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JAMA Oncol. 2018 Jan 1;4(1):71-79. doi: 10.1001/jamaoncol.2017.3684.

Fiber Intake and Survival After Colorectal Cancer Diagnosis.

Song M1,2,3, Wu K3, Meyerhardt JA4, Ogino S4,5,6, Wang M5,7, Fuchs CS8,9,10, Giovannucci EL3,5,11, Chan AT1,2,11,12.

Author information

1
Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston.
2
Division of Gastroenterology, Massachusetts General Hospital, Boston.
3
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
4
Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.
5
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
6
Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
7
Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
8
Yale Cancer Center, New Haven, Connecticut.
9
Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
10
Department of Medical Oncology, Smilow Cancer Hospital, New Haven, Connecticut.
11
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
12
Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.

Abstract

Importance:

Although high dietary fiber intake has been associated with a lower risk of colorectal cancer (CRC), it remains unknown whether fiber benefits CRC survivors.

Objective:

To assess the association of postdiagnostic fiber intake with mortality.

Design, Setting, and Participants:

A total of 1575 health care professionals with stage I to III CRC were evaluated in 2 prospective cohorts, Nurses' Health Study and Health Professionals Follow-up Study. Colorectal cancer-specific and overall mortality were determined after adjusting for other potential predictors for cancer survival. The study was conducted from December 23, 2016, to August 23, 2017.

Exposures:

Consumption of total fiber and different sources of fiber and whole grains assessed by a validated food frequency questionnaire between 6 months and 4 years after CRC diagnosis.

Main Outcomes and Measures:

Hazard ratios (HRs) and 95% CIs of CRC-specific and overall mortality after adjusting for other potential predictors for cancer survival.

Results:

Of the 1575 participants, 963 (61.1%) were women; mean (SD) age was 68.6 (8.9) years. During a median of 8 years of follow-up, 773 deaths were documented, including 174 from CRC. High intake of total fiber after diagnosis was associated with lower mortality. The multivariable HR per each 5-g increment in intake per day was 0.78 (95% CI, 0.65-0.93; P = .006) for CRC-specific mortality and 0.86 (95% CI, 0.79-0.93; P < .001) for all-cause mortality. Patients who increased their fiber intake after diagnosis from levels before diagnosis had a lower mortality, and each 5-g/d increase in intake was associated with 18% lower CRC-specific mortality (95% CI, 7%-28%; P = .002) and 14% lower all-cause mortality (95% CI, 8%-19%; P < .001). According to the source of fiber, cereal fiber was associated with lower CRC-specific mortality (HR per 5-g/d increment, 0.67; 95% CI, 0.50-0.90; P = .007) and all-cause mortality (HR, 0.78; 95% CI, 0.68-0.90; P < .001); vegetable fiber was associated with lower all-cause mortality (HR, 0.83; 95% CI, 0.72-0.96; P = .009) but not CRC-specific mortality (HR, 0.82; 95% CI, 0.60-1.13; P = .22); no association was found for fruit fiber. Whole grain intake was associated with lower CRC-specific mortality (HR per 20-g/d increment, 0.72; 95% CI, 0.59-0.88; P = .002), and this beneficial association was attenuated after adjusting for fiber intake (HR, 0.77; 95% CI, 0.62-0.96; P = .02).

Conclusions and Relevance:

Higher fiber intake after the diagnosis of nonmetastatic CRC is associated with lower CRC-specific and overall mortality. Increasing fiber consumption after diagnosis may confer additional benefits to patients with CRC.

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