© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 7, 525-533,
April 4, 2001
© 2001 Oxford University Press
Fruit, Vegetables, Dietary Fiber, and Risk of Colorectal Cancer
Affiliations of authors: P. Terry, Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden, and Division of Epidemiology, Columbia-Presbyterian Medical Center, New York, NY; E. Giovannucci, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; K. B. Michels, Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health, Boston; L. Bergkvist, Department of Surgery and Center for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden; H. Hansen, Department of Community Medicine, University of Connecticut Health Center, Farmington; L. Holmberg, Regional Oncologic Center, Uppsala, Sweden; A. Wolk, Department of Medical Epidemiology, Karolinska Institutet.
Correspondence to: Paul Terry, M.P.H., Department of Medical Epidemiology, Karolinska Institute, Box 281, SE-171 77 Stockholm, Sweden (e-mail: paul.terry{at}mep.ki.se).
Background: Several recent large prospective cohort studies have failed to demonstrate the presumed protective effect of fruit, vegetable, and dietary fiber consumption on colorectal cancer risk. To further explore this issue, we have examined these associations in a population that consumes relatively low amounts of fruit and vegetables and high amounts of cereals. Methods: We examined data obtained from a food-frequency questionnaire used in a population-based prospective mammography screening study of women in central Sweden. Women with colorectal cancer diagnosed through December 31, 1998, were identified by linkage to regional cancer registries. Cox proportional hazards models were used to estimate relative risks. All statistical tests were two-sided. Results: During an average 9.6 years of follow-up of 61 463 women, we observed 460 incident cases of colorectal cancer (291 colon cancers, 159 rectal cancers, and 10 cancers at both sites). In the entire study population, total fruit and vegetable consumption was inversely associated with colorectal cancer risk. Subanalyses showed that this association was due largely to fruit consumption. The association was stronger, however, and the dose–response effect was more evident among individuals who consumed the lowest amounts of fruit and vegetables. Individuals who consumed less than 1.5 servings of fruit and vegetables per day had a relative risk for developing colorectal cancer of 1.65 (95% confidence interval = 1.23 to 2.20; Ptrend = .001) compared with individuals who consumed more than 2.5 servings. We observed no association between colorectal cancer risk and the consumption of cereal fiber, even at amounts substantially greater than previously examined, or of non-cereal fiber. Conclusions: Individuals who consume very low amounts of fruit and vegetables have the greatest risk of colorectal cancer. Relatively high consumption of cereal fiber does not appear to lower the risk of colorectal cancer.
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