Nutrient intake and nutrient patterns and risk of lung cancer among heavy smokers: results from the COSMOS screening study with annual low-dose CT

Eur J Epidemiol. 2013 Jun;28(6):503-11. doi: 10.1007/s10654-013-9803-1. Epub 2013 Apr 11.


The role of nutrients in lung cancer aetiology remains controversial and has never been evaluated in the context of screening. Our aim was to investigate the role of single nutrients and nutrient patterns in the aetiology of lung cancer in heavy smokers. Asymptomatic heavy smokers (≥20 pack-years) were invited to undergo annual low-dose computed tomography. We assessed diet using a self-administered food frequency questionnaire and collected information on multivitamin supplement use. We performed principal component analysis identifying four nutrient patterns and used Cox proportional Hazards regression to assess the association between nutrients and nutrients patterns and lung cancer risk. During a mean follow-up of 5.7 years, 178 of 4,336 participants were diagnosed with lung cancer by screening. We found a significant risk reduction of lung cancer with increasing vegetable fat consumption (HR for highest vs. lowest quartile = 0.50, 95% CI = 0.31-0.80; P-trend = 0.02). Participants classified in the high "vitamins and fiber" pattern score had a significant risk reduction of lung cancer (HR = 0.57; 95% CI = 0.36-0.90, P-trend = 0.01). Among heavy smokers enrolled in a screening trial, high vegetable fat intake and adherence to the "vitamin and fiber" nutrient pattern were associated with reduced lung cancer incidence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Dietary Fats
  • Dietary Fiber
  • Dietary Supplements*
  • Early Detection of Cancer / methods*
  • Energy Intake
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Italy / epidemiology
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / etiology
  • Male
  • Mass Screening
  • Middle Aged
  • Plant Oils*
  • Principal Component Analysis
  • Proportional Hazards Models
  • Radiation Dosage
  • Risk Factors
  • Smoking / adverse effects
  • Smoking / epidemiology*
  • Surveys and Questionnaires
  • Tomography, X-Ray Computed / methods*


  • Dietary Fats
  • Dietary Fiber
  • Plant Oils