and colon cancer risk in a pooled analysis of 14 cohort studies. J Natl Cancer Inst. 2007;99:1471–83.

    Article  Google Scholar 

  39. Nanri A, Shimazu T, Ishihara J, Takachi R, Mizoue T, Inoue M, et al. Reproducibility and validity of dietary patterns assessed by a food frequency questionnaire used in the 5-year follow-up survey of the Japan Public Health Center-Based Prospective Study. J Epidemiol. 2012;22:205–15.

    Article  Google Scholar 

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We thank the members in each of the study areas for their corporation and technical advice. JPHC Study members are listed at the following website (accessed November 2020): [].


This study was supported by the National Cancer Center Research and Development Fund (since 2010), a Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare of Japan (from 1989 to 2010), and a MAFF Commissioned project study (JPJ009842). These supporting sources were not involved in the research work.

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The authors’ responsibilities were as follows: ST, MI, MI, TY, and NS designed the research; ST, MI, MI, TY, and NS conducted the research; MH and KK analyzed the data; and MH and NS wrote the paper. MH had primary responsibility for the final content. All authors read and approved the final manuscript.

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Correspondence to Norie Sawada.

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Hori, M., Sawada, N., Kito, K. et al. Vegetable and fruit intake and colorectal cancer risk by smoking status in adults: The Japan Public Health Center-based Prospective Study. Eur J Clin Nutr 77, 255–263 (2023).

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