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Dietary Carotenoids and Risk of Lung Cancer in a Pooled Analysis of Seven Cohort Studies

¹ Harvard School of Public Health, Departments of Nutrition, ² Epidemiology, and ³ Biostatistics, Boston, Massachusetts; ⁴ Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland; ⁵ Cancer Prevention Studies Branch, Division of Clinical Sciences, National Cancer Institute, Bethesda, Maryland; ⁶ Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota; ⁷ Department of Epidemiology, Maastricht University, Maastricht, the Netherlands; ⁸ Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; ⁹ Harvard Center for Cancer Prevention, Boston, Massachusetts; ¹⁰ Channing Laboratory, Harvard Medical School/Brigham and Womens’ Hospital, Boston, Massachusetts; ¹¹ Department of Social and Preventive Medicine, University at Buffalo, State University of New York, Buffalo, New York; ¹² Department of Epidemiology, TNO Nutrition and Food Research Institute, Zeist, the Netherlands; ¹³ Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ¹⁴ Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany; ¹⁵ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York

Intervention trials with supplemental ß-carotene have observed either no effect or a harmful effect on lung cancer risk. Because food composition databases for specific carotenoids have only become available recently, epidemiological evidence relating usual dietary levels of these carotenoids with lung cancer risk is limited. We analyzed the association between lung cancer risk and intakes of specific carotenoids using the primary data from seven cohort studies in North America and Europe. Carotenoid intakes were estimated from dietary questionnaires administered at baseline in each study. We calculated study-specific multivariate relative risks (RRs) and combined these using a random-effects model. The multivariate models included smoking history and other potential risk factors. During follow-up of up to 7–16 years across studies, 3,155 incident lung cancer cases were diagnosed among 399,765 participants. ß-Carotene intake was not associated with lung cancer risk (pooled multivariate RR = 0.98; 95% confidence interval, 0.87–1.11; highest versus lowest quintile). The RRs for -carotene, lutein/zeaxanthin, and lycopene were also close to unity. ß-Cryptoxanthin intake was inversely associated with lung cancer risk (RR = 0.76; 95% confidence interval, 0.67–0.86; highest versus lowest quintile). These results did not change after adjustment for intakes of vitamin C (with or without supplements), folate (with or without supplements), and other carotenoids and multivitamin use. The associations generally were similar among never, past, or current smokers and by histological type. Although smoking is the strongest risk factor for lung cancer, greater intake of foods high in ß-cryptoxanthin, such as citrus fruit, may modestly lower the risk.

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