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Dietary intake of fiber, whole grains and risk of colorectal cancer: An updated analysis according to food sources, tumor location and molecular subtypes in two large US cohorts.
Int J Cancer. 2019 12 01; 145(11):3040-3051.IJ

Abstract

Epidemiologic evidence relating fiber intake to colorectal cancer (CRC) remains inconclusive and data are limited on different food sources of fiber and heterogeneity by tumor subsite and molecular profile. We prospectively followed for CRC incidence 90,869 women from the Nurses' Health Study (1980-2012) and 47,924 men from the Health Professionals Follow-up Study (1986-2012), who completed a validated food frequency questionnaire every 4 years. Cox proportional hazards regression was used to examine the associations with CRC risk for total, cereal, fruit and vegetable fiber and whole grains. We also assessed the associations according to tumor subsites (proximal colon, distal colon and rectum) and molecular markers (microsatellite instability, BRAF mutation, CpG island methylator phenotype and KRAS mutation). We documented 3,178 CRC cases during 3,685,903 person-years of follow-up in the NHS and HPFS. Intake of total dietary fiber was not associated with CRC risk after multivariable adjustment in either women (hazard ratio [HR] comparing extreme deciles, 1.17; 95% CI, 0.92-1.48, ptrend = 0.55) or men (HR, 0.90; 95% CI, 0.67-1.21, ptrend = 0.47). Higher intake of cereal fiber and whole grains was associated with lower CRC risk in men with an HR of 0.75 (95% CI, 0.57-1.00) and 0.72 (95% CI, 0.54-0.96), respectively. No heterogeneity was detected by tumor subsite or molecular markers (pheterogeneity > 0.05). Higher intake of total dietary fiber within the range of a typical American diet is unlikely to substantially reduce CRC risk. The potential benefit of cereal fiber and whole grains in men warrants further confirmation.

Authors+Show Affiliations

Department of Colorectal Surgery, the Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA. Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA. Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.Division of Public Health Sciences, Department of Surgery, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO.Yale Cancer Center, New Haven, CT.Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA. Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA. Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA. Broad Institute of MIT and Harvard, Cambridge, MA.Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Broad Institute of MIT and Harvard, Cambridge, MA. Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA.Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31044426

Citation

He, Xiaosheng, et al. "Dietary Intake of Fiber, Whole Grains and Risk of Colorectal Cancer: an Updated Analysis According to Food Sources, Tumor Location and Molecular Subtypes in Two Large US Cohorts." International Journal of Cancer, vol. 145, no. 11, 2019, pp. 3040-3051.
He X, Wu K, Zhang X, et al. Dietary intake of fiber, whole grains and risk of colorectal cancer: An updated analysis according to food sources, tumor location and molecular subtypes in two large US cohorts. Int J Cancer. 2019;145(11):3040-3051.
He, X., Wu, K., Zhang, X., Nishihara, R., Cao, Y., Fuchs, C. S., Giovannucci, E. L., Ogino, S., Chan, A. T., & Song, M. (2019). Dietary intake of fiber, whole grains and risk of colorectal cancer: An updated analysis according to food sources, tumor location and molecular subtypes in two large US cohorts. International Journal of Cancer, 145(11), 3040-3051. https://doi.org/10.1002/ijc.32382
He X, et al. Dietary Intake of Fiber, Whole Grains and Risk of Colorectal Cancer: an Updated Analysis According to Food Sources, Tumor Location and Molecular Subtypes in Two Large US Cohorts. Int J Cancer. 2019 12 1;145(11):3040-3051. PubMed PMID: 31044426.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary intake of fiber, whole grains and risk of colorectal cancer: An updated analysis according to food sources, tumor location and molecular subtypes in two large US cohorts. AU - He,Xiaosheng, AU - Wu,Kana, AU - Zhang,Xuehong, AU - Nishihara,Reiko, AU - Cao,Yin, AU - Fuchs,Charlie S, AU - Giovannucci,Edward L, AU - Ogino,Shuji, AU - Chan,Andrew T, AU - Song,Mingyang, Y1 - 2019/05/21/ PY - 2018/12/21/received PY - 2019/03/12/revised PY - 2019/03/29/accepted PY - 2019/5/3/pubmed PY - 2020/2/1/medline PY - 2019/5/3/entrez KW - colorectal cancer KW - fiber KW - molecular epidemiology KW - whole grains SP - 3040 EP - 3051 JF - International journal of cancer JO - Int J Cancer VL - 145 IS - 11 N2 - Epidemiologic evidence relating fiber intake to colorectal cancer (CRC) remains inconclusive and data are limited on different food sources of fiber and heterogeneity by tumor subsite and molecular profile. We prospectively followed for CRC incidence 90,869 women from the Nurses' Health Study (1980-2012) and 47,924 men from the Health Professionals Follow-up Study (1986-2012), who completed a validated food frequency questionnaire every 4 years. Cox proportional hazards regression was used to examine the associations with CRC risk for total, cereal, fruit and vegetable fiber and whole grains. We also assessed the associations according to tumor subsites (proximal colon, distal colon and rectum) and molecular markers (microsatellite instability, BRAF mutation, CpG island methylator phenotype and KRAS mutation). We documented 3,178 CRC cases during 3,685,903 person-years of follow-up in the NHS and HPFS. Intake of total dietary fiber was not associated with CRC risk after multivariable adjustment in either women (hazard ratio [HR] comparing extreme deciles, 1.17; 95% CI, 0.92-1.48, ptrend = 0.55) or men (HR, 0.90; 95% CI, 0.67-1.21, ptrend = 0.47). Higher intake of cereal fiber and whole grains was associated with lower CRC risk in men with an HR of 0.75 (95% CI, 0.57-1.00) and 0.72 (95% CI, 0.54-0.96), respectively. No heterogeneity was detected by tumor subsite or molecular markers (pheterogeneity > 0.05). Higher intake of total dietary fiber within the range of a typical American diet is unlikely to substantially reduce CRC risk. The potential benefit of cereal fiber and whole grains in men warrants further confirmation. SN - 1097-0215 UR - https://www.unboundmedicine.com/medline/citation/31044426/Dietary_intake_of_fiber_whole_grains_and_risk_of_colorectal_cancer:_An_updated_analysis_according_to_food_sources_tumor_location_and_molecular_subtypes_in_two_large_US_cohorts_ L2 - https://doi.org/10.1002/ijc.32382 DB - PRIME DP - Unbound Medicine ER -