Fruit and vegetable consumption and risk of aggressive and non-aggressive urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition

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Background: Many epidemiological studies have examined fruit and vegetable consumption in relation to the risk of urothelial cell carcinoma (UCC) of the bladder, but results are inconsistent. The association between fruit and vegetable consumption and UCC risk may vary by bladder tumour aggressiveness. Therefore, we examined the relation between fruit and vegetable consumption and the risk of aggressive and non-aggressive UCC in the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods: After 8.9 years of follow-up, 947 UCC were diagnosed among 468,656 EPIC participants. Of these, 421 could be classified as aggressive UCC and 433 as non-aggressive UCC cases. At recruitment, fruit and vegetable consumption was assessed by validated dietary questionnaires. Multivariable hazard ratios were estimated using Cox regression stratified by age, sex and center and adjusted for smoking status, duration and intensity of smoking, and energy intake. Results: Total consumption of fruits and vegetables was not associated with aggressive UCC nor with non-aggressive UCC. A 25 g/day increase in leafy vegetables and grapes consumption was associated with a reduced risk of non-aggressive UCC (hazard ratio (HR) 0.88; 95% confidence interval (CI) 0.78-1.00 and HR 0.87; 95% CI 0.77-0.98, respectively), while the intake of root vegetables was inversely associated with risk of aggressive UCC (HR 0.87; 95% CI 0.77-0.98). Conclusion: Our study did not confirm a protective effect of total fruit and/or vegetable consumption on aggressive or non-aggressive UCC. High consumption of certain types of vegetables and of fruits may reduce the risk of aggressive or non-aggressive UCC; however chance findings cannot be excluded. (C) 2012 Elsevier Ltd. All rights reserved.


  • Martine M. Ros
  • H. Bas Bueno-de-Mesquita
  • Ellen Kampman
  • Frederike L. Buchner
  • Katja K. H. Aben
  • Lars Egevad
  • Kim Overvad
  • Anne Tjonneland
  • Nina Roswall
  • Francoise Clavel-Chapelon
  • Marie Christine Boutron-Ruault
  • Sophie Morois
  • Rudolf Kaaks
  • Birgit Teucher
  • Steffen Weikert
  • Anne von Ruesten
  • Antonia Trichopoulou
  • Androniki Naska
  • Vassiliki Benetou
  • Calogero Saieva
  • Valeria Pala
  • Fulvio Ricceri
  • Rosario Tumino
  • Amalia Mattiello
  • Petra H. M. Peeters
  • Carla H. van Gils
  • Inger T. Gram
  • Dagrun Engeset
  • Maria-Dolores Chirlaque
  • Eva Ardanazx
  • Laudina Rodriguez
  • Pilar Amanio
  • Carlos A. Gonzalez
  • Maria Jose Sanchez
  • Roy Ernstrom
  • Borje Ljungberg
  • Naomi E. Allen
  • Timothy J. Key
  • Kee-Tee Khaw
  • Nick Wareham
  • Nadia Slimani
  • Isabelle Romieu
  • Lambertus A. Kiemeney
  • Elio Riboli
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Urology and Nephrology
  • Cancer and Oncology


  • Urothelial cell carcinomas, Bladder cancer, Aggressive, Non-aggressive, Fruit, Vegetables, EPIC, Cohort
Original languageEnglish
Pages (from-to)3267-3277
JournalEuropean Journal of Cancer
Issue number17
Publication statusPublished - 2012
Publication categoryResearch