Fruits and vegetables: updating the epidemiologic evidence for the WCRF/AICR lifestyle recommendations for cancer prevention.

The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) current dietary recommendations for cancer prevention include "eating at least five portions/servings of a variety of non-starchy vegetables and or fruits every day". The most recent report coordinated by WCRF/AICR (2007) concluded that the evidence of a protective effect of fruits and vegetables on cancer was either "probable"-mouth, pharynx and larynx, oesophagus stomach, lung- or "limited suggestive"-nasopharynx, lung, colorectum, ovary, endometrium, pancreas, liver-. In a previous report published by WCRF/AICR in 1997, the evidence of the association of fruits and vegetables with cancer risk was considered convincing. This judgement was based mainly on the results of case-control studies. The association of fruit and vegetable intake and the risk of colorectal, breast and pancreatic cancer was re-examined in the Continuous Update Project (CUP) and the results were quantitatively summarised in meta-analyses. The CUP, with more data available, has confirmed the conclusion of the WCRF/AICR second expert report that there is no convincing evidence that fruits and vegetables play a role on cancer aetiology. On the other hand, evidence that is more consistent has been collected in the CUP about the role of dietary fibre and colorectal cancer. The evidence on the role of dietary fibre in colorectal cancer aetiology has been recently upgraded by the CUP expert panel from probable to convincing.

Systematic review of efficacy and safety of buprenorphine versus fentanyl or morphine in patients with chronic moderate to severe pain.

OBJECTIVE: To systematically assess efficacy and safety of buprenorphine patch versus fentanyl patch in patients with chronic moderate to severe pain. METHODS: Fifteen databases were searched up to December 2010. Randomised and quasi-randomised trials assessing the efficacy in patients with chronic pain were included. Quantitative methods for data synthesis were used and two network meta-analyses were conducted. RESULTS: Fourteen unique trials (17 publications) were included. No head-to-head randomised trials of buprenorphine patch compared with fentanyl patch were identified. Therefore, less robust evidence from indirect comparisons was used. Results from a network meta-analysis of non-enriched designs (eight trials), using trials versus placebo and trials versus morphine for indirect comparisons, indicated that transdermal fentanyl, in comparison with transdermal buprenorphine, showed significantly more nausea (odds ratio [OR] 4.66, 95% confidence interval (CI) 1.07 to 20.39), a significantly higher number of treatment discontinuations due to adverse events (OR 5.94, 95% CI 1.78 to 19.87), and non-significant differences on all other outcomes, including pain measures. In comparison with morphine, transdermal buprenorphine had a significantly higher decrease of pain intensity (MD [mean difference] -16.20, 95% CI -28.92 to -3.48) while morphine caused more cases of constipation (OR 7.50, 95% CI 1.45 to 38.85) and a significantly higher number of treatment discontinuations due to adverse events (OR 5.80, 95% CI 1.68 to 20.11). All other outcomes showed non-significant differences between transdermal buprenorphine and morphine. The results were similar when also including six trials using enriched designs with the exception of more cases of vomiting for fentanyl (OR 17.32, 95% CI 4.43 to 67.71) and morphine (OR 15.85, 95% CI 3.92 to 64.13) compared to buprenorphine. CONCLUSIONS: The findings indicate comparability of transdermal buprenorphine and transdermal fentanyl for pain measures with significantly fewer adverse events (nausea and treatment discontinuation due to adverse events) caused by transdermal buprenorphine.