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Dietary fibre in food and protection against colorectal cancer
      07/14/03 03:21 PM
HeatherAdministrator

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CardioSource 3 May 2003, Volume 361, Issue 9368 Pages 1496-1501

Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study

Sheila A Bingham a, Nicholas E Day b, Robert Luben b, Pietro Ferrari c, Nadia Slimani c, Teresa Norat c, Françoise Clavel-Chapelon d, Emmanuelle Kesse d, Alexandra Nieters e, Heiner Boeing f, Anne Tjønneland g, Kim Overvad h,i, Carmen Martinez j, Miren Dorronsoro k, Carlos A Gonzalez l, Timothy J Key m, Antonia Trichopoulou n, Androniki Naska n, Paolo Vineis o, Rosario Tumino p, Vittorio Krogh q, H Bas Bueno-de-Mesquita r, Petra HM Peeters s, Göran Berglund t, Göran Hallmans u, Eiliv Lund v, Guri Skeie v, Rudolf Kaaks c and Elio Riboli c *

Abstract
Background Dietary fibre is thought to protect against colorectal cancer but this view has been challenged by recent prospective and intervention studies that showed no protective effect.

Methods
We prospectively examined the association between dietary fibre intake and incidence of colorectal cancer in 519978 individuals aged 25–70 years taking part in the EPIC study, recruited from ten European countries. Participants completed a dietary questionnaire in 1992–98 and were followed up for cancer incidence. Relative risk estimates were obtained from fibre intake, categorised by sex-specific, cohort-wide quintiles, and from linear models relating the hazard ratio to fibre intake expressed as a continuous variable.

Findings
Follow-up consisted of 1939011 person-years, and data for 1065 reported cases of colorectal cancer were included in the analysis. Dietary fibre in foods was inversely related to incidence of large bowel cancer (adjusted relative risk 0·75 [95% CI 0·59–0·95] for the highest versus lowest quintile of intake), the protective effect being greatest for the left side of the colon, and least for the rectum. After calibration with more detailed dietary data, the adjusted relative risk for the highest versus lowest quintile of fibre from food intake was 0·58 (0·41–0·85). No food source of fibre was significantly more protective than others, and non-food supplement sources of fibre were not investigated.

Interpretation
In populations with low average intake of dietary fibre, an approximate doubling of total fibre intake from foods could reduce the risk of colorectal cancer by 40%.

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Affiliations
a MRC Dunn Human Nutrition Unit, Cambridge, UK.
b Strangeways Research Laboratory, University of Cambridge, Cambridge, UK.
c International Agency for Research on Cancer (IARC-WHO), Lyon, France.
d INSERM, U 521, Institut Gustave Roussy, Villejuif, France.
e German Cancer Research Centre, Heidelberg, Germany.
f German Institute of Human Nutrition, Potsdam-Rehbücke, Germany.
g Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
h Department of Clinical Epidemiology, Aalborg Hospital and Aarhus University Hospital, Denmark.
i Department of Epidemiology and Social Medicine, University of Aarhus, Denmark.
j Andalusian School of Public Health, Granada, Spain.
k Department of Public Health of Guipuzkoa, San Sebastian, Spain.
l Catalan Institute of Oncology, Barcelona, Spain.
m Cancer Research UK, Radcliffe Infirmary, Oxford, UK.
n University of Athens Medical School, Greece.
o University of Torino and CPO-Piemonte, Torino, Italy.
p Ragusa Cancer Registry, Sicily, Italy.
q Department of Epidemiology, National Cancer Institute, Milan, Italy.
r National Institute of Public Health and the Environment, Bilthoven, Netherlands.
s Julius Centre for Health Sciences and Primary Care, University Medical Center, Netherlands.
t Malmö Diet and Cancer Study, Lund University, Malmö, Sweden.
u Department of Nutritional Research, University of Umeå, Sweden.
v Institute of Community Medicine, University of Tromsø, Norway.
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* Correspondence to: Dr Elio Riboli, Unit of Nutrition and Cancer, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert-Thomas, 69372 Lyon cedex 08, France

Source


Elsevier Science Inc.



© 2003 Elsevier Science Ltd

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