Dietary Fibre Intake and Risks of Cancers of the Colon and Rectum in the European Prospective Investigation into Cancer and Nutrition (EPIC)
by Neil Murphy, Teresa Norat, Pietro Ferrari, Mazda Jenab, Bas Bueno-de-Mesquita, Guri Skeie, Christina C. Dahm, Kim Overvad, Anja Olsen, Anne Tjønneland, Françoise Clavel-Chapelon, Marie Christine Boutron-Ruault, Antoine Racine, Rudolf Kaaks, Birgit Teucher, Heiner Boeing, Manuela M. Bergmann, Antonia Trichopoulou, Dimitrios Trichopoulos, Pagona Lagiou, Domenico Palli, Valeria Pala, Salvatore Panico, Rosario Tumino, Paolo Vineis, Peter Siersema, Franzel van Duijnhoven, Petra H. M. Peeters, Anette Hjartaker, Dagrun Engeset, Carlos A. González, Maria-José Sánchez, Miren Dorronsoro, Carmen Navarro, Eva Ardanaz, José R. Quirós, Emily Sonestedt, Ulrika Ericson, Lena Nilsson, Richard Palmqvist, Kay-Tee Khaw, Nick Wareham, Timothy J. Key, Francesca L. Crowe, Veronika Fedirko, Petra A. Wark, Shu-Chun Chuang, Elio Riboli
Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location.
After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79–0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals.
Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention.
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