Abstract Background and Aim: Diverse antioxidant compounds found in colored fruits and vegetables have been linked to various health benefits. While anthocyanins, present in purple, red, and blue pigments, and chlorophyll, responsible for green pigments, are recognized for their antioxidant properties, limited evidence exists regarding their preventive effects on gastrointestinal (GI) cancers. In the year 2020, GI cancers constituted 29% of global cancer cases. To address this gap, this prospective cohort study investigates the association between the intake of colored fruits and vegetables and the risk of GI cancer in Korea. Methods: The Cancer Screenee Cohort, comprising adults undergoing check-ups at the National Cancer Center Korea, was analyzed for GI cancer cases diagnosed between October 16, 2007, and December 31, 2020. Of the 10,741 eligible participants, 208 developed GI cancer and 10,533 did not. General and validated semi-quantitative food frequency questionnaires were used to collect demographic data and measure dietary intake. Fruit and vegetable intake (g/day) were categorized into four groups (white, green, orange/yellow, and red/purple) based on the color of the edible parts. Analyses were conducted on total fruits/vegetables, total fruits, total vegetables, and fruits/vegetables in each color category. The intake was divided into quintiles to compare the effects of low and high intake. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI). HRs were adjusted for variables, including age, gender, body mass index, smoking status, alcohol drinking, education, occupation, first-degree family history of any cancer, and marital status. Results: High total fruit and vegetable intake was associated with reduced GI cancer risk (HR = 0.64, 95% CI: 0.42-0.98, p for trend = 0.022). No significant associations were found for total fruits, total vegetables, fruits and vegetables together and separately in green and orange/yellow colors in this study. However, a higher intake of white fruits and vegetables was found to be effective in preventing cancer with adjusted HRs (HR = 0.51, 95% CI: 0.31-0.85, p for trend = 0.019). Similarly, the inverse association was observed in red and purple vegetables with adjusted HRs (HR = 0.52, 95% CI: 0.32-0.84, p for trend = 0.022). Conclusions: This cohort study suggests that the consumption of fruits and vegetables in white color, as well as vegetables in red and purple colors, may have a potential protective effect against GI cancer. Key Words: Gastrointestinal (GI) cancer; fruits and vegetables; colors of fruits and vegetables; color food; cohort studies; Korea Citation Format: Yujin Cho, Jeonghee Lee, Madhawa Gunathilake, Jeongseon Kim. Effect of colored fruits and vegetables intake on gastrointestinal cancer risk: A prospective cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2173.