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Dietary Fibre, Whole Grains, and Risk of Colorectal Cancer: Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

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Review

Dietary Fibre, Whole Grains, and Risk of Colorectal Cancer: Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

Dagfinn Aune et al. BMJ.

Abstract

Objective: To investigate the association between intake of dietary fibre and whole grains and risk of colorectal cancer.

Design: Systematic review and meta-analysis of prospective observational studies.

Data sources: PubMed and several other databases up to December 2010 and the reference lists of studies included in the analysis as well as those listed in published meta-analyses.

Study selection: Prospective cohort and nested case-control studies of dietary fibre or whole grain intake and incidence of colorectal cancer.

Results: 25 prospective studies were included in the analysis. The summary relative risk of developing colorectal cancer for 10 g daily of total dietary fibre (16 studies) was 0.90 (95% confidence interval 0.86 to 0.94, I(2) = 0%), for fruit fibre (n = 9) was 0.93 (0.82 to 1.05, I(2) = 23%), for vegetable fibre (n = 9) was 0.98 (0.91 to 1.06, I(2) = 0%), for legume fibre (n = 4) was 0.62 (0.27 to 1.42, I(2) = 58%), and for cereal fibre (n = 8) was 0.90 (0.83 to 0.97, I(2) = 0%). The summary relative risk for an increment of three servings daily of whole grains (n = 6) was 0.83 (0.78 to 0.89, I(2) = 18%).

Conclusion: A high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. Further studies should report more detailed results, including those for subtypes of fibre and be stratified by other risk factors to rule out residual confounding. Further assessment of the impact of measurement errors on the risk estimates is also warranted.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow chart of publications included in systematic review
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Fig 2 Dose-response analyses between dietary fibre and risk of colorectal cancer. NHS=Nurses’ Health Study; HPFS=Health Professionals Follow-up Study
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Fig 3 Risk of colorectal cancer according to fibre types. NHS=Nurses’ Health Study; HPFS=Health Professionals Follow-up Study
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Fig 4 Dose-response analyses between whole grains and risk of colorectal cancer. NHS=Nurses’ Health Study; HPFS=Health Professionals Follow-up Study

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