Association of Fiber Intake After Colorectal Cancer Diagnosis and Survival

Key Points

  • Higher fiber intake after diagnosis of nonmetastatic colorectal cancer was associated with improved colorectal cancer–specific and overall survival.
  • The benefit appeared to be greatest with a higher intake of cereal fiber.

In a study reported in JAMA Oncology, Song et al found that higher fiber intake after diagnosis of nonmetastatic colorectal cancer is associated with improved colorectal cancer–specific and overall survival. The benefit was also observed with a higher intake of whole grains.

Study Details

The study included 1,575 health-care professionals with stage I to III colorectal cancer from the prospective Nurses’ Health Study (NHS; n = 963) and Health Professionals Follow-up Study (HPFS; n = 612) cohorts. The NHS enrolled 121,700 registered female nurses aged 30 to 55 years in 1976. The HPFS enrolled 51,529 male health-care professionals aged 40 to 75 years in 1986.

Participants received a questionnaire regarding medical history and lifestyle factors at baseline and every 2 years thereafter. Dietary data were collected and updated every 4 years with validated food frequency questionnaires. The current analysis used 1980 for the NHS and 1986 for the HPFS as baselines for data on fiber intake. Follow-up rates were 95.4% in the NHS cohort and 95.9% in the HPFS cohort for each of the questionnaires through 2010. Consumption of total fiber and different sources of fiber and whole grains were assessed between 6 months and 4 years after colorectal cancer diagnosis. The current analysis was performed between December 2016 and August 2017.

Multivariate analysis for colorectal cancer–specific and overall mortality included stratification by age group at diagnosis; sex; cancer stage and adjustment for age at diagnosis; year of diagnosis; tumor grade of differentiation; cancer subsite; prediagnostic fiber intake; postdiagnostic alcohol consumption; pack-years of smoking; body mass index; physical activity (metabolic-equivalent h/wk); regular use of aspirin; glycemic load; and consumption of total fat, folate, calcium, and vitamin D.

Association of Survival and Fiber Intake

Among the 1,575 patients, the mean age was 68.6 years at diagnosis, and 61% were women. Over a median follow-up of 8 years, a total of 773 deaths were documented, with 174 (22.5%) due to colorectal cancer.

On a multivariate analysis, among all patients, higher fiber intake was associated with significantly better colorectal cancer–specific and overall survival, with hazard ratios of 0.78 (P = .006) and 0.86 (P < .001) per each 5-g/d increase in intake, respectively. Patients who increased fiber intake after diagnosis from prediagnosis levels also had significantly improved colorectal cancer–specific and overall survival, with hazard ratios of 0.82 (P = .002) and 0.86 (P < .001) per each 5-g/d increase in intake, respectively.

By the source of fiber, higher cereal fiber intake was associated with lower colorectal cancer–specific mortality (HR per 5-g/d increment = 0.67, P = .007) and all-cause mortality (HR per 5-g/d increment = 0.78, P < .001). Higher intake of vegetable fiber was associated with lower all-cause mortality (HR per 5-g/d increment = 0.83, P = .009) but not colorectal cancer–specific mortality (HR per 5-g/d increment = 0.82, P = .22). Associations with higher intake of fruit fiber were not significant for colorectal cancer–specific mortality (HR per 5-g/d increment = 0.91, P = .58) or all-cause mortality (HR per 5-g/d increment = 0.92, P = .29).

Whole Grain Intake

Increased whole grain intake was associated with lower colorectal cancer–specific mortality (HR per 20-g/d increment = 0.72, P = .002); the risk reduction was attenuated after adjustment for fiber intake in a multivariate analysis (HR = 0.77, P = .02). Higher intake was also associated with lower all-cause mortality (HR per 20-g/d increment = 0.88, P = .008), with the risk reduction being attenuated after adjustment for fiber intake (HR = 0.91, P = .08).

The investigators concluded: “Higher fiber intake after the diagnosis of nonmetastatic [colorectal cancer] is associated with lower [colorectal cancer–] specific and overall mortality. Increasing fiber consumption after diagnosis may confer additional benefits to patients with [colorectal cancer].”

The study was supported by National Institutes of Health grants; an American Association for Cancer Research–AstraZeneca Fellowship in Immuno-oncology research grant; and grants from the American Institute for Cancer Research, Project P Fund for Colorectal Cancer Research, The Friends of the Dana-Farber Cancer Institute, Bennett Family Fund, and the Entertainment Industry Foundation through the National Colorectal Cancer Research Alliance.

Andrew T. Chan, MD, MPH, of the Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, is the corresponding author of the JAMA Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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