Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study.
BACKGROUND
Dietary fibre is thought to protect against colorectal cancer but this view has been challenged by recent prospective and intervention studies that showed no protective effect.


METHODS
We prospectively examined the association between dietary fibre intake and incidence of colorectal cancer in 519978 individuals aged 25-70 years taking part in the EPIC study, recruited from ten European countries. Participants completed a dietary questionnaire in 1992-98 and were followed up for cancer incidence. Relative risk estimates were obtained from fibre intake, categorised by sex-specific, cohort-wide quintiles, and from linear models relating the hazard ratio to fibre intake expressed as a continuous variable.


RESULTS
Follow-up consisted of 1939011 person-years, and data for 1065 reported cases of colorectal cancer were included in the analysis. Dietary fibre in foods was inversely related to incidence of large bowel cancer (adjusted relative risk 0.75 [95% CI 0.59-0.95] for the highest versus lowest quintile of intake), the protective effect being greatest for the left side of the colon, and least for the rectum. After calibration with more detailed dietary data, the adjusted relative risk for the highest versus lowest quintile of fibre from food intake was 0.58 (0.41-0.85). No food source of fibre was significantly more protective than others, and non-food supplement sources of fibre were not investigated.


CONCLUSIONS
In populations with low average intake of dietary fibre, an approximate doubling of total fibre intake from foods could reduce the risk of colorectal cancer by 40%.
MRC Dunn Human Nutrition Unit, Cambridge, UK.
Sheila A
SA
Bingham
Nicholas E
NE
Day
Robert
R
Luben
Pietro
P
Ferrari
Nadia
N
Slimani
Teresa
T
Norat
Françoise
F
Clavel-Chapelon
Emmanuelle
E
Kesse
Alexandra
A
Nieters
Heiner
H
Boeing
Anne
A
Tjønneland
Kim
K
Overvad
Carmen
C
Martinez
Miren
M
Dorronsoro
Carlos A
CA
Gonzalez
Timothy J
TJ
Key
Antonia
A
Trichopoulou
Androniki
A
Naska
Paolo
P
Vineis
Rosario
R
Tumino
Vittorio
V
Krogh
H Bas
HB
Bueno-de-Mesquita
Petra H M
PH
Peeters
Göran
G
Berglund
Göran
G
Hallmans
Eiliv
E
Lund
Guri
G
Skeie
Rudolf
R
Kaaks
Elio
E
Riboli
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000517:prevention & control*; D004043:Dietary Fiber / Q000008:administration & dosage*; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008019:Life Style; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires