© 1990 by Oxford University Press
Journal of the National Cancer Institute, Vol. 82, No. 8, 650-661,
April 18, 1990
© 1990 Oxford University Press
Dietary Fiber, Vegetables, and Colon Cancer: Critical Review and Meta-analyses of the Epidemiologic Evidence
Fox Chase Cancer Center Philadelphia, PA.
Division of Cancer Preventation and Control, National Cancer Institute Bethesda, MD.
*Correspondence to: Bruce Trock, Ph. D., Fox Chase Cancer Center, 510 Township Line Rd., Cheltenham, PA 19012.
Whether colon cancer risk can be modified by a diet rich in vegetables, grains, and fruit, and, if so, whether the protective factor is dietary fiber or other biologically active components correlated with a high-fiber diet are questions of active research interest. Because studies on diet are susceptible to bias from a number of sources, in this review we evaluated the adequacy of study methodology as well as study results to clarify how much protection, if any, is conferred by a high-fiber diet. The review consisted of an aggregate assessment of the strength of evidence from 37 observational epidemiologic studies as well as meta-analyses of data from 16 of the 23 case-control studies. Both types of analyses revealed that the majority of studies gave support for a protective effect associated with fiber-rich diets; an estimated combined odds ratio (OR) of 0.57 (95% confidence interval = 0.50,0.64) was obtained when the highest and lowest quantiles of intake were compared. Risk estimates based on vegetable consumption (OR = 0.48) were only slightly more convincing than those based on an estimate of fiber intake (OR = 0.58), but the data do not permit discrimination between effects due to fiber and nonfiber effects due to vegetables. [J Natl Cancer Inst 82:650–661,1990]
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