© 1992 by Oxford University Press
Journal of the National Cancer Institute, Vol. 84, No. 24, 1887-1896,
December 16, 1992
© 1992 Oxford University Press
Dietary Intake of Fiber and Decreased Risk of Cancers of the Colon and Rectum: Evidence From the Combined Analysis of 13 Case-Control Studies
K. A. L'Abbe is a recipient of a National Health Research Scholar Award (Health and Welfare, Canada)
A. B. Miller is a recipient of a National Health Career Scientist Award (Health and Welfare, Canada)
Epidemiology Unit, National Cancer Institute of Canada, Faculty of Medicine, University of Toronto Ontario, Canada
Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada
Unitat d'Epidemiologia i Registre de Cancer de Mallorca, Palma de Mallorca Spain
Department of Pathology, La Plata National University La Plata, Argentina
Institut National de la Santié et de la Recherche Médicale (INSERM) Lyon, France
International Agency for Research on Cancer Lyon, France
Cancer Control Agency of British Columbia, Vancouver, British Columbia Canada
Department of Epidemiology Studies, Ministry of Health, La Plata, Argentina, and Israel Center for Registration of Cancer and Allied Diseases, Ministry of Health Jerusalem, Israel
Chejiang Medical University Hangzhou, People's Republic of China
Department of Surgery, University of Melbourne Victoria, Australia
Department of Community, Occupational and Family Medicine, National University of Singapore San Francisco
Department of Epidemiology and Biostatistics, University of California San Francisco
Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles
Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis
Department of Family and Preventive Medicine, University of Utah Salt Lake City
Department of Epidemiology, Harvard School of Public Health Boston, Mass
Department of Hygiene and Epidemiology, University of Athens Greece
Department of Health Research and Policy, Division of Epidemiology, Stanford University Stanford, Calif
*Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.
Background: Colorectal cancer is a major public health problem in both North America and western Europe, and incidence and mortality rates are rapidly increasing in many previously low-risk countries. It has been hypothesized that increased intakes of fiber, vitamin C, and beta carotene could decrease the risk of colorectal cancer. Purpose: The objective of this study was to examine the effects of fiber, vitamin C, and beta-carotene intakes on colorectal cancer risk in a combined analysis of data from 13 case-control studies previously conducted in populations with differing colorectal cancer rates and dietary practices. The study was designed to estimate risks in the pooled data, to test the consistency of the associations across the studies, and to examine interactions of the effects of the nutrients with cancer site, sex, and age. Methods: Original data records for 5287 case subjects with colorectal cancer and 10470 control subjects without disease were combined. Logistic regression analysis was used to estimate relative risks and confidence intervals for intakes of fiber, vitamin C, and beta carotene, with the effects of study, sex, and age group being adjusted by stratification. Results: Risk decreased as fiber intake increased; relative risks were 0.79, 0.69, 0.63, and 0.53 for the four highest quintiles of intake compared with the lowest quintile (trend, P<.0001). The inverse association with fiber is seen in 12 of the 13 studies and is similar in magnitude for left- and right-sided colon and rectal cancers, for men and for women, and for different age groups. In contrast, after adjustment for fiber intake, only weak inverse associations are seen for the intakes of vitamin C and beta carotene. Conclusion: This analysis provides substantive evidence that intake of fiber-rich foods is inversely related to risk of cancers of both the colon and rectum. Implications: If causality is assumed, we estimate that risk of colorectal cancer in the U.S. population could be reduced about 31% (50000 cases annually) by an average increase in fiber intake from food sources of about 13 g/d, corresponding to an average increase of about 70%. [J Natl Cancer Inst 84:1887–1896, 1992]
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