Full-text resources of PSJD and other databases are now available in the new Library of Science.
Visit https://bibliotekanauki.pl


Preferences help
enabled [disable] Abstract
Number of results


2009 | 4 | 3 | 320-326

Article title

Reduced risk of colorectal cancer and regular consumption of apples: Hospital based case-control study in Poland


Title variants

Languages of publication



Experimental studies in animals and epidemiological evidence supporting the health benefits from apples encouraged the authors to assess the potential protective impact of apples on the risk of colorectal cancer in the course of the hospital based case-control study. A total of 186 incident cases of colorectal cancer - for which the information on histology, anatomic location, and stage of cancer were available - have been enrolled to the study. The comparison group included 211 controls chosen from the patients of the same hospital with no history of cancer and admitted for treatment of non-neoplastic conditions. Interviews of both cases and controls were conducted in hospital settings by trained interviewers. The results showed that the risk of colorectal cancer inversely correlated with daily number of apple servings, but the significant reduction of OR estimates were observed for an intake of one or more apple servings daily (OR = 0.37, 95%CI: 0.15 − 0.91). The risk of colorectal cancer was estimated from the multivariate logistic model including a set of potential confounding variables, such as, demographic characteristics of subjects (age, gender, place of residency, marital status and occupational activity), total energy intake (in tertiles) and intake of vegetables (number of servings per day). No fruits except for apples were significantly associated with the reduced risk of colorectal cancer. The reduction of colorectal risk associated with apple consumption may result from their rich content of flavonoid and other polyphenols, which can inhibit cancer onset and cell proliferation.










Physical description


1 - 9 - 2009
3 - 7 - 2009


  • Chair of Epidemiology and Preventive Medicine, Jagiellonian University, 31-034, Krakow, Poland
  • Institute for Clinical Medicine and Rehabilitation, 27-100, Pavia, Italy
  • Chair of Epidemiology and Preventive Medicine, Jagiellonian University, 31-034, Krakow, Poland
  • Chair of Epidemiology and Preventive Medicine, Jagiellonian University, 31-034, Krakow, Poland
  • Chair of Epidemiology and Preventive Medicine, Jagiellonian University, 31-034, Krakow, Poland


  • [1] Hertog M, Feskens E, Hollman P et al. Dietary flavonoids and cancer risk in the Zutphen Elderly study. Nutr Cancer 1994; 22: 175–184 [Crossref][WoS][PubMed]
  • [2] Knekt P, Jarvinen R, Seppanen R et al. Dietary flavonoids and the risk of lung cancer and other malignant neoplasms. Am J Epidemiol 1997; 146: 223–230 [Crossref][PubMed]
  • [3] Le Marchand L, Murphy S, Hankin J et al. Intake of flavonoids and lung cancer. J Natl Cancer Inst 2000; 92: 154–160 http://dx.doi.org/10.1093/jnci/92.2.154[Crossref]
  • [4] Kubik A, Zatloukal P, Tomasek L et al. Lung cancer risk among nonsmoking women in relation to diet and physical activity. Neoplasma 2004; 51: 136–143 [PubMed]
  • [5] Hubbard G, Wolffram S, Lovegrove J et al. The role of polyphenolic compounds in the diet as inhibitors of platelet function. Proc Nutr Soc 2003; 62: 469–478 http://dx.doi.org/10.1079/PNS2003253[Crossref]
  • [6] Sesso H, Gaziano JM, Liu S et al. Flavonoid intake and risk of cardiovascular disease in women. Am J Clin Nutr 2003; 77: 1400–1408 [PubMed]
  • [7] Knekt P, Jarvinen R, Hakkinen R et al. Flavonoid intake and coronary mortality in Finland: a cohort study. BMJ 1996; 3I 2:478–481 [Crossref]
  • [8] Knekt P, Isotupa S, Rissanen H et al. Quercetin intake and the incidence of cerebrovascular disease. Eur Clin Nutr 2000; 54: 415–417 http://dx.doi.org/10.1038/sj.ejcn.1600974[Crossref]
  • [9] Arts I, D. Jacobs, Harnack L, Gross M et al. Dietary catechins in relation to coronary heart disease among postmenopausal women. Epidemiology 2001; 12: 668–675 http://dx.doi.org/10.1097/00001648-200111000-00015[Crossref]
  • [10] Shaheen S, Sterne J, Thompson R et al. Dietary antioxidants and asthma in adults- population based case-control study. Am J Respir Crit Care Med 2001; 164: 1823–1828 [PubMed][Crossref]
  • [11] Tabak C, Arts I, Smit H et al. Chronic obstructive pulmonary disease and intake of catechins, flavonols, and f1avones. AmJ Respir Crit Care Med 2001; 164: 61–64
  • [12] Butland B, Fehily A, Elwood P. Diet, lung function, and lung decline in a cohort of 2512 middle aged men. Thorax 2000; 55: 102–108 http://dx.doi.org/10.1136/thorax.55.2.102[Crossref]
  • [13] de Oliviera M, Sichieri R, Moura A. Weight loss associated with a daily intake of three apples or three pears among overweight women. Nutr 2003; 19: 253–256 http://dx.doi.org/10.1016/S0899-9007(02)00850-X[Crossref]
  • [14] Deneo-Pellegrini H, De Stefani E, Ronco A. Vegetables, fruits, and risk of colorectal cancer. A case-control study from Uruguay. Nutr Cancer 1996; 25: 297–304 http://dx.doi.org/10.1080/01635589609514453[Crossref]
  • [15] Gallus C, Talamini R, Giacosa A, et al. Does an apple a day keep the oncologist away? Annals Oncol 2005; 16: 1841–1844 http://dx.doi.org/10.1093/annonc/mdi361[Crossref]
  • [16] Margetts BM, Pietinen P, Ribolo E. EPIC European prospective investigation into cancer and nutrition. Validation studies on dietary assessment methods. Int J Epidemiol 1997; 26(Suppl. 1): 1–189 http://dx.doi.org/10.1093/ije/26.suppl_1.S1[Crossref]
  • [17] La Vecchia C. Mediterranean epidemiological evidence on tomatoes and the prevention of digestive-tract cancers. Proc Soc Exp Biol Med 1998; 218:125–128 [PubMed][Crossref]
  • [18] McCullough ML, Robertson AS, Chao A, et al. A prospective study of whole grains, fruits, vegetables and colon cancer risk. Cancer Causes Control 2003;14: 959–970 http://dx.doi.org/10.1023/B:CACO.0000007983.16045.a1[Crossref]
  • [19] Michels KB, Edward G, Joshipura KJ, et al. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst 2000; 92: 1740–1752 http://dx.doi.org/10.1093/jnci/92.21.1740[Crossref]
  • [20] Eberhardt M, Lee C, Liu RH. Antioxidant activity of fresh apples. Nature 2000; 405:903–904 [PubMed]
  • [21] Boyer J, Liu RH. Apple phytochemicals and their health benefits. Nutr J 2004; 3: 5 http://dx.doi.org/10.1186/1475-2891-3-5[Crossref]
  • [22] Oszmianski J, Wolniak M, Wojdylo A et al. Comparative study of polyphenolic content and antiradical activity of cloudy and clear apple juices. J Sci Food Agri 2007; 57: 573–579 http://dx.doi.org/10.1002/jsfa.2707[Crossref]
  • [23] Knapp B, Kahle K, Erk Th et al. Human intestinal hydrolysis of phenol glycosides - a study with quercetin and p-nitrophenol glycosides using ileostomy fluid. Mol Nutr Food Res 2007; 51: 1423–1429 http://dx.doi.org/10.1002/mnfr.200700036[WoS][Crossref]
  • [24] Kahle K, Kraus M, Richling E. Polyphenol profiles of apple juices. Mol Nutr Food Res 2005; 49: 797–808 http://dx.doi.org/10.1002/mnfr.200500064[Crossref]
  • [25] Barth SW, Faendrich Ch, Bub A et al. Cloudy apple juice is more effective than apple polyphenols and an apple juice derived cloud fraction in a rat model of colon carcinogenesis. J Agri Food Chem 2007; 55: 1181–1187 http://dx.doi.org/10.1021/jf063078t[WoS][Crossref]
  • [26] Rossi M, Negri E, Talamini R et al. Flavonoids and colorectal cancer in Italy. Cancer Epidemiol Biomarkers Prev 2006; 15: 1555–1558 http://dx.doi.org/10.1158/1055-9965.EPI-06-0017[Crossref]
  • [27] Theodoratou E, Kyle J, Cetnarskyj R. et al. Dietary flavonoids and risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 2007; 16: 684–693 http://dx.doi.org/10.1158/1055-9965.EPI-06-0785[Crossref]
  • [28] Arts I, Hollman P, Mesquita H et al. Dietary catechins and epithelial cancer incidence: the Zutphen Elderly Study. Int J Cancer 2001, 92: 298–302 http://dx.doi.org/10.1002/1097-0215(200102)9999:9999<::AID-IJC1187>3.0.CO;2-8[Crossref]
  • [29] Feskanich D, Ziegler R, Michaud D et al. Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. J Natl Cancer Inst 2000; 92: 1812–1823 http://dx.doi.org/10.1093/jnci/92.22.1812[Crossref]
  • [30] Arts IC, Jacobs DR Jr, Gross M, et al. Dietary catechins and cancer incidence among postmenopausal women: the Iowa Women’s Health Study (United States). Cancer Causes Control 2002;13: 373–382 http://dx.doi.org/10.1023/A:1015290131096[Crossref]
  • [31] Lin J, Zhang SM, Wu K et al. Flavonoid Intake and Colorectal Cancer Risk in Men and Women. Am J Epidemiol 2006;164: 644–651 http://dx.doi.org/10.1093/aje/kwj296[Crossref]
  • [32] Bobe G, Sansbury LB, Albert PS et al. Dietary flavonoids and colorectal adenoma recurrence in the Polyp Prevention Trial. Cancer Epidemiol Biomarkers Prev 2007; 17: 1344–1353 http://dx.doi.org/10.1158/1055-9965.EPI-07-0747[Crossref][WoS]
  • [33] Manach C, Scalbert A, Morand C, et al. Polyphenols: food sources and bioavailability. Am J Clin Nutr 2004;79: 727–747 [PubMed]
  • [34] Kuhnau J. The flavonoids. A class of semi-essential food components: their role in human nutrition. World Rev Nutr Diet 1976; 24:117–191 [Crossref][PubMed]
  • [35] Yang CS, Landau JM, Huang MT et al. Inhibition of carcinogenesis by dietary polyphenolic compounds. Annu Rev Nutr 2001; 21: 381–406 http://dx.doi.org/10.1146/annurev.nutr.21.1.381[Crossref]
  • [36] Hollman PC, van Trijp JM, Buysman MN et al. Relative bioavailability of the antioxidant flavonoid quercetin from various foods in man. FEBS Lett 1997;418: 152–156 http://dx.doi.org/10.1016/S0014-5793(97)01367-7[Crossref]
  • [37] Ross JA, Kasum CM. Dietary flavonoids: bioavailability, metabolic effects, and safety. Annu Rev Nutr 2002; 22: 19–34 http://dx.doi.org/10.1146/annurev.nutr.22.111401.144957[Crossref]
  • [38] Hollman PC, de Vries JH, van Leeuwen SD et al. Absorption of dietary quercetin glycosides and quercetin in healthy ileostomy volunteers. Am J Clin Nutr 1995; 62: 1276–1282 [PubMed]
  • [39] Lee MJ, Wang ZY, Li H, et al. Analysis of plasma and urinary tea polyphenols in human subjects. Cancer Epidemiol Biomarkers Prev 1995; 4: 393–399 [PubMed]
  • [40] Spencer JP. Metabolism of tea flavonoids in the gastrointestinal tract. J Nutr 2003;133(suppl): 3255S–3261S

Document Type

Publication order reference


YADDA identifier

JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.