Dietary Intake of Fiber and Decreased Risk of Cancers of the Colon and Rectum: Evidence From the Combined Analysis of 13 Case-Control Studies
Identifieur interne : 002E06 ( Istex/Corpus ); précédent : 002E05; suivant : 002E07Dietary Intake of Fiber and Decreased Risk of Cancers of the Colon and Rectum: Evidence From the Combined Analysis of 13 Case-Control Studies
Auteurs : Geoffrey R. Howe ; Enrique Benito ; Roberto Castelleto ; Jacqueline Cornée ; Jacques Estève ; Richard P. Gallagher ; José M. Iscovich ; Jiao Deng-Ao ; Rudolf Kaaks ; Gabriel A. Kune ; Susan Kune ; Kristan A. L'Abbé ; Hin P. Lee ; Marion Lee ; Anthony B. Miller ; Ruth K. Peters ; John D. Potter ; Elio Riboli ; Martha L. Slattery ; Dimitrios Trichopoulos ; Albert Tuyns ; Anastasia Tzonou ; Alice S. Whittemore ; Anna H. Wu-Williams ; Zheng ShuSource :
- JNCI: Journal of the National Cancer Institute [ 0027-8874 ] ; 1992-12-16.
Abstract
Background: Colorectal cancer is a major public health problem in both North America and western Europe, and incidence and mortality rates are rapidly increasing in many previously low-risk countries. It has been hypothesized that increased intakes of fiber, vitamin C, and beta carotene could decrease the risk of colorectal cancer. Purpose: The objective of this study was to examine the effects of fiber, vitamin C, and beta-carotene intakes on colorectal cancer risk in a combined analysis of data from 13 case-control studies previously conducted in populations with differing colorectal cancer rates and dietary practices. The study was designed to estimate risks in the pooled data, to test the consistency of the associations across the studies, and to examine interactions of the effects of the nutrients with cancer site, sex, and age. Methods: Original data records for 5287 case subjects with colorectal cancer and 10470 control subjects without disease were combined. Logistic regression analysis was used to estimate relative risks and confidence intervals for intakes of fiber, vitamin C, and beta carotene, with the effects of study, sex, and age group being adjusted by stratification. Results: Risk decreased as fiber intake increased; relative risks were 0.79, 0.69, 0.63, and 0.53 for the four highest quintiles of intake compared with the lowest quintile (trend, P<.0001). The inverse association with fiber is seen in 12 of the 13 studies and is similar in magnitude for left- and right-sided colon and rectal cancers, for men and for women, and for different age groups. In contrast, after adjustment for fiber intake, only weak inverse associations are seen for the intakes of vitamin C and beta carotene. Conclusion: This analysis provides substantive evidence that intake of fiber-rich foods is inversely related to risk of cancers of both the colon and rectum. Implications: If causality is assumed, we estimate that risk of colorectal cancer in the U.S. population could be reduced about 31% (50000 cases annually) by an average increase in fiber intake from food sources of about 13 g/d, corresponding to an average increase of about 70%. [J Natl Cancer Inst 84:1887–1896, 1992]
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DOI: 10.1093/jnci/84.24.1887
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Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</mods:affiliation></affiliation></author><author><name sortKey="Benito, Enrique" sort="Benito, Enrique" uniqKey="Benito E" first="Enrique" last="Benito">Enrique Benito</name><affiliation><mods:affiliation>Unitat d'Epidemiologia i Registre de Cancer de Mallorca, Palma de Mallorca Spain</mods:affiliation></affiliation></author><author><name sortKey="Castelleto, Roberto" sort="Castelleto, Roberto" uniqKey="Castelleto R" first="Roberto" last="Castelleto">Roberto Castelleto</name><affiliation><mods:affiliation>Department of Pathology, La Plata National University La Plata, Argentina</mods:affiliation></affiliation></author><author><name sortKey="Cornee, Jacqueline" sort="Cornee, Jacqueline" uniqKey="Cornee J" first="Jacqueline" last="Cornée">Jacqueline Cornée</name><affiliation><mods:affiliation>Institut National de la Santié et de la Recherche Médicale (INSERM) Lyon, France</mods:affiliation></affiliation></author><author><name sortKey="Esteve, Jacques" sort="Esteve, Jacques" uniqKey="Esteve J" first="Jacques" last="Estève">Jacques Estève</name><affiliation><mods:affiliation>International Agency for Research on Cancer Lyon, France</mods:affiliation></affiliation></author><author><name sortKey="Gallagher, Richard P" sort="Gallagher, Richard P" uniqKey="Gallagher R" first="Richard P." last="Gallagher">Richard P. 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Iscovich</name><affiliation><mods:affiliation>Department of Epidemiology Studies, Ministry of Health, La Plata, Argentina, and Israel Center for Registration of Cancer and Allied Diseases, Ministry of Health Jerusalem, Israel</mods:affiliation></affiliation></author><author><name sortKey="Deng Ao, Jiao" sort="Deng Ao, Jiao" uniqKey="Deng Ao J" first="Jiao" last="Deng-Ao">Jiao Deng-Ao</name><affiliation><mods:affiliation>Chejiang Medical University Hangzhou, People's Republic of China</mods:affiliation></affiliation></author><author><name sortKey="Kaaks, Rudolf" sort="Kaaks, Rudolf" uniqKey="Kaaks R" first="Rudolf" last="Kaaks">Rudolf Kaaks</name><affiliation><mods:affiliation>International Agency for Research on Cancer Lyon, France</mods:affiliation></affiliation></author><author><name sortKey="Kune, Gabriel A" sort="Kune, Gabriel A" uniqKey="Kune G" first="Gabriel A." last="Kune">Gabriel A. Kune</name><affiliation><mods:affiliation>Department of Surgery, University of Melbourne Victoria, Australia</mods:affiliation></affiliation></author><author><name sortKey="Kune, Susan" sort="Kune, Susan" uniqKey="Kune S" first="Susan" last="Kune">Susan Kune</name><affiliation><mods:affiliation>Department of Surgery, University of Melbourne Victoria, Australia</mods:affiliation></affiliation></author><author><name sortKey="L Abbe, Kristan A" sort="L Abbe, Kristan A" uniqKey="L Abbe K" first="Kristan A." last="L'Abbé">Kristan A. L'Abbé</name><affiliation><mods:affiliation>K. A. L'Abbe is a recipient of a National Health Research Scholar Award (Health and Welfare, Canada)</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Lee, Hin P" sort="Lee, Hin P" uniqKey="Lee H" first="Hin P." last="Lee">Hin P. Lee</name><affiliation><mods:affiliation>Department of Community, Occupational and Family Medicine, National University of Singapore San Francisco</mods:affiliation></affiliation></author><author><name sortKey="Lee, Marion" sort="Lee, Marion" uniqKey="Lee M" first="Marion" last="Lee">Marion Lee</name><affiliation><mods:affiliation>Department of Epidemiology and Biostatistics, University of California San Francisco</mods:affiliation></affiliation></author><author><name sortKey="Miller, Anthony B" sort="Miller, Anthony B" uniqKey="Miller A" first="Anthony B." last="Miller">Anthony B. Miller</name><affiliation><mods:affiliation>A. B. Miller is a recipient of a National Health Career Scientist Award (Health and Welfare, Canada)</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Peters, Ruth K" sort="Peters, Ruth K" uniqKey="Peters R" first="Ruth K." last="Peters">Ruth K. Peters</name><affiliation><mods:affiliation>Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles</mods:affiliation></affiliation></author><author><name sortKey="Potter, John D" sort="Potter, John D" uniqKey="Potter J" first="John D." last="Potter">John D. Potter</name><affiliation><mods:affiliation>Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis</mods:affiliation></affiliation></author><author><name sortKey="Riboli, Elio" sort="Riboli, Elio" uniqKey="Riboli E" first="Elio" last="Riboli">Elio Riboli</name><affiliation><mods:affiliation>International Agency for Research on Cancer Lyon, France</mods:affiliation></affiliation></author><author><name sortKey="Slattery, Martha L" sort="Slattery, Martha L" uniqKey="Slattery M" first="Martha L." last="Slattery">Martha L. Slattery</name><affiliation><mods:affiliation>Department of Family and Preventive Medicine, University of Utah Salt Lake City</mods:affiliation></affiliation></author><author><name sortKey="Trichopoulos, Dimitrios" sort="Trichopoulos, Dimitrios" uniqKey="Trichopoulos D" first="Dimitrios" last="Trichopoulos">Dimitrios Trichopoulos</name><affiliation><mods:affiliation>Department of Epidemiology, Harvard School of Public Health Boston, Mass</mods:affiliation></affiliation></author><author><name sortKey="Tuyns, Albert" sort="Tuyns, Albert" uniqKey="Tuyns A" first="Albert" last="Tuyns">Albert Tuyns</name><affiliation><mods:affiliation>International Agency for Research on Cancer Lyon, France</mods:affiliation></affiliation></author><author><name sortKey="Tzonou, Anastasia" sort="Tzonou, Anastasia" uniqKey="Tzonou A" first="Anastasia" last="Tzonou">Anastasia Tzonou</name><affiliation><mods:affiliation>Department of Hygiene and Epidemiology, University of Athens Greece</mods:affiliation></affiliation></author><author><name sortKey="Whittemore, Alice S" sort="Whittemore, Alice S" uniqKey="Whittemore A" first="Alice S." last="Whittemore">Alice S. Whittemore</name><affiliation><mods:affiliation>Department of Health Research and Policy, Division of Epidemiology, Stanford University Stanford, Calif</mods:affiliation></affiliation></author><author><name sortKey="Wu Williams, Anna H" sort="Wu Williams, Anna H" uniqKey="Wu Williams A" first="Anna H." last="Wu-Williams">Anna H. Wu-Williams</name><affiliation><mods:affiliation>Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles</mods:affiliation></affiliation></author><author><name sortKey="Shu, Zheng" sort="Shu, Zheng" uniqKey="Shu Z" first="Zheng" last="Shu">Zheng Shu</name><affiliation><mods:affiliation>Chejiang Medical University Hangzhou, People's Republic of China</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:F49BD49F4F14BAA65953EC0999B2054DFD504418</idno><date when="1992" year="1992">1992</date><idno type="doi">10.1093/jnci/84.24.1887</idno><idno type="url">https://api.istex.fr/document/F49BD49F4F14BAA65953EC0999B2054DFD504418/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002E06</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">002E06</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Dietary Intake of Fiber and Decreased Risk of Cancers of the Colon and Rectum: Evidence From the Combined Analysis of 13 Case-Control Studies</title><author><name sortKey="Howe, Geoffrey R" sort="Howe, Geoffrey R" uniqKey="Howe G" first="Geoffrey R." last="Howe">Geoffrey R. Howe</name><affiliation><mods:affiliation>Epidemiology Unit, National Cancer Institute of Canada, Faculty of Medicine, University of Toronto Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</mods:affiliation></affiliation><affiliation><mods:affiliation>*Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</mods:affiliation></affiliation></author><author><name sortKey="Benito, Enrique" sort="Benito, Enrique" uniqKey="Benito E" first="Enrique" last="Benito">Enrique Benito</name><affiliation><mods:affiliation>Unitat d'Epidemiologia i Registre de Cancer de Mallorca, Palma de Mallorca Spain</mods:affiliation></affiliation></author><author><name sortKey="Castelleto, Roberto" sort="Castelleto, Roberto" uniqKey="Castelleto R" first="Roberto" last="Castelleto">Roberto Castelleto</name><affiliation><mods:affiliation>Department of Pathology, La Plata National University La Plata, Argentina</mods:affiliation></affiliation></author><author><name sortKey="Cornee, Jacqueline" sort="Cornee, Jacqueline" uniqKey="Cornee J" first="Jacqueline" last="Cornée">Jacqueline Cornée</name><affiliation><mods:affiliation>Institut National de la Santié et de la Recherche Médicale (INSERM) Lyon, France</mods:affiliation></affiliation></author><author><name sortKey="Esteve, Jacques" sort="Esteve, Jacques" uniqKey="Esteve J" first="Jacques" last="Estève">Jacques Estève</name><affiliation><mods:affiliation>International Agency for Research on Cancer Lyon, France</mods:affiliation></affiliation></author><author><name sortKey="Gallagher, Richard P" sort="Gallagher, Richard P" uniqKey="Gallagher R" first="Richard P." last="Gallagher">Richard P. Gallagher</name><affiliation><mods:affiliation>Cancer Control Agency of British Columbia, Vancouver, British Columbia Canada</mods:affiliation></affiliation></author><author><name sortKey="Iscovich, Jose M" sort="Iscovich, Jose M" uniqKey="Iscovich J" first="José M." last="Iscovich">José M. Iscovich</name><affiliation><mods:affiliation>Department of Epidemiology Studies, Ministry of Health, La Plata, Argentina, and Israel Center for Registration of Cancer and Allied Diseases, Ministry of Health Jerusalem, Israel</mods:affiliation></affiliation></author><author><name sortKey="Deng Ao, Jiao" sort="Deng Ao, Jiao" uniqKey="Deng Ao J" first="Jiao" last="Deng-Ao">Jiao Deng-Ao</name><affiliation><mods:affiliation>Chejiang Medical University Hangzhou, People's Republic of China</mods:affiliation></affiliation></author><author><name sortKey="Kaaks, Rudolf" sort="Kaaks, Rudolf" uniqKey="Kaaks R" first="Rudolf" last="Kaaks">Rudolf Kaaks</name><affiliation><mods:affiliation>International Agency for Research on Cancer Lyon, France</mods:affiliation></affiliation></author><author><name sortKey="Kune, Gabriel A" sort="Kune, Gabriel A" uniqKey="Kune G" first="Gabriel A." last="Kune">Gabriel A. Kune</name><affiliation><mods:affiliation>Department of Surgery, University of Melbourne Victoria, Australia</mods:affiliation></affiliation></author><author><name sortKey="Kune, Susan" sort="Kune, Susan" uniqKey="Kune S" first="Susan" last="Kune">Susan Kune</name><affiliation><mods:affiliation>Department of Surgery, University of Melbourne Victoria, Australia</mods:affiliation></affiliation></author><author><name sortKey="L Abbe, Kristan A" sort="L Abbe, Kristan A" uniqKey="L Abbe K" first="Kristan A." last="L'Abbé">Kristan A. L'Abbé</name><affiliation><mods:affiliation>K. A. L'Abbe is a recipient of a National Health Research Scholar Award (Health and Welfare, Canada)</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Lee, Hin P" sort="Lee, Hin P" uniqKey="Lee H" first="Hin P." last="Lee">Hin P. Lee</name><affiliation><mods:affiliation>Department of Community, Occupational and Family Medicine, National University of Singapore San Francisco</mods:affiliation></affiliation></author><author><name sortKey="Lee, Marion" sort="Lee, Marion" uniqKey="Lee M" first="Marion" last="Lee">Marion Lee</name><affiliation><mods:affiliation>Department of Epidemiology and Biostatistics, University of California San Francisco</mods:affiliation></affiliation></author><author><name sortKey="Miller, Anthony B" sort="Miller, Anthony B" uniqKey="Miller A" first="Anthony B." last="Miller">Anthony B. Miller</name><affiliation><mods:affiliation>A. B. Miller is a recipient of a National Health Career Scientist Award (Health and Welfare, Canada)</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Peters, Ruth K" sort="Peters, Ruth K" uniqKey="Peters R" first="Ruth K." last="Peters">Ruth K. Peters</name><affiliation><mods:affiliation>Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles</mods:affiliation></affiliation></author><author><name sortKey="Potter, John D" sort="Potter, John D" uniqKey="Potter J" first="John D." last="Potter">John D. Potter</name><affiliation><mods:affiliation>Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis</mods:affiliation></affiliation></author><author><name sortKey="Riboli, Elio" sort="Riboli, Elio" uniqKey="Riboli E" first="Elio" last="Riboli">Elio Riboli</name><affiliation><mods:affiliation>International Agency for Research on Cancer Lyon, France</mods:affiliation></affiliation></author><author><name sortKey="Slattery, Martha L" sort="Slattery, Martha L" uniqKey="Slattery M" first="Martha L." last="Slattery">Martha L. Slattery</name><affiliation><mods:affiliation>Department of Family and Preventive Medicine, University of Utah Salt Lake City</mods:affiliation></affiliation></author><author><name sortKey="Trichopoulos, Dimitrios" sort="Trichopoulos, Dimitrios" uniqKey="Trichopoulos D" first="Dimitrios" last="Trichopoulos">Dimitrios Trichopoulos</name><affiliation><mods:affiliation>Department of Epidemiology, Harvard School of Public Health Boston, Mass</mods:affiliation></affiliation></author><author><name sortKey="Tuyns, Albert" sort="Tuyns, Albert" uniqKey="Tuyns A" first="Albert" last="Tuyns">Albert Tuyns</name><affiliation><mods:affiliation>International Agency for Research on Cancer Lyon, France</mods:affiliation></affiliation></author><author><name sortKey="Tzonou, Anastasia" sort="Tzonou, Anastasia" uniqKey="Tzonou A" first="Anastasia" last="Tzonou">Anastasia Tzonou</name><affiliation><mods:affiliation>Department of Hygiene and Epidemiology, University of Athens Greece</mods:affiliation></affiliation></author><author><name sortKey="Whittemore, Alice S" sort="Whittemore, Alice S" uniqKey="Whittemore A" first="Alice S." last="Whittemore">Alice S. Whittemore</name><affiliation><mods:affiliation>Department of Health Research and Policy, Division of Epidemiology, Stanford University Stanford, Calif</mods:affiliation></affiliation></author><author><name sortKey="Wu Williams, Anna H" sort="Wu Williams, Anna H" uniqKey="Wu Williams A" first="Anna H." last="Wu-Williams">Anna H. Wu-Williams</name><affiliation><mods:affiliation>Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles</mods:affiliation></affiliation></author><author><name sortKey="Shu, Zheng" sort="Shu, Zheng" uniqKey="Shu Z" first="Zheng" last="Shu">Zheng Shu</name><affiliation><mods:affiliation>Chejiang Medical University Hangzhou, People's Republic of China</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">JNCI: Journal of the National Cancer Institute</title><idno type="ISSN">0027-8874</idno><idno type="eISSN">1460-2105</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="1992-12-16">1992-12-16</date><biblScope unit="volume">84</biblScope><biblScope unit="issue">24</biblScope><biblScope unit="page" from="1887">1887</biblScope><biblScope unit="page" to="1896">1896</biblScope></imprint><idno type="ISSN">0027-8874</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0027-8874</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Background: Colorectal cancer is a major public health problem in both North America and western Europe, and incidence and mortality rates are rapidly increasing in many previously low-risk countries. It has been hypothesized that increased intakes of fiber, vitamin C, and beta carotene could decrease the risk of colorectal cancer. Purpose: The objective of this study was to examine the effects of fiber, vitamin C, and beta-carotene intakes on colorectal cancer risk in a combined analysis of data from 13 case-control studies previously conducted in populations with differing colorectal cancer rates and dietary practices. The study was designed to estimate risks in the pooled data, to test the consistency of the associations across the studies, and to examine interactions of the effects of the nutrients with cancer site, sex, and age. Methods: Original data records for 5287 case subjects with colorectal cancer and 10470 control subjects without disease were combined. Logistic regression analysis was used to estimate relative risks and confidence intervals for intakes of fiber, vitamin C, and beta carotene, with the effects of study, sex, and age group being adjusted by stratification. Results: Risk decreased as fiber intake increased; relative risks were 0.79, 0.69, 0.63, and 0.53 for the four highest quintiles of intake compared with the lowest quintile (trend, P<.0001). The inverse association with fiber is seen in 12 of the 13 studies and is similar in magnitude for left- and right-sided colon and rectal cancers, for men and for women, and for different age groups. In contrast, after adjustment for fiber intake, only weak inverse associations are seen for the intakes of vitamin C and beta carotene. Conclusion: This analysis provides substantive evidence that intake of fiber-rich foods is inversely related to risk of cancers of both the colon and rectum. Implications: If causality is assumed, we estimate that risk of colorectal cancer in the U.S. population could be reduced about 31% (50000 cases annually) by an average increase in fiber intake from food sources of about 13 g/d, corresponding to an average increase of about 70%. [J Natl Cancer Inst 84:1887–1896, 1992]</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Geoffrey R. Howe</name><affiliations><json:string>Epidemiology Unit, National Cancer Institute of Canada, Faculty of Medicine, University of Toronto Ontario, Canada</json:string><json:string>Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</json:string><json:string>*Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</json:string></affiliations></json:item><json:item><name>Enrique Benito</name><affiliations><json:string>Unitat d'Epidemiologia i Registre de Cancer de Mallorca, Palma de Mallorca Spain</json:string></affiliations></json:item><json:item><name>Roberto Castelleto</name><affiliations><json:string>Department of Pathology, La Plata National University La Plata, Argentina</json:string></affiliations></json:item><json:item><name>Jacqueline Cornée</name><affiliations><json:string>Institut National de la Santié et de la Recherche Médicale (INSERM) Lyon, France</json:string></affiliations></json:item><json:item><name>Jacques Estève</name><affiliations><json:string>International Agency for Research on Cancer Lyon, France</json:string></affiliations></json:item><json:item><name>Richard P. Gallagher</name><affiliations><json:string>Cancer Control Agency of British Columbia, Vancouver, British Columbia Canada</json:string></affiliations></json:item><json:item><name>José M. Iscovich</name><affiliations><json:string>Department of Epidemiology Studies, Ministry of Health, La Plata, Argentina, and Israel Center for Registration of Cancer and Allied Diseases, Ministry of Health Jerusalem, Israel</json:string></affiliations></json:item><json:item><name>Jiao Deng-ao</name><affiliations><json:string>Chejiang Medical University Hangzhou, People's Republic of China</json:string></affiliations></json:item><json:item><name>Rudolf Kaaks</name><affiliations><json:string>International Agency for Research on Cancer Lyon, France</json:string></affiliations></json:item><json:item><name>Gabriel A. Kune</name><affiliations><json:string>Department of Surgery, University of Melbourne Victoria, Australia</json:string></affiliations></json:item><json:item><name>Susan Kune</name><affiliations><json:string>Department of Surgery, University of Melbourne Victoria, Australia</json:string></affiliations></json:item><json:item><name>Kristan A. L'Abbé</name><affiliations><json:string>K. A. L'Abbe is a recipient of a National Health Research Scholar Award (Health and Welfare, Canada)</json:string><json:string>Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada</json:string></affiliations></json:item><json:item><name>Hin P. Lee</name><affiliations><json:string>Department of Community, Occupational and Family Medicine, National University of Singapore San Francisco</json:string></affiliations></json:item><json:item><name>Marion Lee</name><affiliations><json:string>Department of Epidemiology and Biostatistics, University of California San Francisco</json:string></affiliations></json:item><json:item><name>Anthony B. Miller</name><affiliations><json:string>A. B. Miller is a recipient of a National Health Career Scientist Award (Health and Welfare, Canada)</json:string><json:string>Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada</json:string></affiliations></json:item><json:item><name>Ruth K. Peters</name><affiliations><json:string>Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles</json:string></affiliations></json:item><json:item><name>John D. Potter</name><affiliations><json:string>Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis</json:string></affiliations></json:item><json:item><name>Elio Riboli</name><affiliations><json:string>International Agency for Research on Cancer Lyon, France</json:string></affiliations></json:item><json:item><name>Martha L. Slattery</name><affiliations><json:string>Department of Family and Preventive Medicine, University of Utah Salt Lake City</json:string></affiliations></json:item><json:item><name>Dimitrios Trichopoulos</name><affiliations><json:string>Department of Epidemiology, Harvard School of Public Health Boston, Mass</json:string></affiliations></json:item><json:item><name>Albert Tuyns</name><affiliations><json:string>International Agency for Research on Cancer Lyon, France</json:string></affiliations></json:item><json:item><name>Anastasia Tzonou</name><affiliations><json:string>Department of Hygiene and Epidemiology, University of Athens Greece</json:string></affiliations></json:item><json:item><name>Alice S. Whittemore</name><affiliations><json:string>Department of Health Research and Policy, Division of Epidemiology, Stanford University Stanford, Calif</json:string></affiliations></json:item><json:item><name>Anna H. Wu-Williams</name><affiliations><json:string>Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles</json:string></affiliations></json:item><json:item><name>Zheng Shu</name><affiliations><json:string>Chejiang Medical University Hangzhou, People's Republic of China</json:string></affiliations></json:item></author><articleId><json:string>84.24.1887</json:string></articleId><arkIstex>ark:/67375/HXZ-10Q9VDB8-3</arkIstex><language><json:string>unknown</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Background: Colorectal cancer is a major public health problem in both North America and western Europe, and incidence and mortality rates are rapidly increasing in many previously low-risk countries. It has been hypothesized that increased intakes of fiber, vitamin C, and beta carotene could decrease the risk of colorectal cancer. Purpose: The objective of this study was to examine the effects of fiber, vitamin C, and beta-carotene intakes on colorectal cancer risk in a combined analysis of data from 13 case-control studies previously conducted in populations with differing colorectal cancer rates and dietary practices. The study was designed to estimate risks in the pooled data, to test the consistency of the associations across the studies, and to examine interactions of the effects of the nutrients with cancer site, sex, and age. Methods: Original data records for 5287 case subjects with colorectal cancer and 10470 control subjects without disease were combined. Logistic regression analysis was used to estimate relative risks and confidence intervals for intakes of fiber, vitamin C, and beta carotene, with the effects of study, sex, and age group being adjusted by stratification. Results: Risk decreased as fiber intake increased; relative risks were 0.79, 0.69, 0.63, and 0.53 for the four highest quintiles of intake compared with the lowest quintile (trend, P>.0001). The inverse association with fiber is seen in 12 of the 13 studies and is similar in magnitude for left- and right-sided colon and rectal cancers, for men and for women, and for different age groups. In contrast, after adjustment for fiber intake, only weak inverse associations are seen for the intakes of vitamin C and beta carotene. Conclusion: This analysis provides substantive evidence that intake of fiber-rich foods is inversely related to risk of cancers of both the colon and rectum. Implications: If causality is assumed, we estimate that risk of colorectal cancer in the U.S. population could be reduced about 31% (50000 cases annually) by an average increase in fiber intake from food sources of about 13 g/d, corresponding to an average increase of about 70%. [J Natl Cancer Inst 84:1887–1896, 1992]</abstract><qualityIndicators><score>10</score><pdfWordCount>7204</pdfWordCount><pdfCharCount>45899</pdfCharCount><pdfVersion>1.2</pdfVersion><pdfPageCount>10</pdfPageCount><pdfPageSize>599 x 800 pts</pdfPageSize><refBibsNative>false</refBibsNative><abstractWordCount>347</abstractWordCount><abstractCharCount>2207</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Dietary Intake of Fiber and Decreased Risk of Cancers of the Colon and Rectum: Evidence From the Combined Analysis of 13 Case-Control Studies</title><pmid><json:string>1334153</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>JNCI: Journal of the National Cancer Institute</title><language><json:string>unknown</json:string></language><issn><json:string>0027-8874</json:string></issn><eissn><json:string>1460-2105</json:string></eissn><publisherId><json:string>jnci</json:string></publisherId><volume>84</volume><issue>24</issue><pages><first>1887</first><last>1896</last></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>ARTICLES</value></json:item></subject></host><namedEntities><unitex><date><json:string>1992</json:string><json:string>1991</json:string></date><geogName><json:string>Lake City</json:string></geogName><orgName><json:string>Department of Pathology, La Plata National University, La Space</json:string><json:string>Study Argentina Australia I Australia</json:string><json:string>National Cancer Institute of Canada</json:string><json:string>North American Whites</json:string><json:string>Department of Surgery</json:string><json:string>Vancouver Singapore Majorca Los Angeles Utah Years</json:string><json:string>Argentina, and Israel Center for Registration of Cancer and Allied Henderson</json:string><json:string>Medical Research Council, Cambridge, British Columbia, Canada</json:string><json:string>University of Canada</json:string><json:string>Department of Surgery, University of Melbourne, Paffenbarger, Department of Health Research and Policy</json:string><json:string>Gleneagles Hospital, Singapore</json:string><json:string>Canada, United States I, and United States</json:string><json:string>Chejiang Medical University</json:string><json:string>Stanford University</json:string><json:string>Belgium Canada China France Greece North American Chinese Singapore Spain United States I United States</json:string><json:string>University of Hospital, Adelaide, Australia</json:string><json:string>National Health Career Scientist Award</json:string><json:string>Argentina Australia I Australia</json:string><json:string>Department of Epidemiology, Harvard School of Public Health, Boston, Mass</json:string><json:string>National Cancer Institute</json:string><json:string>National Cancer Institute Table</json:string><json:string>Department of Hygiene and Epidemiology</json:string><json:string>Tuyns, International Agency for Bosch</json:string><json:string>Department of Preventive Medicine, Gastroenterology Unit, Hospital Son Dureta, Palma</json:string><json:string>National Health Research Scholar Award</json:string><json:string>University of Southern California, Los Angeles</json:string><json:string>University of Athens, Greece</json:string><json:string>San Martin Hospital, La Plata, Argentina</json:string><json:string>National Cancer Institute of Canada, Faculty of Medicine</json:string><json:string>Department of Preventive Medicine, University of Southern California, Los Angeles</json:string><json:string>Department of Epidemiology Studies, Ministry of Health, England</json:string><json:string>Division of Epidemiology</json:string><json:string>Department of Community, Occupational and Family</json:string><json:string>Department of Community Medicine, Royal Adelaide Medicine, National University of Singapore</json:string><json:string>Cancer Control Agency</json:string><json:string>University of Melbourne</json:string><json:string>Munoz, International Agency</json:string><json:string>Department of Epidemiology and Biostatistics</json:string><json:string>Belgium Canada China France Greece North American Chinese Singapore Spain United States I United States Hf All</json:string><json:string>Netherlands Cancer Institute, Amsterdam</json:string><json:string>University of Utah</json:string><json:string>British University</json:string><json:string>Research on Cancer, Lyon, France</json:string><json:string>National Cancer Institute of Canada, Faculty of Medicine, University of Toronto, Ontario, Canada</json:string><json:string>Department of Health Research and Policy</json:string><json:string>Ministry of Health, Jerusalem, Israel</json:string><json:string>Department of Family and Preventive Medicine</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>N. Chopita</json:string><json:string>Jacqueline Cornee</json:string><json:string>A. Tzonou</json:string><json:string>Rudolf Kaaks</json:string><json:string>A. H. Wu-Williams</json:string><json:string>R. Kaaks</json:string><json:string>E. Benito</json:string><json:string>Unit</json:string><json:string>S. W. Duffy</json:string><json:string>A. Obrador</json:string><json:string>Jacques Esteve</json:string><json:string>L. F. Watson</json:string><json:string>O. Manousos</json:string><json:string>Elio Riboli</json:string><json:string>D. Trichopoulos</json:string><json:string>K. Chen</json:string><json:string>Anastasia Tzonou</json:string><json:string>Anna H. Wu-Williams</json:string><json:string>R. K. Peters</json:string><json:string>Control</json:string><json:string>Alice S. Whittemore</json:string><json:string>A. S. Whittemore</json:string><json:string>Albert Tuyns</json:string><json:string>Geoffrey R. Howe</json:string><json:string>M. C. Pike</json:string><json:string>Jose M. Iscovich</json:string><json:string>A. Stigglebout</json:string><json:string>F. X. J. Esteve</json:string><json:string>T. M. Mack</json:string><json:string>Richard P. Gallagher</json:string><json:string>J. Kaldor</json:string><json:string>P. Lee</json:string><json:string>G. R. Howe</json:string><json:string>Martha L. Slattery</json:string><json:string>A. Jmelnitzsky</json:string><json:string>John D. Potter</json:string><json:string>M. L. Slattery</json:string><json:string>Palma de Mallorca</json:string><json:string>A. Bernedo</json:string><json:string>Ruth K. Peters</json:string><json:string>Roberto Castelleto</json:string><json:string>Dimitrios Trichopoulos</json:string><json:string>E. Riboli</json:string><json:string>H. P. Lee</json:string><json:string>Gabriel A. Kune</json:string><json:string>C. Ling</json:string><json:string>J. Cornee</json:string><json:string>D. Jiao</json:string><json:string>Dr</json:string><json:string>A. Sorenson</json:string><json:string>K. A. L'Abbi</json:string><json:string>Journal</json:string><json:string>Anthony B. Miller</json:string><json:string>X. Wang</json:string><json:string>B. E. La Plata</json:string><json:string>S. Kune</json:string><json:string>A. B. Miller</json:string><json:string>J. Y. Xu</json:string><json:string>K. A. L'AbW</json:string><json:string>Kristan A. L'Abbe</json:string><json:string>R. Castelleto</json:string><json:string>Enrique Benito</json:string><json:string>S. Zheng</json:string><json:string>J. D. Potter</json:string><json:string>L. Gourley</json:string><json:string>M. Jain</json:string><json:string>M. Mulct</json:string><json:string>A. J. McMichael</json:string><json:string>C. Z. Teh</json:string><json:string>G. A. Kune</json:string><json:string>D. Jung</json:string><json:string>R. P. Gallagher</json:string><json:string>J. M. Iscovich</json:string><json:string>M. Lee</json:string><json:string>Susan Kune</json:string></persName><placeName><json:string>Minneapolis</json:string><json:string>Stanford</json:string><json:string>Calgary</json:string><json:string>Singapore</json:string><json:string>Columbia</json:string><json:string>Greece</json:string><json:string>United States</json:string><json:string>Australia</json:string><json:string>Canada</json:string><json:string>Melbourne</json:string><json:string>Hangzhou</json:string><json:string>Argentina</json:string><json:string>Victoria</json:string><json:string>American</json:string><json:string>People's Republic of China</json:string><json:string>Ningbo</json:string><json:string>Vancouver</json:string><json:string>Toronto</json:string><json:string>Europe</json:string><json:string>Los Angeles</json:string><json:string>Athens</json:string><json:string>America</json:string><json:string>San Francisco</json:string><json:string>REDMOND</json:string><json:string>York</json:string><json:string>France</json:string><json:string>Republic of China</json:string><json:string>Calif.</json:string><json:string>Marseille</json:string><json:string>Sweden</json:string><json:string>Spain</json:string><json:string>Lyon</json:string></placeName><ref_url></ref_url><ref_bibl></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/HXZ-10Q9VDB8-3</json:string></ark><categories><wos><json:string>science</json:string><json:string>oncology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>oncology & carcinogenesis</json:string></scienceMetrix><scopus><json:string>1 - Life Sciences</json:string><json:string>2 - Biochemistry, Genetics and Molecular Biology</json:string><json:string>3 - Cancer Research</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Oncology</json:string></scopus></categories><publicationDate>1992</publicationDate><copyrightDate>1992</copyrightDate><doi><json:string>10.1093/jnci/84.24.1887</json:string></doi><id>F49BD49F4F14BAA65953EC0999B2054DFD504418</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/F49BD49F4F14BAA65953EC0999B2054DFD504418/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/F49BD49F4F14BAA65953EC0999B2054DFD504418/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/F49BD49F4F14BAA65953EC0999B2054DFD504418/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Dietary Intake of Fiber and Decreased Risk of Cancers of the Colon and Rectum: Evidence From the Combined Analysis of 13 Case-Control Studies</title><respStmt><resp>Références bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://publisher-list.data.istex.fr">Oxford University Press</publisher><availability><licence><p>© Oxford University Press</p></licence><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M">oup</p></availability><date>1992</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note><note>*Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Dietary Intake of Fiber and Decreased Risk of Cancers of the Colon and Rectum: Evidence From the Combined Analysis of 13 Case-Control Studies</title><author xml:id="author-0000"><persName><forename type="first">Geoffrey R.</forename><surname>Howe</surname></persName><affiliation>Epidemiology Unit, National Cancer Institute of Canada, Faculty of Medicine, University of Toronto Ontario, Canada</affiliation><affiliation>Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</affiliation><affiliation>*Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Enrique</forename><surname>Benito</surname></persName><affiliation>Unitat d'Epidemiologia i Registre de Cancer de Mallorca, Palma de Mallorca Spain</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Roberto</forename><surname>Castelleto</surname></persName><affiliation>Department of Pathology, La Plata National University La Plata, Argentina</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Jacqueline</forename><surname>Cornée</surname></persName><affiliation>Institut National de la Santié et de la Recherche Médicale (INSERM) Lyon, France</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Jacques</forename><surname>Estève</surname></persName><affiliation>International Agency for Research on Cancer Lyon, France</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Richard P.</forename><surname>Gallagher</surname></persName><affiliation>Cancer Control Agency of British Columbia, Vancouver, British Columbia Canada</affiliation></author><author xml:id="author-0006"><persName><forename type="first">José M.</forename><surname>Iscovich</surname></persName><affiliation>Department of Epidemiology Studies, Ministry of Health, La Plata, Argentina, and Israel Center for Registration of Cancer and Allied Diseases, Ministry of Health Jerusalem, Israel</affiliation></author><author xml:id="author-0007"><persName><forename type="first">Jiao</forename><surname>Deng-ao</surname></persName><affiliation>Chejiang Medical University Hangzhou, People's Republic of China</affiliation></author><author xml:id="author-0008"><persName><forename type="first">Rudolf</forename><surname>Kaaks</surname></persName><affiliation>International Agency for Research on Cancer Lyon, France</affiliation></author><author xml:id="author-0009"><persName><forename type="first">Gabriel A.</forename><surname>Kune</surname></persName><affiliation>Department of Surgery, University of Melbourne Victoria, Australia</affiliation></author><author xml:id="author-0010"><persName><forename type="first">Susan</forename><surname>Kune</surname></persName><affiliation>Department of Surgery, University of Melbourne Victoria, Australia</affiliation></author><author xml:id="author-0011"><persName><forename type="first">Kristan A.</forename><surname>L'Abbé</surname></persName><affiliation>K. A. L'Abbe is a recipient of a National Health Research Scholar Award (Health and Welfare, Canada)</affiliation><affiliation>Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada</affiliation></author><author xml:id="author-0012"><persName><forename type="first">Hin P.</forename><surname>Lee</surname></persName><affiliation>Department of Community, Occupational and Family Medicine, National University of Singapore San Francisco</affiliation></author><author xml:id="author-0013"><persName><forename type="first">Marion</forename><surname>Lee</surname></persName><affiliation>Department of Epidemiology and Biostatistics, University of California San Francisco</affiliation></author><author xml:id="author-0014"><persName><forename type="first">Anthony B.</forename><surname>Miller</surname></persName><affiliation>A. B. Miller is a recipient of a National Health Career Scientist Award (Health and Welfare, Canada)</affiliation><affiliation>Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada</affiliation></author><author xml:id="author-0015"><persName><forename type="first">Ruth K.</forename><surname>Peters</surname></persName><affiliation>Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles</affiliation></author><author xml:id="author-0016"><persName><forename type="first">John D.</forename><surname>Potter</surname></persName><affiliation>Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis</affiliation></author><author xml:id="author-0017"><persName><forename type="first">Elio</forename><surname>Riboli</surname></persName><affiliation>International Agency for Research on Cancer Lyon, France</affiliation></author><author xml:id="author-0018"><persName><forename type="first">Martha L.</forename><surname>Slattery</surname></persName><affiliation>Department of Family and Preventive Medicine, University of Utah Salt Lake City</affiliation></author><author xml:id="author-0019"><persName><forename type="first">Dimitrios</forename><surname>Trichopoulos</surname></persName><affiliation>Department of Epidemiology, Harvard School of Public Health Boston, Mass</affiliation></author><author xml:id="author-0020"><persName><forename type="first">Albert</forename><surname>Tuyns</surname></persName><affiliation>International Agency for Research on Cancer Lyon, France</affiliation></author><author xml:id="author-0021"><persName><forename type="first">Anastasia</forename><surname>Tzonou</surname></persName><affiliation>Department of Hygiene and Epidemiology, University of Athens Greece</affiliation></author><author xml:id="author-0022"><persName><forename type="first">Alice S.</forename><surname>Whittemore</surname></persName><affiliation>Department of Health Research and Policy, Division of Epidemiology, Stanford University Stanford, Calif</affiliation></author><author xml:id="author-0023"><persName><forename type="first">Anna H.</forename><surname>Wu-Williams</surname></persName><affiliation>Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles</affiliation></author><author xml:id="author-0024"><persName><forename type="first">Zheng</forename><surname>Shu</surname></persName><affiliation>Chejiang Medical University Hangzhou, People's Republic of China</affiliation></author><idno type="istex">F49BD49F4F14BAA65953EC0999B2054DFD504418</idno><idno type="ark">ark:/67375/HXZ-10Q9VDB8-3</idno><idno type="DOI">10.1093/jnci/84.24.1887</idno><idno type="article-id">84.24.1887</idno></analytic><monogr><title level="j">JNCI: Journal of the National Cancer Institute</title><idno type="pISSN">0027-8874</idno><idno type="eISSN">1460-2105</idno><idno type="publisher-id">jnci</idno><idno type="PublisherID-hwp">jnci</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="1992-12-16"></date><biblScope unit="volume">84</biblScope><biblScope unit="issue">24</biblScope><biblScope unit="page" from="1887">1887</biblScope><biblScope unit="page" to="1896">1896</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1992</date></creation><abstract><p>Background: Colorectal cancer is a major public health problem in both North America and western Europe, and incidence and mortality rates are rapidly increasing in many previously low-risk countries. It has been hypothesized that increased intakes of fiber, vitamin C, and beta carotene could decrease the risk of colorectal cancer. Purpose: The objective of this study was to examine the effects of fiber, vitamin C, and beta-carotene intakes on colorectal cancer risk in a combined analysis of data from 13 case-control studies previously conducted in populations with differing colorectal cancer rates and dietary practices. The study was designed to estimate risks in the pooled data, to test the consistency of the associations across the studies, and to examine interactions of the effects of the nutrients with cancer site, sex, and age. Methods: Original data records for 5287 case subjects with colorectal cancer and 10470 control subjects without disease were combined. Logistic regression analysis was used to estimate relative risks and confidence intervals for intakes of fiber, vitamin C, and beta carotene, with the effects of study, sex, and age group being adjusted by stratification. Results: Risk decreased as fiber intake increased; relative risks were 0.79, 0.69, 0.63, and 0.53 for the four highest quintiles of intake compared with the lowest quintile (trend, P<.0001). The inverse association with fiber is seen in 12 of the 13 studies and is similar in magnitude for left- and right-sided colon and rectal cancers, for men and for women, and for different age groups. In contrast, after adjustment for fiber intake, only weak inverse associations are seen for the intakes of vitamin C and beta carotene. Conclusion: This analysis provides substantive evidence that intake of fiber-rich foods is inversely related to risk of cancers of both the colon and rectum. Implications: If causality is assumed, we estimate that risk of colorectal cancer in the U.S. population could be reduced about 31% (50000 cases annually) by an average increase in fiber intake from food sources of about 13 g/d, corresponding to an average increase of about 70%. [J Natl Cancer Inst 84:1887–1896, 1992]</p></abstract><textClass><keywords scheme="Journal Subject"><list><head></head><item><term>ARTICLES</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1992-12-16">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2017-10-6">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/F49BD49F4F14BAA65953EC0999B2054DFD504418/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup, element #text not found" wicri:toSee="no header"><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article">
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<name><surname>Howe</surname><given-names>Geoffrey R.</given-names></name><xref ref-type="aff" rid="au3"></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref>
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<name><surname>Benito</surname><given-names>Enrique</given-names></name><xref ref-type="aff" rid="au5"></xref>
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<contrib contrib-type="author">
<name><surname>Castelleto</surname><given-names>Roberto</given-names></name><xref ref-type="aff" rid="au6"></xref>
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<name><surname>Cornée</surname><given-names>Jacqueline</given-names></name><xref ref-type="aff" rid="au7"></xref>
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<name><surname>Estève</surname><given-names>Jacques</given-names></name><xref ref-type="aff" rid="au8"></xref>
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<name><surname>Gallagher</surname><given-names>Richard P.</given-names></name><xref ref-type="aff" rid="au9"></xref>
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<name><surname>Iscovich</surname><given-names>José M.</given-names></name><xref ref-type="aff" rid="au10"></xref>
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<contrib contrib-type="author">
<name><surname>Deng-ao</surname><given-names>Jiao</given-names></name><xref ref-type="aff" rid="au11"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Kaaks</surname><given-names>Rudolf</given-names></name><xref ref-type="aff" rid="au8"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Kune</surname><given-names>Gabriel A.</given-names></name><xref ref-type="aff" rid="au12"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Kune</surname><given-names>Susan</given-names></name><xref ref-type="aff" rid="au12"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>L'Abbé</surname><given-names>Kristan A.</given-names></name><xref ref-type="aff" rid="au1"></xref><xref ref-type="aff" rid="au4"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Lee</surname><given-names>Hin P.</given-names></name><xref ref-type="aff" rid="au13"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Lee</surname><given-names>Marion</given-names></name><xref ref-type="aff" rid="au14"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Miller</surname><given-names>Anthony B.</given-names></name><xref ref-type="aff" rid="au2"></xref><xref ref-type="aff" rid="au4"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Peters</surname><given-names>Ruth K.</given-names></name><xref ref-type="aff" rid="au15"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Potter</surname><given-names>John D.</given-names></name><xref ref-type="aff" rid="au16"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Riboli</surname><given-names>Elio</given-names></name><xref ref-type="aff" rid="au8"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Slattery</surname><given-names>Martha L.</given-names></name><xref ref-type="aff" rid="au17"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Trichopoulos</surname><given-names>Dimitrios</given-names></name><xref ref-type="aff" rid="au18"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Tuyns</surname><given-names>Albert</given-names></name><xref ref-type="aff" rid="au8"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Tzonou</surname><given-names>Anastasia</given-names></name><xref ref-type="aff" rid="au19"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Whittemore</surname><given-names>Alice S.</given-names></name><xref ref-type="aff" rid="au20"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Wu-Williams</surname><given-names>Anna H.</given-names></name><xref ref-type="aff" rid="au15"></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Shu</surname><given-names>Zheng</given-names></name><xref ref-type="aff" rid="au11"></xref>
</contrib>
<aff id="au1">K. A. L'Abbe is a recipient of a National Health Research Scholar Award (Health and Welfare, Canada)</aff>
<aff id="au2">A. B. Miller is a recipient of a National Health Career Scientist Award (Health and Welfare, Canada)</aff>
<aff id="au3"><institution>Epidemiology Unit, National Cancer Institute of Canada, Faculty of Medicine, University of Toronto</institution> <addr-line>Ontario, Canada</addr-line></aff>
<aff id="au4"><institution>Department of Preventive Medicine and Biostatistics), University of Toronto</institution> <addr-line>Ontario, Canada</addr-line></aff>
<aff id="au5"><institution>Unitat d'Epidemiologia i Registre de Cancer de Mallorca, Palma de Mallorca</institution> <addr-line>Spain</addr-line></aff>
<aff id="au6"><institution>Department of Pathology, La Plata National University</institution> <addr-line>La Plata, Argentina</addr-line></aff>
<aff id="au7"><institution>Institut National de la Santié et de la Recherche Médicale (INSERM)</institution> <addr-line>Lyon, France</addr-line></aff>
<aff id="au8"><institution>International Agency for Research on Cancer</institution> <addr-line>Lyon, France</addr-line></aff>
<aff id="au9"><institution>Cancer Control Agency of British Columbia, Vancouver, British Columbia</institution> <addr-line>Canada</addr-line></aff>
<aff id="au10"><institution>Department of Epidemiology Studies, Ministry of Health, La Plata, Argentina, and Israel Center for Registration of Cancer and Allied Diseases, Ministry of Health</institution> <addr-line>Jerusalem, Israel</addr-line></aff>
<aff id="au11"><institution>Chejiang Medical University</institution> <addr-line>Hangzhou, People's Republic of China</addr-line></aff>
<aff id="au12"><institution>Department of Surgery, University of Melbourne</institution> <addr-line>Victoria, Australia</addr-line></aff>
<aff id="au13"><institution>Department of Community, Occupational and Family Medicine, National University of Singapore</institution> <addr-line>San Francisco</addr-line></aff>
<aff id="au14"><institution>Department of Epidemiology and Biostatistics, University of California</institution> <addr-line>San Francisco</addr-line></aff>
<aff id="au15"><institution>Department of Preventive Medicine, School of Medicine, University of Southern California</institution> <addr-line>Los Angeles</addr-line></aff>
<aff id="au16"><institution>Division of Epidemiology, School of Public Health, University of Minnesota</institution> <addr-line>Minneapolis</addr-line></aff>
<aff id="au17"><institution>Department of Family and Preventive Medicine, University of Utah</institution> <addr-line>Salt Lake City</addr-line></aff>
<aff id="au18"><institution>Department of Epidemiology, Harvard School of Public Health</institution> <addr-line>Boston, Mass</addr-line></aff>
<aff id="au19"><institution>Department of Hygiene and Epidemiology, University of Athens</institution> <addr-line>Greece</addr-line></aff>
<aff id="au20"><institution>Department of Health Research and Policy, Division of Epidemiology, Stanford University</institution> <addr-line>Stanford, Calif</addr-line></aff>
</contrib-group>
<author-notes>
<corresp id="cor1"><sup>*</sup><italic>Correspondence to</italic>: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</corresp>
</author-notes>
<pub-date pub-type="ppub">
<day>16</day>
<month>12</month>
<year>1992</year>
</pub-date>
<volume>84</volume>
<issue>24</issue>
<fpage>1887</fpage>
<lpage>1896</lpage>
<history>
<date date-type="received">
<day>03</day>
<month>6</month>
<year>1992</year>
</date>
<date date-type="rev-recd">
<day>10</day>
<month>9</month>
<year>1992</year>
</date>
<date date-type="accepted">
<day>17</day>
<month>9</month>
<year>1992</year>
</date>
</history>
<copyright-statement>© Oxford University Press</copyright-statement>
<copyright-year>1992</copyright-year>
<abstract>
<p><italic>Background:</italic> Colorectal cancer is a major public health problem in both North America and western Europe, and incidence and mortality rates are rapidly increasing in many previously low-risk countries. It has been hypothesized that increased intakes of fiber, vitamin C, and beta carotene could decrease the risk of colorectal cancer. <italic>Purpose</italic>: The objective of this study was to examine the effects of fiber, vitamin C, and beta-carotene intakes on colorectal cancer risk in a combined analysis of data from 13 case-control studies previously conducted in populations with differing colorectal cancer rates and dietary practices. The study was designed to estimate risks in the pooled data, to test the consistency of the associations across the studies, and to examine interactions of the effects of the nutrients with cancer site, sex, and age. <italic>Methods</italic>: Original data records for 5287 case subjects with colorectal cancer and 10470 control subjects without disease were combined. Logistic regression analysis was used to estimate relative risks and confidence intervals for intakes of fiber, vitamin C, and beta carotene, with the effects of study, sex, and age group being adjusted by stratification. <italic>Results</italic>: Risk decreased as fiber intake increased; relative risks were 0.79, 0.69, 0.63, and 0.53 for the four highest quintiles of intake compared with the lowest quintile (trend, <italic>P</italic><.0001). The inverse association with fiber is seen in 12 of the 13 studies and is similar in magnitude for left- and right-sided colon and rectal cancers, for men and for women, and for different age groups. In contrast, after adjustment for fiber intake, only weak inverse associations are seen for the intakes of vitamin C and beta carotene. <italic>Conclusion</italic>: This analysis provides substantive evidence that intake of fiber-rich foods is inversely related to risk of cancers of both the colon and rectum. <italic>Implications</italic>: If causality is assumed, we estimate that risk of colorectal cancer in the U.S. population could be reduced about 31% (50000 cases annually) by an average increase in fiber intake from food sources of about 13 g/d, corresponding to an average increase of about 70%. [J Natl Cancer Inst 84:1887–1896, 1992]</p>
</abstract>
</article-meta>
</front>
</article>
</istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Dietary Intake of Fiber and Decreased Risk of Cancers of the Colon and Rectum: Evidence From the Combined Analysis of 13 Case-Control Studies</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Dietary Intake of Fiber and Decreased Risk of Cancers of the Colon and Rectum: Evidence From the Combined Analysis of 13 Case-Control Studies</title></titleInfo><name type="personal"><namePart type="given">Geoffrey R.</namePart><namePart type="family">Howe</namePart><affiliation>Epidemiology Unit, National Cancer Institute of Canada, Faculty of Medicine, University of Toronto Ontario, Canada</affiliation><affiliation>Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</affiliation><affiliation>*Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Enrique</namePart><namePart type="family">Benito</namePart><affiliation>Unitat d'Epidemiologia i Registre de Cancer de Mallorca, Palma de Mallorca Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Roberto</namePart><namePart type="family">Castelleto</namePart><affiliation>Department of Pathology, La Plata National University La Plata, Argentina</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jacqueline</namePart><namePart type="family">Cornée</namePart><affiliation>Institut National de la Santié et de la Recherche Médicale (INSERM) Lyon, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jacques</namePart><namePart type="family">Estève</namePart><affiliation>International Agency for Research on Cancer Lyon, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Richard P.</namePart><namePart type="family">Gallagher</namePart><affiliation>Cancer Control Agency of British Columbia, Vancouver, British Columbia Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">José M.</namePart><namePart type="family">Iscovich</namePart><affiliation>Department of Epidemiology Studies, Ministry of Health, La Plata, Argentina, and Israel Center for Registration of Cancer and Allied Diseases, Ministry of Health Jerusalem, Israel</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jiao</namePart><namePart type="family">Deng-ao</namePart><affiliation>Chejiang Medical University Hangzhou, People's Republic of China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rudolf</namePart><namePart type="family">Kaaks</namePart><affiliation>International Agency for Research on Cancer Lyon, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gabriel A.</namePart><namePart type="family">Kune</namePart><affiliation>Department of Surgery, University of Melbourne Victoria, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Susan</namePart><namePart type="family">Kune</namePart><affiliation>Department of Surgery, University of Melbourne Victoria, Australia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kristan A.</namePart><namePart type="family">L'Abbé</namePart><affiliation>K. A. L'Abbe is a recipient of a National Health Research Scholar Award (Health and Welfare, Canada)</affiliation><affiliation>Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Hin P.</namePart><namePart type="family">Lee</namePart><affiliation>Department of Community, Occupational and Family Medicine, National University of Singapore San Francisco</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Marion</namePart><namePart type="family">Lee</namePart><affiliation>Department of Epidemiology and Biostatistics, University of California San Francisco</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anthony B.</namePart><namePart type="family">Miller</namePart><affiliation>A. B. Miller is a recipient of a National Health Career Scientist Award (Health and Welfare, Canada)</affiliation><affiliation>Department of Preventive Medicine and Biostatistics), University of Toronto Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ruth K.</namePart><namePart type="family">Peters</namePart><affiliation>Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">John D.</namePart><namePart type="family">Potter</namePart><affiliation>Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elio</namePart><namePart type="family">Riboli</namePart><affiliation>International Agency for Research on Cancer Lyon, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Martha L.</namePart><namePart type="family">Slattery</namePart><affiliation>Department of Family and Preventive Medicine, University of Utah Salt Lake City</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Dimitrios</namePart><namePart type="family">Trichopoulos</namePart><affiliation>Department of Epidemiology, Harvard School of Public Health Boston, Mass</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Albert</namePart><namePart type="family">Tuyns</namePart><affiliation>International Agency for Research on Cancer Lyon, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anastasia</namePart><namePart type="family">Tzonou</namePart><affiliation>Department of Hygiene and Epidemiology, University of Athens Greece</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alice S.</namePart><namePart type="family">Whittemore</namePart><affiliation>Department of Health Research and Policy, Division of Epidemiology, Stanford University Stanford, Calif</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anna H.</namePart><namePart type="family">Wu-Williams</namePart><affiliation>Department of Preventive Medicine, School of Medicine, University of Southern California Los Angeles</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Zheng</namePart><namePart type="family">Shu</namePart><affiliation>Chejiang Medical University Hangzhou, People's Republic of China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">1992-12-16</dateIssued><copyrightDate encoding="w3cdtf">1992</copyrightDate></originInfo><abstract>Background: Colorectal cancer is a major public health problem in both North America and western Europe, and incidence and mortality rates are rapidly increasing in many previously low-risk countries. It has been hypothesized that increased intakes of fiber, vitamin C, and beta carotene could decrease the risk of colorectal cancer. Purpose: The objective of this study was to examine the effects of fiber, vitamin C, and beta-carotene intakes on colorectal cancer risk in a combined analysis of data from 13 case-control studies previously conducted in populations with differing colorectal cancer rates and dietary practices. The study was designed to estimate risks in the pooled data, to test the consistency of the associations across the studies, and to examine interactions of the effects of the nutrients with cancer site, sex, and age. Methods: Original data records for 5287 case subjects with colorectal cancer and 10470 control subjects without disease were combined. Logistic regression analysis was used to estimate relative risks and confidence intervals for intakes of fiber, vitamin C, and beta carotene, with the effects of study, sex, and age group being adjusted by stratification. Results: Risk decreased as fiber intake increased; relative risks were 0.79, 0.69, 0.63, and 0.53 for the four highest quintiles of intake compared with the lowest quintile (trend, P<.0001). The inverse association with fiber is seen in 12 of the 13 studies and is similar in magnitude for left- and right-sided colon and rectal cancers, for men and for women, and for different age groups. In contrast, after adjustment for fiber intake, only weak inverse associations are seen for the intakes of vitamin C and beta carotene. Conclusion: This analysis provides substantive evidence that intake of fiber-rich foods is inversely related to risk of cancers of both the colon and rectum. Implications: If causality is assumed, we estimate that risk of colorectal cancer in the U.S. population could be reduced about 31% (50000 cases annually) by an average increase in fiber intake from food sources of about 13 g/d, corresponding to an average increase of about 70%. [J Natl Cancer Inst 84:1887–1896, 1992]</abstract><note type="author-notes">*Correspondence to: Geoffrey R. Howe, Ph.D., NCIC Epidemiology Unit, University of Toronto, McMurrich Bldg., 3rd Fl., 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8, Canada.</note><relatedItem type="host"><titleInfo><title>JNCI: Journal of the National Cancer Institute</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><topic>ARTICLES</topic></subject><identifier type="ISSN">0027-8874</identifier><identifier type="eISSN">1460-2105</identifier><identifier type="PublisherID">jnci</identifier><identifier type="PublisherID-hwp">jnci</identifier><part><date>1992</date><detail type="volume"><caption>vol.</caption><number>84</number></detail><detail type="issue"><caption>no.</caption><number>24</number></detail><extent unit="pages"><start>1887</start><end>1896</end></extent></part></relatedItem><identifier type="istex">F49BD49F4F14BAA65953EC0999B2054DFD504418</identifier><identifier type="DOI">10.1093/jnci/84.24.1887</identifier><identifier type="ArticleID">84.24.1887</identifier><accessCondition type="use and reproduction" contentType="copyright">© Oxford University Press</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M">oup</recordContentSource><recordOrigin>© Oxford University Press</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/F49BD49F4F14BAA65953EC0999B2054DFD504418/metadata/json</uri></json:item></metadata><annexes><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/F49BD49F4F14BAA65953EC0999B2054DFD504418/annexes/pdf</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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