© 1996 by Oxford University Press
Journal of the National Cancer Institute, Vol. 88, No. 2, 81-92,
January 17, 1996
© 1996 Oxford University Press
Randomized, Double-Blinded, Placebo-Controlled Study of Effect of Wheat Bran Fiber and Calcium on Fecal Bile Acids in Patients With Resected Adenomatous Colon Polyps
1Department of Medicine and Arizona Cancer Center, University of Arizona Tucson
2Department of Family and Community Medicine and Arizona Cancer Center, University of Arizona Tucson
3Arizona Cancer Center, University of Arizona Tucson
4Departments of Foods and Nutrition, Purdue University Lafayette, IN
5College of Nursing, Arizona State University Tempe
6School of Public Health, University of North Carolina Chapel Hill
7Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ
David S. Alberts, M.D., Arizona Cancer Center, 1515 N. Campbell Ave. Tucson, AZ 85724.
BACKGROUND:: Ongoing epidemiologic and nutritional studies suggest that colorectal carcinogenesis is consistent with complex interactions between genetic susceptibility and environmental and dietary factors. Among the dietary components found to reduce colon cancer risk are high intakes of dietary fiber and calcium.
PURPOSE:: We designed and conducted a randomized, double-blinded, placebo-controlled trial involving supplementation of the customary dietary intake with fiber and calcium and measurements of fecal bile acids to examine the potential mechanisms by which added dietary interventions might reduce colorectal cancer risk.
METHODS:: In a randomized, double-blinded, phase II study, we used a factorial design to measure the effects of dietary wheat bran fiber (2.0 or 13.5 g/day) in the form of cereal and supplemental calcium carbonate (250 or 1500 mg/day elemental calcium) taken as a tablet on fecal bile acid concentrations and excretion rates. Measurements were made at base-line randomization (i.e., after a 3-month placebo run-in period using 2.0 g wheat bran fiber plus 250 mg calcium carbonate) and after 3 and 9 months on treatment in a randomly selected 52-patient subsample of the 95 fully assessable study participants who had a history of colon adenoma resection. Concentrations of fecal bile acids, total, primary (i.e., chenodeoxycholic and cholic), and secondary (i.e., deoxycholic, lithocholic, and ursodeoxycholic), were measured in 72-hour stool samples by gas-liquid chromatography. All P values resulted from two-sided tests.
RESULTS:: All geometric mean fecal bile acid concentrations and excretion rates were lower at 9 months than at 0 months or 3 months on treatment in the high-dose fiber, high-dose calcium, and high-dose fiber/high-dose calcium treatment groups. The high-dose fiber effect at 9 months of supplementation was statistically significant with respect to virtually all geometric mean fecal bile acid concentrations and excretion rates. For example at 9 months versus 0 months, high-dose fiber supplementation caused a reduction in fecal concentrations of total bile acids (52% reduction; P = .001) and deoxycholic acid (48% reduction; P = .003). High-dose calcium supplementation also had a significant, but lower, effect at 9 months versus 0 months on the geometric mean total bile acid (35% reduction; P = .044) and deoxycholic fecal bile acid (36% reduction; P = .052) concentrations.
CONCLUSIONS:: High-dose wheat bran fiber and calcium carbonate supplements given for 9 months are associated with statistically significant reductions in both total and secondary fecal bile acid concentrations and excretion rates in patients with resected colon adenomas. This study supports the hypothesis that one of the important ways in which a high intake of wheat bran fiber and calcium may reduce the risk of colorectal neoplasia and cancer is by reduction of the concentrations of fecal bile acids.
IMPLICATION:: Phase III studies of these agents in the prevention of adenoma recurrence are necessary to confirm this hypothesis and have now been initiated at multiple institutions. [J Natl Cancer Inst 1996; 88: 81–92]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Schatzkin, C. C. Abnet, A. J. Cross, M. Gunter, R. Pfeiffer, M. Gail, U. Lim, and G. Davey-Smith Mendelian Randomization: How It Can--and Cannot--Help Confirm Causal Relations between Nutrition and Cancer Cancer Prevention Research, February 1, 2009; 2(2): 104 - 113. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Oh, W. C. Willett, K. Wu, C. S. Fuchs, and E. L. Giovannucci Calcium and Vitamin D Intakes in Relation to Risk of Distal Colorectal Adenoma in Women Am. J. Epidemiol., May 15, 2007; 165(10): 1178 - 1186. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. S. Alberts, J. G. Einspahr, D. L. Earnest, M. F. Krutzsch, P. Lin, L. M. Hess, D. K. Heddens, D. J. Roe, M. E. Martinez, G. Salen, et al. Fecal Bile Acid Concentrations in a Subpopulation of the Wheat Bran Fiber Colon Polyp Trial Cancer Epidemiol. Biomarkers Prev., March 1, 2003; 12(3): 197 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. T. Jacobs, A. R. Giuliano, D. J. Roe, J. M. Guillen-Rodriguez, L. M. Hess, D. S. Alberts, and M. E. Martinez Intake of Supplemental and Total Fiber and Risk of Colorectal Adenoma Recurrence in the Wheat Bran Fiber Trial Cancer Epidemiol. Biomarkers Prev., September 1, 2002; 11(9): 906 - 914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Peters, K. A. McGlynn, N. Chatterjee, E. Gunter, M. Garcia-Closas, N. Rothman, and R. Sinha Vitamin D, Calcium, and Vitamin D Receptor Polymorphism in Colorectal Adenomas Cancer Epidemiol. Biomarkers Prev., December 1, 2001; 10(12): 1267 - 1274. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Ornish, B. M. Davis, M. Gerber, A. Lowenfels, P. Maisonneuve, R. J. Muller, P. A. Duprey, A. Schatzkin, E. Lanza, L. Freedman, et al. High-Fiber Diet and Colorectal Adenomas N. Engl. J. Med., September 7, 2000; 343(10): 736 - 738. [Full Text]
|
|
|
|
|
|
D. S. Alberts, M. E. Martinez, D. J. Roe, J. M. Guillen-Rodriguez, J. R. Marshall, J. B. van Leeuwen, M. E. Reid, C. Ritenbaugh, P. A. Vargas, A.B. Bhattacharyya, et al. Lack of Effect of a High-Fiber Cereal Supplement on the Recurrence of Colorectal Adenomas N. Engl. J. Med., April 20, 2000; 342(16): 1156 - 1162. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. S. Alberts A Unifying Vision of Cancer Therapy for the 21st Century J. Clin. Oncol., November 1, 1999; 17(90001): 13 - 21. [Full Text] [PDF]
|
|
|
|
|
|
M. E. Martínez, J. R. Marshall, E. Graver, R. C. Whitacre, K. Woolf, C. Ritenbaugh, and D. S. Alberts Reliability and Validity of a Self-Administered Food Frequency Questionnaire in a Chemoprevention Trial of Adenoma Recurrence Cancer Epidemiol. Biomarkers Prev., October 1, 1999; 8(10): 941 - 946. [Abstract] [Full Text]
|
|
|
|
|
|
J.A. Baron, M. Beach, J.S. Mandel, R.U. van Stolk, R.W. Haile, R.S. Sandler, R. Rothstein, R.W. Summers, D.C. Snover, G.J. Beck, et al. Calcium Supplements for the Prevention of Colorectal Adenomas N. Engl. J. Med., January 14, 1999; 340(2): 101 - 107. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.F. Chaplin Review : Bile acids, fibre and colon cancer: the story unfolds Perspectives in Public Health, February 1, 1998; 118(1): 53 - 61. [Abstract]
|
|