***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Epidemiologic evidence on the association between nut consumption and  lung cancer  risk is limited . Methods : We investigated this relationship in the Environment and Genetics in Lung Cancer Etiology ( EAGLE ) study , a population -based case – control study , and the National Institutes of Health ( NIH ) American Association of Retired Persons ( AARP ) Diet and Health Study , a prospect i ve cohort . We identified 2,098 lung cases for EAGLE and 18,533 incident cases in AARP .  Diet was assessed by food frequency question naire for both studies . Multivariable ORs and HRs and respective 95 % confidence intervals ( CI ) were calculated using unconditional logistic regression and Cox proportional hazards regression for EAGLE and AARP , respectively . Results : Higher frequency of intake of nut consumption  was inversely associated with overall lung cancer risk ( highest vs. lowest quintile , OREAGLE = 0.74 ; 95 % CI , 0.57–0.95 ; HRAARP = 0.86 ; 95 % CI , 0.81–0.91 ) , regardless of smoking status . Results from the prospect i ve cohort showed similar associations across histologic subtypes and a more pronounced benefits from nut consumption for those who smoked 1 to 20 cigarettes/day ( OREAGLE = 0.61 ; 95 % CI , 0.39–0.95 ; HRAARP = 0.83 ; 95 % CI , 0.74–0.94 ) . Conclusions : Nut consumption was inversely associated with  lung cancer  in two large population -based studies , and associations were independent of cigarette smoking and other known risk factors . Impact : To our knowledge , this is the first study that examined the association between nut consumption and lung cancer risk by histologic subtypes and smoking intensity . Cancer Epidemiol Biomarkers Prev ; 26(6 ) ; 826–36 . © 2017 AACR Background : Lung cancer is the leading cause of cancer death . Little is known about whether prediagnostic nutritional factors may affect survival . We examined the associations of prediagnostic calcium intake from foods and /or supplements with lung cancer survival . Methods : The present analysis included 23,882 incident , primary lung cancer patients from 12 prospect i ve cohort studies .  Dietary calcium intake was assessed using food-frequency question naires at baseline in each cohort and st and ardized to caloric intake of 2,000 kcal/d for women and 2,500 kcal/d for men . Stratified , multivariable-adjusted Cox regression was applied to compute hazard ratios ( HR ) and 95 % confidence intervals ( CI ) . Results : The 5-year survival rates were 56 % , 21 % , and 5.7 % for localized , regional , and distant stage lung cancer , respectively . Low prediagnostic dietary calcium intake ( < 500–600 mg/d , less than half of the recommendation ) was associated with a small increase in risk of death compared with recommended calcium intakes ( 800–1,200 mg/d ) ; HR ( 95 % CI ) was 1.07 ( 1.01–1.13 ) after adjusting for age , stage , histology , grade , smoking status , pack-years , and other potential prognostic factors . The association between low calcium intake and higher lung cancer mortality was evident primarily among localized/regional stage patients , with HR ( 95 % CI ) of 1.15 ( 1.04–1.27 ) . No association was found for supplemental calcium with survival in the multivariable-adjusted model . Conclusions : This large pooled analysis is the first , to our knowledge , to indicate that low prediagnostic dietary calcium intake may be associated with poorer survival among early-stage lung cancer patients . Impact : This multinational prospect i ve study linked low calcium intake to lung cancer prognosis . Cancer Epidemiol Biomarkers Prev ; 26(7 ) ; 1060–70 . © 2017 AACR To prospect ively evaluate the associations of dietary calcium and magnesium intake with cancer incidence and mortality , data of 24,323 participants of the Heidelberg cohort of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-Heidelberg ) , who were aged 35–64 years and cancer-free at recruitment ( 1994–1998 ) , were analyzed using multivariate Cox regression models . After an average follow-up time of 11 years , 2,050 incident cancers were diagnosed and 513 cancer deaths occurred .  Dietary calcium intake  was inversely but not statistically significantly associated with colorectal cancer risk ( hazard ratio [ HR ] for per 100 mg increase in intake : 0.95 ; 95 % confidence interval [ CI ] : 0.88 , 1.02 ) and lung cancer risk ( HR for per 100 mg increase in intake : 0.94 ; 95 % CI : 0.87 , 1.02 ) . No statistically significant associations were observed between dietary calcium intake and site-specific or overall cancer incidence or mortality . Dietary magnesium intake  was not statistically significantly associated with any of the investigated outcomes . This prospect i ve cohort study provides no strong evidence to support that high dietary calcium and magnesium intake in the intake range observed in a German population may reduce cancer incidence or mortality BACKGROUND Experimental and epidemiologic investigations suggest that alpha-tocopherol ( the most prevalent chemical form of vitamin E found in vegetable oils , seeds , grains , nuts , and other foods ) and beta-carotene ( a plant pigment and major precursor of vitamin A found in many yellow , orange , and dark-green , leafy vegetables and some fruit ) might reduce the risk of cancer , particularly lung cancer . The initial findings of the Alpha-Tocopherol , Beta-Carotene Cancer Prevention Study ( ATBC Study ) indicated , however , that lung cancer incidence was increased among participants who received beta-carotene as a supplement .  Similar results were recently reported by the Beta-Carotene and Retinol Efficacy Trial ( CARET ) , which tested a combination of beta-carotene and vitamin A. PURPOSE We examined the effects of alpha-tocopherol and beta-carotene supplementation on the incidence of lung cancer across subgroups of participants in the ATBC Study defined by base-line characteristics ( e.g. , age , number of cigarettes smoked , dietary or serum vitamin status , and alcohol consumption ) , by study compliance , and in relation to clinical factors , such as disease stage and histologic type . Our primary purpose was to determine whether the pattern of intervention effects across subgroups could facilitate further interpretation of the main ATBC Study results and shed light on potential mechanisms of action and relevance to other population s. METHODS A total of 29,133 men aged 50 - 69 years who smoked five or more cigarettes daily were r and omly assigned to receive alpha-tocopherol ( 50 mg ) , beta-carotene ( 20 mg ) , alpha-tocopherol and beta-carotene , or a placebo daily for 5 - 8 years ( median , 6.1 years ) . Data regarding smoking and other risk factors for lung cancer and dietary factors were obtained at study entry , along with measurements of serum levels of alpha-tocopherol and beta-carotene . Incident cases of lung cancer ( n = 894 ) were identified through the Finnish Cancer Registry and death certificates . Each lung cancer diagnosis was independently confirmed , and histology or cytology was available for 94 % of the cases . Intervention effects were evaluated by use of survival analysis and proportional hazards models . All P values were derived from two-sided statistical tests . RESULTS No overall effect was observed for lung cancer from alpha-tocopherol supplementation ( relative risk [ RR ] = 0.99 ; 95 % confidence interval [ CI ] = 0.87 - 1.13 ; P = .86 , logrank test ) . beta-Carotene supplementation was associated with increased lung cancer risk ( RR = 1.16 ; 95 % CI = 1.02 - 1.33 ; P = .02 , logrank test ) . The beta-carotene effect appeared stronger , but not substantially different , in participants who smoked at least 20 cigarettes daily ( RR = 1.25 ; 95 % CI = 1.07 - 1.46 ) compared with those who smoked five to 19 cigarettes daily ( RR = 0.97 ; 95 % CI = 0.76 - 1.23 ) and in those with a higher alcohol intake ( > or = 11 g of ethanol/day [ just under one drink per day ] ; RR = 1.35 ; 95 % CI = 1.01 - 1.81 ) compared with those with a lower intake ( RR = 1.03 ; 95 % CI = 0.85 - 1.24 ) . CONCLUSIONS Supplementation with alpha-tocopherol or beta-carotene does not prevent lung cancer in older men who smoke . beta-Carotene supplementation at pharmacologic levels may modestly increase lung cancer incidence in cigarette smokers , and this effect may be associated with heavier smoking and higher alcohol intake . IMPLICATION S While the most direct way to reduce lung cancer risk is not to smoke tobacco , smokers should avoid high-dose beta-carotene supplementation Background : Calcium has been implicated in carcinogenesis and linked to the risk of several cancers in epidemiologic studies ; however , few studies have investigated the association of calcium intake with lung cancer risk , particularly among nonsmokers . Methods : We evaluated the association of intakes of calcium and related minerals , assessed through a food frequency question naire , with lung cancer risk among 71,267 female nonsmokers who were cancer free at baseline in the Shanghai Women 's Health Study , a population -based , prospect i ve cohort study . Multivariate Cox regression was used to calculate hazard ratios ( HR ) and 95 % confidence intervals ( CI ) . Results : During follow-up through December 2009 ( median follow-up time : 11.2 years ) , 428 incident lung cancer cases accrued . The median intakes of dietary calcium , magnesium , and phosphorus were 441 , 266 , and 935 mg/d , respectively . Intakes of calcium , phosphorus , and the calcium-to-magnesium ( Ca : Mg ) ratio were inversely associated with lung cancer risk . The corresponding HRs ( 95 % CIs ) for the highest compared with the lowest quartile were 0.66 ( 0.48 , 0.91 ) for calcium , 0.55 ( 0.36 , 0.85 ) for phosphorus , and 0.62 ( 0.47 , 0.82 ) for the Ca : Mg ratio . No association was observed for dietary magnesium intake or the use of calcium- or vitamin D-containing supplements . Conclusions and Impact : Our study provides some of the first evidence suggesting a possible role for increasing  dietary calcium intake in lung cancer prevention among female nonsmokers , especially in population s with relatively low calcium intake . Cancer Epidemiol Biomarkers Prev ; 22(1 ) ; 50–7 . © 2012 AACR Background Lung cancer is the leading cause of cancer mortality worldwide . Tobacco smoking is its primary cause , and yet the precise molecular alterations induced by smoking in lung tissue that lead to lung cancer and impact survival have remained obscure . A new framework of research is needed to address the challenges offered by this complex disease . Methods / Design We design ed a large population -based case-control study that combines a traditional molecular epidemiology design with a more integrative approach to investigate the dynamic process that begins with smoking initiation , proceeds through dependency/smoking persistence , continues with lung cancer development and ends with progression to disseminated disease or response to therapy and survival . The study allows the integration of data from multiple sources in the same subjects ( risk factors , germline variation , genomic alterations in tumors , and clinical endpoints ) to tackle the disease etiology from different angles . Before beginning the study , we conducted a phone survey and pilot investigations to identify the best approach to ensure an acceptable participation in the study from cases and controls . Between 2002 and 2005 , we enrolled 2101 incident primary lung cancer cases and 2120 population controls , with 86.6 % and 72.4 % participation rate , respectively , from a catchment area including 216 municipalities in the Lombardy region of Italy . Lung cancer cases were enrolled in 13 hospitals and population controls were r and omly sample d from the area to match the cases by age , gender and residence . Detailed epidemiological information and biospecimens were collected from each participant , and clinical data and tissue specimens from the cases . Collection of follow-up data on treatment and survival is ongoing . Discussion EAGLE is a new population -based case-control study that explores the full spectrum of lung cancer etiology , from smoking addiction to lung cancer outcome , through examination of epidemiological , molecular , and clinical data . We have provided a detailed description of the study design , field activities , management , and opportunities for research following this integrative approach , which allows a sharper and more comprehensive vision of the complex nature of this disease . The study is poised to accelerate the emergence of new preventive and therapeutic strategies with potentially enormous impact on public health CONTEXT Despite lung-specific in vitro and in vivo studies that support a chemopreventive role for 
    Output:
    
Items in the diet that offer a protective effect on lung parenchyma are fruits , vegetables , fish , nuts , soy , B vitamins , vitamin D , vitamin E , vitamin C , and zinc .
Changing dietary habits to decrease the risk of lung cancer can be performed in parallel with smoking cessation programs .