Although beta‐carotene was prevalent in multivitamins, high‐dose beta‐carotene was observed among multivitamin formulas sold to promote visual health. It is unclear if dietary beta-carotene reduces the risk of colon cancer. The trial intervention results, however, do not support the observed associations or a role for supplemental β-carotene in lung cancer prevention in the populations, dosages, and duration of supplementation tested, and they are, on the surface, at odds with the observational epidemiology. Eating foods rich in beta carotene is recommended to possibly decrease the risk of developing stomach, lung, prostate, breast, and head and neck cancer… This may indicate that a diet with adequate fruits and vegetables-not simply the consumption of a specific phytochemical-may be related to reduced cancer risk. As subsequently reported (22), there were only 31 lung cancer deaths among the 792 total cancer deaths, with slightly fewer in the group that received the supplemental β-carotene combination (11 compared with 20 deaths). This trial studied >18000 men and women, of whom 388 developed lung cancer, with a 28% increase in lung cancer incidence in participants who received the β-carotene–retinyl palmitate combination daily for an average of 4 y compared with participants who received placebo. Indeed, the only plausible way the associations might not be real is if vegetable, fruit, and β-carotene intakes were strongly related to another truly protective (and unmeasured) exposure that is confounding their association with lung cancer; however, no such factor has yet been identified. Bendich A, Machlin LJ, Scandurra O, et al. The results on this issue are mixed, but ultimately, researchers aren’t sure if there may be interactions between different carotenoids that are used together for treatment, or if beta-carotene interacts with other phytonutrients . Randomized intervention trials are included in the definition of nutritional epidemiology in that they are among the state-of-the-science methods available to and used by chronic-disease epidemiologists to disentangle many of the myriad important diet-health associations under investigation. Some examples are carrots, apricots, plums, peppers, chilies, pumpkin and sweet potatoes. Beta-carotene in multivitamins and the possible risk of lung cancer among smokers versus former smokers: a meta-analysis and evaluation of national brands. Cancer. A large body of observational epidemiologic study has demonstrated that individuals who eat more fruits and vegetables rich in carotenoids and/or who have higher levels of serum beta-carotene have a lower risk of cancer, particularly lung cancer. Can dietary β-carotene materially reduce human cancer rates? Cancer Epidemiol Biomarkers Prev. Although there is no recommended dietary allowance for β-carotene, the recommendation for vitamin A of 800 and 1000 retinol equivalents (or μg retinol) for adult women and men, respectively, represents ≈4.8 and 6.0 mg β-carotene intake daily, assuming that the entire vitamin A requirement is met by provitamin A β-carotene. Some of the best sources of beta-carotene include carrots, pumpkins, sweet potatoes, winter squash, broccoli, cantaloupe, apricots, mangoes, kale, spinach, watercress and … In early 1994 the ATBC Study Group reported its initial trial intervention findings concerning β-carotene and α-tocopherol supplementation (19). The results for β-carotene (20 mg in 1 capsule taken daily for 5–8 y) were surprising in that they provided no evidence for benefit in the prevention of lung cancer in older male cigarette smokers and instead suggested an adverse outcome, with more incident lung cancers diagnosed in those receiving β-carotene supplements. 5) The entire body of evidence was reinterpreted, with further discussion, debate, and consensus conferences in the mid-1990s. Le Marchand L, Hankin JH, Kolonel LN, Beecher GR, Wilkens LR, Zhao LP. Further, the supplementation trials suggest not only lack of benefit of β-carotene in lung cancer prevention, but possible harm in smokers from not only lung cancer but overall mortality as well. 10 The harmful effect of beta‐carotene supplementation on lung cancer was also well established in smokers and asbestos workers supplemented with 20–30 mg of beta‐carotene per day. Knekt P, Reunanen A, Jarvinen R, Seppanen R, Heliovaara M, Aromaa A. Results from CARET corroborated this finding (25). Thereafter, the concordant data from the ATBC Study and CARET created a striking apparent contradiction to the previous observational epidemiology. Beta‐carotene, a provitamin A, is available in multivitamins. Folate and cancer: a review of the literature, Poor plasma status of carotene and vitamin C is associated with higher mortality from ischemic heart disease and stroke: Basel Prospective Study, Antioxidant vitamin intake and coronary mortality in a longitudinal population study, Serum carotenoids and coronary heart disease—the Lipid Research Clinics Coronary Primary Prevention Trial and Follow-Up Study, Antioxidant vitamins in the prevention of coronary artery disease, Intake of specific carotenoids and lung cancer risk, Importance of α-carotene, β-carotene, and other phytochemicals in the etiology of lung cancer risk, Dietary vitamin A and risk of cancer in the Western Electric Study, Dietary vitamin C and β-carotene and risk of death in middle-age men. Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. One study of 29,000 male smokers found an 18% increase in lung cancer in the group receiving 20 mg of beta-carotene a day for 5 to 8 years. NLM If the β-carotene supplementation trials had not been conducted, for example, it is possible that guidelines more specific than those promoting greater consumption of vegetables and fruit might have emerged. Other relevant and somewhat more specific recommendations include the 1989 National Research Council Diet and Health report supporting consumption of ≥5 fruit and vegetable servings/d and the National Cancer Institute–DHHS sponsorship of the 5-A-Day Program initiated in 1991, which similarly promotes ≥5 servings of fruit and vegetables/d (2, 3). Therefore, on the basis of this body of observational evidence, nutrition recommendations promoting vegetable and fruit consumption are warranted. Epidemiology, Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence, Epidemiologic evidence for β-carotene and cancer prevention, Diet and lung cancer risk: findings from the Western New York Diet Study, Serum beta-carotene, vitamins A and E, selenium, and the risk of lung cancer, Dietary antioxidants and the risk of lung cancer, Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group, The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers, Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease, Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population, Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease, α-Tocopherol and β-carotene supplements and lung cancer incidence in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study: effects of baseline characteristics and study compliance, Risk factors for lung cancer incidence and intervention effects in CARET, the Beta-Carotene and Retinol Efficacy Trial. The best way to ensure adequate levels of beta carotene or vitamin A is via your diet, not through pills. Each large supplementation trial has typically reported its intervention findings for most important events, such as cancer, cardiovascular disease, and total mortality. Beta carotene is an oil-soluble nutrient, and the body may be better able to absorb it when foods are cooked, especially when they are cooked in oil. New England Journal of Medicine 1994;330:1029–35. This occurred in the late 1980s and early 1990s. Key TJ (2011) Fruit and vegetables and cancer risk. Semin Oncol. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. No adverse or beneficial effects were observed in the β-carotene group, even in the small number of smoking participants (11%). concerning β-carotene and lung cancer evolved for the most part similarly to that of many other questions of dietary factors and disease, such as the roles of dietary fats and fiber in human health, as follows 1. A large body of … 1999 Summer;60(3):160-165. N Engl J Med 1994;330:1029-35. For example, if it is corroborated through laboratory studies that such toxicity resulted from combining a high-dose β-carotene supplement with active cigarette smoking through a direct interaction between cigarette smoke and β-carotene in lung tissue, as has been discussed (26), this might suggest particular caution regarding β-carotene use by cigarette smokers. Lycopene, another type of carotenoid, has also demonstrated similar effects against lung cancer. For the purposes of the present discussion, it is important to note that such an effect was detectable because of the large size and controlled experimental design of these studies, which minimized or eliminated confounding factors. The metaanalysis of … Studies About β-Carotene and Lung Cancer Risk. It is what gives color to carrots, sweet potatoes, and other foods. Specifically, further evaluation of other carotenoids and phytochemicals, both in the diet and in serum, is clearly warranted because any one or more of these substances present in vegetables and fruit might be responsible for the inverse association with lung cancer. Copyright © 2021 American Society for Nutrition. However, scientific evidence shows that people who eat a lot of fruits and vegetables containing beta-carotene are less likely to develop cancer and heart disease – whether or not they smoke. Initial studies of this kind include those of Le Marchand et al (34) and Ziegler et al (35), which further explored the role of other dietary carotenoids using newly available food-composition data. A β-carotene breakdown product suspected of causing cancer at high dose is trans -β-apo-8'-carotenal (common apocarotenal ), which has been found in one study to be mutagenic and genotoxic in cell cultures which do not respond to β-carotene itself. Subjects received 20,000 mcg of β-carotene daily, and results showed an increased occurrence of lung cancer as well as ischemic heart disease. The similarity of the associations for vegetables and fruit and β-carotene (and possibly other carotenoid) intake have been interpreted as being consistent with specific beneficial effects of this substance, the biological plausibility of which is supported by studies of several properties and functions of β-carotene, for example, antioxidation, inhibition of tumor initiation and promotion, and enhancement of immunity and cellular maturation. The results indicate that beta-carotene supplementation is contraindicated among smokers. This no doubt reflected, in part, the growing literature regarding the inverse association between vegetable and fruit consumption and cancer risk. The fact that the relative risk estimates for the dietary and serum β-carotene associations are not as large as in many of the prior observational studies could be easily attributed to the greater homogeneity and higher baseline risk of the ATBC Study and CARET populations. One other important issue must be considered. High-dose beta-carotene supplements in humans were shown to increase the risk of lung cancer among people who smoke in two out of three intervention trials. In fact, high beta-carotene intake has been linked to higher risk of lung cancer in male smokers and aggressive prostate cancer. These findings contrast with epidemiologic studies on dietary-derived beta-carotene and circulating beta-carotene levels which generally report a decreased risk of lung cancer. Beta-carotene and other carotenoids protect plants from UV radiation and other harms. In the case of β-carotene and lung cancer, the trial results raised further questions that require the testing of specific hypotheses. Ultimately, abstinence from smoking remains the best way to reduce lung cancer risk. 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