Development of a comprehensive dietary antioxidant index and application to lung cancer risk in a cohort of male smokers

Am J Epidemiol. 2004 Jul 1;160(1):68-76. doi: 10.1093/aje/kwh173.


In many observational studies, a higher intake of individual antioxidants is inversely associated with lung cancer risk. Data from in vitro and animal experiments suggest that there are biochemical interactions among antioxidant nutrients; therefore, consideration of multiple antioxidants simultaneously may be important in terms of risk estimation. The authors constructed a dietary antioxidant index and evaluated its ability to predict lung cancer risk within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort. At baseline (1985-1988), 27,111 Finnish male smokers aged 50-69 years completed a dietary questionnaire that assessed usual frequency of consumption and portion sizes for the previous 12 months. A total of 1,787 incident cases of lung cancer were identified during a follow-up period of up to 14.4 years (1985-1999). Principal components analyses were individually applied to the carotenoid, flavonoid, and vitamin E nutrient groups, and summation of retained principal component scores, plus selenium and vitamin C, yielded the composite antioxidant index. In multivariate proportional hazards models, the relative risks for lung cancer according to increasing quintiles of the antioxidant index were 1.00 (referent), 1.00 (95% confidence interval (CI): 0.87, 1.14), 0.91 (95% CI: 0.79, 1.05), 0.79 (95% CI: 0.68, 0.92), and 0.84 (95% CI: 0.72, 0.98) (p for trend = 0.002). These findings support the hypothesis that a combination of dietary antioxidants reduces lung cancer risk in male smokers.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Antioxidants / administration & dosage
  • Antioxidants / therapeutic use*
  • Cohort Studies
  • Diet*
  • Double-Blind Method
  • Finland / epidemiology
  • Humans
  • Incidence
  • Life Style
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / etiology
  • Lung Neoplasms / prevention & control*
  • Male
  • Middle Aged
  • Registries
  • Risk Factors
  • Smoking / adverse effects*
  • Surveys and Questionnaires
  • alpha-Tocopherol / administration & dosage
  • alpha-Tocopherol / therapeutic use
  • beta Carotene / administration & dosage
  • beta Carotene / therapeutic use


  • Antioxidants
  • beta Carotene
  • alpha-Tocopherol