Dietary Fiber and the Risk of Colorectal Cancer and Adenoma in Women
Charles S. Fuchs, M.D., Edward L. Giovannucci, M.D., Graham A. Colditz, M.D., David J. Hunter, M.B., B.S., Meir J. Stampfer, M.D., Bernard Rosner, Ph.D., Frank E. Speizer, M.D., and Walter C. Willett, M.D.
Background A high intake of dietary fiber has been thought toreduce the risk of colorectal cancer and adenoma.
Methods We conducted a prospective study of 88,757 women, whowere 34 to 59 years old and had no history of cancer, inflammatorybowel disease, or familial polyposis, who completed a dietaryquestionnaire in 1980. During a 16-year follow-up period, 787cases of colorectal cancer were documented. In addition, 1012patients with adenomas of the distal colon and rectum were foundamong 27,530 participants who underwent endoscopy during thefollow-up period.
Results After adjustment for age, established risk factors,and total energy intake, we found no association between theintake of dietary fiber and the risk of colorectal cancer; therelative risk for the highest as compared with the lowest quintilegroup with respect to fiber intake was 0.95 (95 percent confidenceinterval, 0.73 to 1.25). No protective effect of dietary fiberwas observed when we omitted adjustment for total energy intake,when events during the first six years of follow-up were excluded,or when we excluded women who altered their fiber intake duringthe follow-up period. No significant association between fiberintake and the risk of colorectal adenoma was found.
Conclusions Our data do not support the existence of an importantprotective effect of dietary fiber against colorectal canceror adenoma.
Source Information
From the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (C.S.F., E.L.G., G.A.C., D.J.H., M.J.S., B.R., F.E.S., W.C.W.); the Department of Adult Oncology, DanaFarber Cancer Institute (C.S.F.); and the Departments of Epidemiology (G.A.C., D.J.H., M.J.S., W.C.W.), Environmental Health (F.E.S.), Nutrition (E.L.G., M.J.S., W.C.W.), and Biostatistics (B.R.), Harvard School of Public Health all in Boston.
Address reprint requests to Dr. Fuchs at the DanaFarber Cancer Institute, 44 Binney St., Boston, MA 02115.
Dietary Fiber and Colorectal Cancer
Ravin N. D., Mohandas K.M., Cummings J. H., Southgate D. A.T., Heaton K. W., Lewis S. J., Madar Z., Stark A., Camire M. E., Fuchs C. S., Willett W. C.
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N Engl J Med 1999;
340:1924-1926, Jun 17, 1999.
Correspondence
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[Abstract][Full Text]
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[Abstract][Full Text]
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344: 675-676
[Full Text]
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(2001). DNA Methyltransferase Inhibition Enhances Apoptosis Induced by Histone Deacetylase Inhibitors. Cancer Res.
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[Abstract][Full Text]
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[Abstract][Full Text]
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[Abstract][Full Text]
Voorrips, L. E., Goldbohm, R. A., van Poppel, G., Sturmans, F., Hermus, R. J. J., van den Brandt, P. A.
(2000). Vegetable and Fruit Consumption and Risks of Colon and Rectal Cancer in a Prospective Cohort Study The Netherlands Cohort Study on Diet and Cancer. Am J Epidemiol
152: 1081-1092
[Abstract][Full Text]
Michels, K. B., Edward Giovannucci, , Joshipura, K. J., Rosner, B. A., Stampfer, M. J., Fuchs, C. S., Colditz, G. A., Speizer, F. E., Willett, W. C.
(2000). Prospective Study of Fruit and Vegetable Consumption and Incidence of Colon and Rectal Cancers. JNCI J Natl Cancer Inst
92: 1740-1752
[Abstract][Full Text]
Willett, W. C.
(2000). Diet and Cancer. The Oncologist
5: 393-404
[Abstract][Full Text]
Reddy, B. S., Hirose, Y., Cohen, L. A., Simi, B., Cooma, I., Rao, C. V.
(2000). Preventive Potential of Wheat Bran Fractions against Experimental Colon Carcinogenesis: Implications for Human Colon Cancer Prevention. Cancer Res.
60: 4792-4797
[Abstract][Full Text]
Gråsten, S. M., Juntunen, K. S., Poutanen, K. S., Gylling, H. K., Miettinen, T. A., Mykkänen, H. M.
(2000). Rye Bread Improves Bowel Function and Decreases the Concentrations of Some Compounds That Are Putative Colon Cancer Risk Markers in Middle-Aged Women and Men. J. Nutr.
130: 2215-2221
[Abstract][Full Text]
Janne, P. A., Mayer, R. J.
(2000). Chemoprevention of Colorectal Cancer. NEJM
342: 1960-1968
[Full Text]
McKean-Cowdin, R., Feigelson, H. S., Ross, R. K., Pike, M. C., Henderson, B. E.
(2000). Declining Cancer Rates in the 1990s. JCO
18: 2258-2268
[Abstract][Full Text]
Slavin, J. L.
(2000). Mechanisms for the Impact of Whole Grain Foods on Cancer Risk. J. Am. Coll. Nutr.
19: 300S-307
[Abstract][Full Text]
Jacobs, D. R. Jr, Pereira, M. A., Meyer, K. A., Kushi, L. H.
(2000). Fiber from Whole Grains, but not Refined Grains, Is Inversely Associated with All-Cause Mortality in Older Women: The Iowa Women's Health Study. J. Am. Coll. Nutr.
19: 326S-330
[Abstract][Full Text]
Schatzkin, A., Lanza, E., Corle, D., Lance, P., Iber, F., Caan, B., Shike, M., Weissfeld, J., Burt, R., Cooper, M. R., Kikendall, J. W., Cahill, J., Freedman, L., Marshall, J., Schoen, R. E., Slattery, M., The Polyp Prevention Trial Study Group,
(2000). Lack of Effect of a Low-Fat, High-Fiber Diet on the Recurrence of Colorectal Adenomas. NEJM
342: 1149-1155
[Abstract][Full Text]
Alberts, D. S., Martinez, M. E., Roe, D. J., Guillen-Rodriguez, J. M., Marshall, J. R., van Leeuwen, J. B., Reid, M. E., Ritenbaugh, C., Vargas, P. A., Bhattacharyya, A.B., Earnest, D. L., Sampliner, R. E., Parish, D., Koonce, K., Fales, L., The Phoenix Colon Cancer Prevention Physicians' Ne,
(2000). Lack of Effect of a High-Fiber Cereal Supplement on the Recurrence of Colorectal Adenomas. NEJM
342: 1156-1162
[Abstract][Full Text]
Reddy, B. S.
(2000). Novel Approaches to the Prevention of Colon Cancer by Nutritional Manipulation and Chemoprevention. Cancer Epidemiol. Biomarkers Prev.
9: 239-247
[Abstract][Full Text]
MARIC, R, CHENG;, K K, LAGERGREN, J, NYREN, P
(2000). Association between colon cancer and adenocarcinoma of the oesophagus • Reply. Gut
46: 293a-293
[Full Text]
Kien, C. L., Chang, J. C., Cooper, J. R.
(2000). Butyric Acid Is Synthesized by Piglets. J. Nutr.
130: 234-237
[Abstract][Full Text]
Augenlicht, L. H., Anthony, G. M., Church, T. L., Edelmann, W., Kucherlapati, R., Yang, K., Lipkin, M., Heerdt, B. G.
(1999). Short-Chain Fatty Acid Metabolism, Apoptosis, and Apc-initiated Tumorigenesis in the Mouse Gastrointestinal Mucosa. Cancer Res.
59: 6005-6009
[Abstract][Full Text]
Nixon, D.
(1999). Alternative and Complementary Therapies in Oncology Care. JCO
17: 35-37
[Full Text]
Newmark, H., Wittkowski, K. M., Shiff, S. J., Hirsch, J., Holmes, M. D., Rosner, B., Willett, W. C.
(1999). Dietary Fat and Risk of Breast Cancer. JAMA
282: 1223-1224
[Full Text]
Martínez, M. E., Marshall, J. R., Graver, E., Whitacre, R. C., Woolf, K., Ritenbaugh, C., Alberts, D. S.
(1999). Reliability and Validity of a Self-Administered Food Frequency Questionnaire in a Chemoprevention Trial of Adenoma Recurrence. Cancer Epidemiol. Biomarkers Prev.
8: 941-946
[Abstract][Full Text]
Pierre, F., Perrin, P., Bassonga, E., Bornet, F., Meflah, K., Menanteau, J.
(1999). T cell status influences colon tumor occurrence in Min mice fed short chain fructo-oligosaccharides as a diet supplement. Carcinogenesis
20: 1953-1956
[Abstract][Full Text]
Hallfrisch, J., Behall, K. M.
(1999). Breath Hydrogen and Methane Responses of Men and Women to Breads Made with White Flour or Whole Wheat Flours of Different Particle Sizes. J. Am. Coll. Nutr.
18: 296-302
[Abstract][Full Text]
Garner, C. M.
(1999). Dietary fibre intake was not associated with a lower risk of colorectal cancer in women. Evid. Based Nurs.
2: 89-89
[Full Text]
Ravin, N. D., Mohandas, K.M., Cummings, J. H., Southgate, D. A.T., Heaton, K. W., Lewis, S. J., Madar, Z., Stark, A., Camire, M. E., Fuchs, C. S., Willett, W. C.
(1999). Dietary Fiber and Colorectal Cancer. NEJM
340: 1924-1926
[Full Text]
Potter, J. D.
(1999). Colorectal Cancer: Molecules and Populations. JNCI J Natl Cancer Inst
91: 916-932
[Abstract][Full Text]
Levin, B.
(1999). Colorectal Cancer Screening: Sifting Through the Evidence. JNCI J Natl Cancer Inst
91: 399-400
[Full Text]
Temple, R.
(1999). Meta-analysis and Epidemiologic Studies in Drug Development and Postmarketing Surveillance. JAMA
281: 841-844
[Full Text]
(1999). Does Dietary Fiber Reduce Risk for Colorectal Cancer?. Journal Watch Dermatology
1999: 13-13
[Full Text]
(1999). Dietary Fiber Healthful, But Doesn't Prevent Colon Cancer. JWatch Women's Health
1999: 14-14
[Full Text]
(1999). Does Dietary Fiber Reduce Risk for Colorectal Cancer?. JWatch General
1999: 2-2
[Full Text]
Potter, J. D.
(1999). Fiber and Colorectal Cancer -- Where to Now?. NEJM
340: 223-224
[Full Text]
GARLAND, C. F., GARLAND, F. C., GORHAM, E. D.
(1999). Calcium and Vitamin D: Their Potential Roles in Colon and Breast Cancer Prevention. Ann. N. Y. Acad. Sci.
889: 107-119
[Abstract][Full Text]