Low Intake of Vegetables and Fruits and Risk of Colorectal Cancer: The Japan Collaborative Cohort Study

Background: The evidence for an association between low intake of vegetables and fruits and increased colorectal cancer risk is inconclusive. Evaluating the colorectal cancer risk associated with continued low intake is important. Methods: We used data of 45 516 and 14 549 subjects aged 40-79 years obtained in the baseline and interim surveys, respectively, from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). The intake frequency of vegetables and fruits as assessed by a self-administered questionnaire was classified into tertiles of low, middle, and high groups, and the low group was subdivided into 2 equal groups (lower low and higher low groups). Colorectal cancer incidence determined from follow-up was used. Cox's proportional hazard model was employed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for covariates. Results: During 598 605 person-years of subject follow-up after baseline, we identified 806 colorectal cancer cases. HRs for the lower low versus the middle and high intake frequencies of vegetables and fruits at baseline were 0.95 (95% CI 0.77-1.16) and 1.08 (95% CI 0.90-1.29), respectively. During 125 980 person-years of subject follow-up after the interim survey, 197 colorectal cancer cases were identified. HRs for the low versus middle and high intake frequencies of vegetables and fruits in both baseline and interim surveys were 0.91 (95% CI 0.61-1.37) and 0.87 (95% CI 0.59-1.27), respectively. Conclusions: Our results suggest that low intake and continued low intake of vegetables and fruits are not strongly associated with colorectal cancer risk.