Lack of Effect of a Low-Fat, High-Fiber Diet on the Recurrence of Colorectal Adenomas
Arthur Schatzkin, M.D., Dr.P.H., Elaine Lanza, Ph.D., Donald Corle, M.S., Peter Lance, M.D., Frank Iber, M.D., Bette Caan, Dr.P.H., Moshe Shike, M.D., Joel Weissfeld, M.D., M.P.H., Randall Burt, M.D., M. Robert Cooper, M.D., J. Walter Kikendall, M.D., Jack Cahill, M.A., Laurence Freedman, James Marshall, Robert E. Schoen, Martha Slattery, for The Polyp Prevention Trial Study Group
Background We tested the hypothesis that dietary interventioncan inhibit the development of recurrent colorectal adenomas,which are precursors of most large-bowel cancers.
Methods We randomly assigned 2079 men and women who were 35years of age or older and who had had one or more histologicallyconfirmed colorectal adenomas removed within six months beforerandomization to one of two groups: an intervention group givenintensive counseling and assigned to follow a diet that waslow in fat (20 percent of total calories) and high in fiber(18 g of dietary fiber per 1000 kcal) and fruits and vegetables(3.5 servings per 1000 kcal), and a control group given a standardbrochure on healthy eating and assigned to follow their usualdiet. Subjects entered the study after undergoing complete colonoscopyand removal of adenomatous polyps; they remained in the studyfor approximately four years, undergoing colonoscopy one andfour years after randomization.
Results A total of 1905 of the randomized subjects (91.6 percent)completed the study. Of the 958 subjects in the interventiongroup and the 947 in the control group who completed the study,39.7 percent and 39.5 percent, respectively, had at least onerecurrent adenoma; the unadjusted risk ratio was 1.00 (95 percentconfidence interval, 0.90 to 1.12). Among subjects with recurrentadenomas, the mean (±SE) number of such lesions was 1.85±0.08in the intervention group and 1.84±0.07 in the controlgroup. The rate of recurrence of large adenomas (with a maximaldiameter of at least 1 cm) and advanced adenomas (defined aslesions that had a maximal diameter of at least 1 cm or at least25 percent villous elements or evidence of high-grade dysplasia,including carcinoma) did not differ significantly between thetwo groups.
Conclusions Adopting a diet that is low in fat and high in fiber,fruits, and vegetables does not influence the risk of recurrenceof colorectal adenomas.
Source Information
From the National Cancer Institute, Bethesda, Md. (A.S., E.L., D.C.); the School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (P.L.); Edward Hines, Jr., Hospital, Veterans Affairs Medical Center, Hines, Ill. (F.I.); the Kaiser Foundation Research Institute, Oakland, Calif. (B.C.); Memorial Sloan-Kettering Cancer Center, New York (M.S.); the University of Pittsburgh, Pittsburgh (J.W.); the University of Utah, Salt Lake City (R.B.); Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (M.R.C.); Walter Reed Army Medical Center, Washington, D.C. (J.W.K.); and Westat, Rockville, Md. (J.C.).
High-Fiber Diet and Colorectal Adenomas
Ornish D., Davis B. M., Gerber M., Lowenfels A., Maisonneuve P., Muller R. J., Duprey P. A., Schatzkin A., Lanza E., Freedman L., Alberts D. S., Martínez M. E., Marshall J. R.
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Full Text
N Engl J Med 2000;
343:736-738, Sep 7, 2000.
Correspondence
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[Abstract][Full Text]
Marshall, J. R.
(2003). Methodologic and Statistical Considerations Regarding Use of Biomarkers of Nutritional Exposure in Epidemiology. J. Nutr.
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Fung, T., Hu, F. B., Fuchs, C., Giovannucci, E., Hunter, D. J., Stampfer, M. J., Colditz, G. A., Willett, W. C.
(2003). Major Dietary Patterns and the Risk of Colorectal Cancer in Women. Arch Intern Med
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Fallon, U. B
(2003). Commentary: Colon cancer, folate and genetic status. Int J Epidemiol
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Boyle, P., Leon, M. E.
(2002). Epidemiology of colorectal cancer. Br Med Bull
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McCullough, M. L, Feskanich, D., Stampfer, M. J, Giovannucci, E. L, Rimm, E. B, Hu, F. B, Spiegelman, D., Hunter, D. J, Colditz, G. A, Willett, W. C
(2002). Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am. J. Clin. Nutr.
76: 1261-1271
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Mitchell, R. J., Farrington, S. M., Dunlop, M. G., Campbell, H.
(2002). Mismatch Repair Genes hMLH1 and hMSH2 and Colorectal Cancer: A HuGE Review. Am J Epidemiol
156: 885-902
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Jacobs, E. T., Giuliano, A. R., Roe, D. J., Guillen-Rodriguez, J. M., Alberts, D. S., Martinez, M. E.
(2002). Baseline Dietary Fiber Intake and Colorectal Adenoma Recurrence in the Wheat Bran Fiber Randomized Trial. JNCI J Natl Cancer Inst
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Lippman, S. M., Hong, W. K.
(2002). Cancer Prevention Science and Practice. Cancer Res.
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Jacobs, E. T., Giuliano, A. R., Roe, D. J., Guillen-Rodriguez, J. M., Hess, L. M., Alberts, D. S., Martinez, M. E.
(2002). Intake of Supplemental and Total Fiber and Risk of Colorectal Adenoma Recurrence in the Wheat Bran Fiber Trial. Cancer Epidemiol. Biomarkers Prev.
11: 906-914
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Wacker, M., Wanek, P., Eder, E., Hylla, S., Gostner, A., Scheppach, W.
(2002). Effect of Enzyme-resistant Starch on Formation of 1,N2-Propanodeoxyguanosine Adducts of trans-4-Hydroxy-2-nonenal and Cell Proliferation in the Colonic Mucosa of Healthy Volunteers. Cancer Epidemiol. Biomarkers Prev.
11: 915-920
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Shike, M., Latkany, L., Riedel, E., Fleisher, M., Schatzkin, A., Lanza, E., Corle, D., Begg, C. B.
(2002). Lack of Effect of a Low-Fat, High-Fruit, -Vegetable, and -Fiber Diet on Serum Prostate-Specific Antigen of Men Without Prostate Cancer: Results From a Randomized Trial. JCO
20: 3592-3598
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Flood, A., Velie, E. M, Chaterjee, N., Subar, A. F, Thompson, F. E, Lacey, J. V Jr, Schairer, C., Troisi, R., Schatzkin, A.
(2002). Fruit and vegetable intakes and the risk of colorectal cancer in the Breast Cancer Detection Demonstration Project follow-up cohort. Am. J. Clin. Nutr.
75: 936-943
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Nathan, D. M.
(2002). The Impact of Clinical Trials on the Treatment of Diabetes Mellitus. J. Clin. Endocrinol. Metab.
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Colangelo, L. A., Gapstur, S. M., Gann, P. H., Dyer, A. R., Liu, K.
(2002). Colorectal Cancer Mortality and Factors Related to the Insulin Resistance Syndrome. Cancer Epidemiol. Biomarkers Prev.
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Temple, N. J., Balay-Karperien, A. L.
(2002). Nutrition in Cancer Prevention: An Integrated Approach. J. Am. Coll. Nutr.
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Byers, T., Nestle, M., McTiernan, A., Doyle, C., Currie-Williams, A., Gansler, T., Thun, M., the American Cancer Society 2001 Nutrition and Phy,
(2002). American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer with Healthy Food Choices and Physical Activity. CA Cancer J Clin
52: 92-119
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Young, R. C., Wilson, C. M.
(2002). Cancer Prevention: Past, Present, and Future. Clin. Cancer Res.
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Woodson, K., Lanza, E., Tangrea, J. A., Albert, P. S., Slattery, M., Pinsky, J., Caan, B., Paskett, E., Iber, F., Kikendall, J. W., Lance, P., Shike, M., Weissfeld, J., Schatzkin, A.
(2001). Hormone Replacement Therapy and Colorectal Adenoma Recurrence Among Women in the Polyp Prevention Trial. JNCI J Natl Cancer Inst
93: 1799-1805
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Schlenker, E. D.
(2001). The Evolution of Research in Family and Consumer Sciences: Food, Nutrition, and Health. Family and Consumer Sciences Research Journal
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[Abstract]
Gerber, M.
(2001). The Comprehensive Approach to Diet: A Critical Review. J. Nutr.
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Ioannidis, J. P. A., Haidich, A.-B., Pappa, M., Pantazis, N., Kokori, S. I., Tektonidou, M. G., Contopoulos-Ioannidis, D. G., Lau, J.
(2001). Comparison of Evidence of Treatment Effects in Randomized and Nonrandomized Studies. JAMA
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Michels, K. B., Giovannucci, E., Feskanich, D., Willett, W. C.
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Sandhu, M. S., White, I. R., McPherson, K.
(2001). Systematic Review of the Prospective Cohort Studies on Meat Consumption and Colorectal Cancer Risk: A Meta-Analytical Approach. Cancer Epidemiol. Biomarkers Prev.
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