title: Relationship of diet to risk of colorectal adenoma in men.
abstract: BACKGROUND
  Rates of colorectal cancer in various countries are strongly correlated with per-capita consumption of red meat and animal fat and inversely associated with fiber consumption. There have been few studies, however, of dietary risk factors for colorectal adenomas, which are precursors of cancer.
  
  
  OBJECTIVE
  Our purpose was to determine prospectively the relationship between dietary factors and risk of colorectal adenomas.
  
  
  METHODS
  Using data from the Health Professionals Follow-up Study, we documented 170 cases of adenomas of the left colon or rectum in 7284 male health professionals who completed a food-frequency questionnaire in 1986 and who had a colonoscopy or sigmoidoscopy between 1986 and 1988. Relative risk (RR) of adenoma was determined according to quintiles of nutrient intakes.
  
  
  RESULTS
  After adjustment for total energy intake, saturated fat was positively associated with risk of colorectal adenoma (P for trend = .006); RR for the highest versus the lowest quintile of intake was 2.0 (95% confidence interval [CI] = 1.2-3.2). Dietary fiber was inversely associated with risk of adenoma (P for trend less than .0001); RR for men in the highest versus the lowest quintile was 0.36 (95% CI = 0.22-0.60). All sources of fiber (vegetables, fruits, and grains) were associated with decreased risk of adenoma. For subjects on a high-saturated fat, low-fiber diet, the RR was 3.7 (95% CI = 1.5-8.8) compared with those on a low-saturated fat, high-fiber diet. The ratio of the intake of red meat to the intake of chicken and fish was positively associated with risk of adenoma (P for trend = .02).
  
  
  CONCLUSIONS
  These prospective data provide evidence for the hypothesis that a diet high in saturated fat and low in fiber increases the risk of colorectal adenoma. They also support existing recommendations to substitute chicken and fish for red meat in the diet and to increase intake of vegetables, fruits, and grains to reduce risk of colorectal cancer.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, Mass. 02115.
authors.forename: E
authors.initials: E
authors.lastname: Giovannucci
authors.forename: M J
authors.initials: MJ
authors.lastname: Stampfer
authors.forename: G
authors.initials: G
authors.lastname: Colditz
authors.forename: E B
authors.initials: EB
authors.lastname: Rimm
authors.forename: W C
authors.initials: WC
authors.lastname: Willett
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D003111:Colonic Polyps / Q000453:epidemiology / Q000209:etiology*; D003113:Colonoscopy; D004041:Dietary Fats / Q000008:administration & dosage* / Q000009:adverse effects; D004043:Dietary Fiber / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008460:Meat; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D004041:Dietary Fats; D004043:Dietary Fiber