A higher intake of white-edible-colored fruits and vegetables is associated with lower gastrointestinal cancer risk among Korean adults in a prospective cohort study

Although fruits and vegetables were studied botanically in previous studies, few have examined their associations with gastrointestinal (GI) cancer risk based on color classification. Color is familiar to the public and translates phytochemical science into dietary guidance. We hypothesized that the intake of fruits and vegetables would be differently associated with GI cancer risk by color. This cohort study investigated the association between fruit and vegetable colors and GI cancer risk in 11,286 participants from the Cancer Screenee Cohort, who underwent health check-ups at the National Cancer Center between 2007 and 2021. Dietary data were collected through food frequency questionnaires. A Cox proportional hazards regression model evaluated the association between fruit and vegetable color groups (green, orange/yellow, red/purple, and white) and GI cancer risk. Over a mean follow-up of 8 years, 214 GI cancers (esophageal, gastric, small intestine, liver, pancreatic, and colorectal) were identified. Higher total fruit and vegetable intake was associated with reduced GI cancer risk (hazard ratio [HR] = 0.57, 95% confidence interval [CI]: 0.38-0.88, P for trend = .013). Among color groups, white-colored fruits and vegetables (HR = 0.64, 95% CI: 0.41-0.99, P for trend = .021), and white-colored fruits (HR = 0.59, 95% CI: 0.38-0.92, P for trend = .021) were associated with a lower risk of GI cancer after fully adjusting for demographic variables, dietary factors, and comorbidities. Findings were consistent across subgroup analyses. No significant associations were found for green, orange/yellow, or red/purple groups. These results suggest that white-colored fruits and vegetables may contribute to GI cancer prevention.