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Multicenter Study
. 2012;7(6):e39361.
doi: 10.1371/journal.pone.0039361. Epub 2012 Jun 22.

Dietary Fibre Intake and Risks of Cancers of the Colon and Rectum in the European Prospective Investigation Into Cancer and Nutrition (EPIC)

Free PMC article
Multicenter Study

Dietary Fibre Intake and Risks of Cancers of the Colon and Rectum in the European Prospective Investigation Into Cancer and Nutrition (EPIC)

Neil Murphy et al. PLoS One. .
Free PMC article


Background: Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location.

Methodology/principal findings: After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals.

Conclusions/significance: Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.


Figure 1
Figure 1. Multivariable hazard ratios and 95% confidence intervals of colorectal cancer risk by country, per 10 g/day increase in total dietary fibre intake.
Hazard ratios were estimated by Cox proportional hazard models adjusted for total energy intake (continuous), body mass index (continuous), physical activity index (inactive, moderately inactive, moderately active, active, or missing), smoking status and intensity (never; current, 1–15 cigarettes per day; current, 16–25 cigarettes per day; current, 16+ cigarettes per day; former, quit ≤10 years; former, quit 11–20 years; former, quit 20+ years; current, pipe/cigar/occasional; current/former, missing; unknown), education status (none, primary school completed, technical/professional school, secondary school, longer education including university, or not specified), ever use of contraceptive pill (yes, no, or unknown), ever use of menopausal hormone therapy (yes, no, or unknown), menopausal status (premenopausal, postmenopausal, perimenopausal/unknown menopausal status, or surgical postmenopausal), and intakes of alcohol, folate, red and processed meat, and calcium (all continuous), and stratified by age (1-year categories), sex, and centre. *Uncalibrated model shown.

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