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Association Between Consumption of Fruits and Vegetables and Risk of Colorectal Adenoma: A PRISMA-Compliant Meta-Analysis of Observational Studies.

Ben Q, Zhong J, Liu J, Wang L, Sun Y, Yv L, Yuan Y - Medicine (Baltimore) (2015)

Bottom Line: In addition, linear dose-response analysis also showed similar results, for example, for per 100 g/d increment of fruits, the SRR was 0.94 (95% CI: 0.92-0.97) and for vegetables it was 0.98 (95% CI: 0.96-1.01).Nonlinear association was only observed for vegetables (Pnonlinearity = 0.024), but not for fruits (Pnonlinearity = 0.583).Thus, this meta-analysis suggested that fruits consumption have a significant protective effect on CRA risk, but not vegetables.Moreover, we recommend additional studies with prospective designs that use validated questionnaires and control for important confounders to further validate the overall results.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Gastroenterology (QB, JZ, LW, YS, LY, YY), Ruijin Hospital, Shanghai Jiaotong University; and Department of Integrative Medicine (JL), Zhongshan Hospital, Fudan University, Shanghai, PR China.

ABSTRACT
There have been contradictory results about the association of fruits and vegetables intake with colorectal adenoma (CRA) risk, the precursor lesion of colorectal cancer. Herein, we have conducted a meta-analysis of the published observational studies to have a clear understanding about this association.Eligible studies up to November 30, 2014, were identified and retrieved by searching MEDLINE and EMBASE databases along with the manual review of the reference list of the retrieved studies. The quality of the included studies was evaluated using Newcastle-Ottawa Quality Assessment Scale, and random-effects model was used to calculate summary relative risk (SRR) and corresponding 95% confidence interval (CI).A total of 22 studies involving 11,696 CRA subjects were part of this meta-analysis. The SRR for the highest versus the lowest intake of vegetables alone was 0.91 (95% CI: 0.80-1.02, Pheterogeneity = 0.025), whereas for vegetables and fruits combined, it was 0.82 (95% CI: 0.75-0.91, Pheterogeneity = 0.369), and for fruits alone, it was 0.79 (95% CI: 0.71-0.88, Pheterogeneity = 0.111). In addition, linear dose-response analysis also showed similar results, for example, for per 100 g/d increment of fruits, the SRR was 0.94 (95% CI: 0.92-0.97) and for vegetables it was 0.98 (95% CI: 0.96-1.01). Nonlinear association was only observed for vegetables (Pnonlinearity = 0.024), but not for fruits (Pnonlinearity = 0.583).Thus, this meta-analysis suggested that fruits consumption have a significant protective effect on CRA risk, but not vegetables. Moreover, we recommend additional studies with prospective designs that use validated questionnaires and control for important confounders to further validate the overall results.

No MeSH data available.


Related in: MedlinePlus

Flow diagram representing the systematic literature search on vegetables and fruits intake and CRA risk.
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Figure 1: Flow diagram representing the systematic literature search on vegetables and fruits intake and CRA risk.

Mentions: Based on the study selection criteria, we identified a total of 10,867 potentially relevant articles (7816 articles from the MEDLINE database and 3051 articles from the EMBASE database). In addition, 13 more articles were identified by studying the cross-reference list. Among these 10,880 articles, 77 were considered potentially relevant and their full texts were retrieved for further evaluation, and 55 were excluded for various reasons (Fig. 1). Therefore, a total of 22 articles (5 cohort and 17 case-control studies) involving 11,696 subjects with CRA were used for this meta-analysis. Table 1 and Table 2 depict the characteristics of these studies. All these studies represented different populations, 4 studies were from Asia (Japan), 10 from North America, 7 from Europe, and 1 was from Israel. Most studies had relevant controls for some conventional risk factors, including BMI (n = 13), smoking (n = 13), physical activity (n = 11), and dietary energy intake (n = 15). Some studies were also adjusted for alcohol use (n = 9) and other dietary variables or nutrients (n = 6). The quality scores of each study were summarized in Supplementary Table 1, http://links.lww.com/MD/A455. The quality scores ranged from 5 to 9, with the median score of 8. The majority of the included studies (18/22) were of high quality (NOS score ≥7).


Association Between Consumption of Fruits and Vegetables and Risk of Colorectal Adenoma: A PRISMA-Compliant Meta-Analysis of Observational Studies.

Ben Q, Zhong J, Liu J, Wang L, Sun Y, Yv L, Yuan Y - Medicine (Baltimore) (2015)

Flow diagram representing the systematic literature search on vegetables and fruits intake and CRA risk.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4620815&req=5

Figure 1: Flow diagram representing the systematic literature search on vegetables and fruits intake and CRA risk.
Mentions: Based on the study selection criteria, we identified a total of 10,867 potentially relevant articles (7816 articles from the MEDLINE database and 3051 articles from the EMBASE database). In addition, 13 more articles were identified by studying the cross-reference list. Among these 10,880 articles, 77 were considered potentially relevant and their full texts were retrieved for further evaluation, and 55 were excluded for various reasons (Fig. 1). Therefore, a total of 22 articles (5 cohort and 17 case-control studies) involving 11,696 subjects with CRA were used for this meta-analysis. Table 1 and Table 2 depict the characteristics of these studies. All these studies represented different populations, 4 studies were from Asia (Japan), 10 from North America, 7 from Europe, and 1 was from Israel. Most studies had relevant controls for some conventional risk factors, including BMI (n = 13), smoking (n = 13), physical activity (n = 11), and dietary energy intake (n = 15). Some studies were also adjusted for alcohol use (n = 9) and other dietary variables or nutrients (n = 6). The quality scores of each study were summarized in Supplementary Table 1, http://links.lww.com/MD/A455. The quality scores ranged from 5 to 9, with the median score of 8. The majority of the included studies (18/22) were of high quality (NOS score ≥7).

Bottom Line: In addition, linear dose-response analysis also showed similar results, for example, for per 100 g/d increment of fruits, the SRR was 0.94 (95% CI: 0.92-0.97) and for vegetables it was 0.98 (95% CI: 0.96-1.01).Nonlinear association was only observed for vegetables (Pnonlinearity = 0.024), but not for fruits (Pnonlinearity = 0.583).Thus, this meta-analysis suggested that fruits consumption have a significant protective effect on CRA risk, but not vegetables.Moreover, we recommend additional studies with prospective designs that use validated questionnaires and control for important confounders to further validate the overall results.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Gastroenterology (QB, JZ, LW, YS, LY, YY), Ruijin Hospital, Shanghai Jiaotong University; and Department of Integrative Medicine (JL), Zhongshan Hospital, Fudan University, Shanghai, PR China.

ABSTRACT
There have been contradictory results about the association of fruits and vegetables intake with colorectal adenoma (CRA) risk, the precursor lesion of colorectal cancer. Herein, we have conducted a meta-analysis of the published observational studies to have a clear understanding about this association.Eligible studies up to November 30, 2014, were identified and retrieved by searching MEDLINE and EMBASE databases along with the manual review of the reference list of the retrieved studies. The quality of the included studies was evaluated using Newcastle-Ottawa Quality Assessment Scale, and random-effects model was used to calculate summary relative risk (SRR) and corresponding 95% confidence interval (CI).A total of 22 studies involving 11,696 CRA subjects were part of this meta-analysis. The SRR for the highest versus the lowest intake of vegetables alone was 0.91 (95% CI: 0.80-1.02, Pheterogeneity = 0.025), whereas for vegetables and fruits combined, it was 0.82 (95% CI: 0.75-0.91, Pheterogeneity = 0.369), and for fruits alone, it was 0.79 (95% CI: 0.71-0.88, Pheterogeneity = 0.111). In addition, linear dose-response analysis also showed similar results, for example, for per 100 g/d increment of fruits, the SRR was 0.94 (95% CI: 0.92-0.97) and for vegetables it was 0.98 (95% CI: 0.96-1.01). Nonlinear association was only observed for vegetables (Pnonlinearity = 0.024), but not for fruits (Pnonlinearity = 0.583).Thus, this meta-analysis suggested that fruits consumption have a significant protective effect on CRA risk, but not vegetables. Moreover, we recommend additional studies with prospective designs that use validated questionnaires and control for important confounders to further validate the overall results.

No MeSH data available.


Related in: MedlinePlus