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The fibre–folate debate in colo-rectal cancer

Published online by Cambridge University Press:  07 March 2007

Sheila Bingham
Sheila Bingham*
Affiliation:
MRC Dunn Human Nutrition Unit, Wellcome Trust/MRC Building, Hills Road, Cambridge CB2 2XY, UK
*
Corresponding author: Professor Sheila Bingham, fax +44 1223 252765, email [email protected]
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Abstract

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Intervention and prospective studies showing no effect of fibre in protection against colo-rectal cancer have challenged consensus recommendations that population intakes of fibre should be increased to reduce the risk of colo-rectal cancer. The European Prospective Investigation of Cancer and Nutrition (EPIC) of 519 978 individuals aged 25–70 years is the largest prospective study of diet and cancer to date worldwide. It incorporates ten different European countries in order to increase heterogeneity in dietary habits and calibration procedures to reduce measurement error. Data for 1065 reported cases of colo-rectal cancer were reported in 2003. There was a 40% reduction in risk for the highest quintile v. lowest quintile of fibre in food after calibration. It has been suggested that these effects were a result of confounding by folate and other factors. Although there are a number of hypotheses to explain why folate should be protective in colo-rectal cancer, a meta-analysis has shown that folate in food may be protective but there is no effect of total folate (i.e. food plus supplements). In a further analysis of 1826 cases in EPIC, identified in the latest follow-up, the inclusion of an additional 761 cases has confirmed the previously published results, with a strong and significant reduction in colo-rectal cancer of approximately 9% reduction in risk for each uncalibrated quintile increase in fibre (P<0·001 for linear trend) compared with an 8% reduction in the previous report, which had not been adjusted for folate. Inclusion of the other covariates (physical activity, alcohol, smoking and red and processed meat) with folate has confirmed this significant inverse association for colon cancer and strengthened the association with left-sided colon cancer (P<0·001).

Keywords

DietColo-rectal cancerFibreFolate
Type
Symposium on ‘Plant foods and public health’
Information
Proceedings of the Nutrition Society , Volume 65 , Issue 1 , February 2006 , pp. 19 - 23
Copyright
Copyright © The Nutrition Society 2006

References

Agudo, A, Slimani, N, Ocke, MC, Naska, A, Miller, AB, Kroke, A et al. (2002) Consumption of vegetable, fruit and other plant foods in the EPIC cohorts from ten European countries. Public Health Nutrition 5 1179–1196.CrossRefGoogle Scholar
Alberts, DS, Martinez, ME, Roe, DJ, Guillen-Rodriguez, JM, Marshall, JR, van Leeuwen, JB et al. (2000) Lack of effect of a high fibre cereal supplement on the recurrence of colorectal adenomas New England Journal of Medicine 342 1156–1162.CrossRefGoogle ScholarPubMed
Bingham, S (1990) Mechanisms and experimental evidence relating dietary fibre and starch to protection against large bowel cancer. Proceedings of the Nutrition Society 49 153–171.CrossRefGoogle ScholarPubMed
Bingham, SA, Day, NE, Luben, R, Ferrari, P, Slimani, N, Norat, T et al. (2003) Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study Lancet 361 1496–1501.CrossRefGoogle ScholarPubMed
Bingham, SA, Norat, T, Moskal, A, Ferrari, P, Slimani, N, Clavel-Chapelon, F et al. (2005) Is the association with fibre from foods in colorectal cancer confounded by folate intake? Cancer Epidemiology, Biomarkers & Prevention 14 1552–1556.CrossRefGoogle ScholarPubMed
Boffa, LC, Luption, JR, Mariani, MR, Ceppi, M, Newmark, H, Scalmati, A, Lipkin, M (1992) Modulation of colonic cell proliferation, histone acetylation and luminal short chain fatty acids by variation of dietary fibre (wheat bran) in rats. Cancer Research 52 5906–5912.Google ScholarPubMed
Bonithon-Kopp, C, Kronborg, O, Giacosa, A, Rath, U, Faivre, J (2000) Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. Lancet 356 1300–1306.CrossRefGoogle ScholarPubMed
Chai, F, Evdoukiou, A, Young, GP, Zalewski, PD (2000) Involvement of p21 and its cleavage by DEVD-caspase during apoptosis of colorectal cancer cells induced by butyrate. Carcinogenesis 21 7–14.CrossRefGoogle ScholarPubMed
Day, NE, McKeown, N, Wong, MY, Welch, A, Bingham, S (2001) Epidemiological assessment of diet: a comparison of a 7-day diary with a food frequency questionnaire using urinary markers of nitrogen, potassium and sodium. International Journal of Epidemiology 30 309–317.CrossRefGoogle Scholar
Department of Health (1998) Nutritional Aspects of the Development of Cancer. Report on Health and Social Subjects no. 48. London: H. M. Stationery Office.Google Scholar
Domon-Dell, C, Wang, Q, Kim, S, Kedinger, M, Evers, BM, Freund, JN (2002) Stimulation of the intestinal Cdx2 homeobox gene by butyrate in colon cancer cells. Gut 50 525–529.CrossRefGoogle ScholarPubMed
Fuchs, CS, Giovannucci, E, Colditz, GA, Hunter, DJ, Stampfer, MJ, Rosner, B, Speizer, FE, Willett, WC (1999) Dietary fibre and the risk of colorectal cancer and adenoma in women. New England Journal of Medicine 340 169–176.CrossRefGoogle ScholarPubMed
Key, TJ, Fraser, GE, Thorogood, M, Appleby, PN, Beral, V, Reeves, G et al. (1998) Mortality in vegetarians and non-vegetarians: a collaborative analysis of 8300 deaths among 76,000 men and women in five prospective studies. Public Health Nutrition 1 33–41.CrossRefGoogle Scholar
Kim, YI (2004) Folate and DNA methylation: A mechanistic link between folate deficiency and colorectal cancer? Cancer Epidemiology, Biomarkers & Prevention 13 511–519.CrossRefGoogle ScholarPubMed
Kipnis, V, Midthune, D, Freedman, LS, Bingham, S, Schatzkin, A, Subar, A, Carroll, R (2001) Empirical evidence of correlated biases in dietary assessment instruments and its implications. American Journal of Epidemiology 153 394–403.CrossRefGoogle Scholar
Little, J, Sharp, L, Duthie, S & Narayanan, S (2003) Colon cancer and genetic variation in folate metabolism: The clinical bottom line. Journal of Nutrition 133, Suppl. 3758S– 3766S.CrossRefGoogle Scholar
Michels, KB, Fuchs, CS, Giovannucci, E, Colditz, GA, Hunter, DJ, Stampfer, MJ, Willett, WC (2005) Fibre intake and incidence of colorectal cancer among 76,947 women and 47,279 men. Cancer Epidemiology, Biomarkers & Prevention 14 842–849.CrossRefGoogle Scholar
Norat, N, Bingham, S, Ferrari, P, Slimani, N, Jenab, M, Mazuir, M et al. (2005) Meat and fish consumption, and colorectal cancer risk: the European Prospective Investigation into Cancer and Nutrition. Journal of the National Cancer Institute 97 906–916.CrossRefGoogle ScholarPubMed
Papas, MA, Giovannucci, E, Platz, E (2004) Fiber from fruit and colorectal neoplasia. Cancer Epidemiology, Biomarkers & Prevention 13 1267–1270.CrossRefGoogle ScholarPubMed
Pietinen, P, Malila, N, Virtanen, M, Hartman, T, Tangrea, J, Albanes, D, Virtamo, J (1999) Diet and risk of colorectal cancer in a cohort of Finnish men. Cancer Causes and Control 10 387–396.CrossRefGoogle Scholar
Riboli, E, Hunt, KJ, Slimani, N, Ferrari, P, Norat, T, Fahey, M et al. (2002) EPIC: study populations and data collection. Public Health Nutrition 5 1113–1124.CrossRefGoogle Scholar
Riboli, E & Kaaks, R (1997) The EPIC project: Rationale and study design. International Journal of Epidemiology 26, Suppl. 1 S6–S14.CrossRefGoogle ScholarPubMed
Sanjoaquin, MA, Allen, N, Couto, E, Roddam, AW, Key, TJ (2005) Folate intake and colorectal cancer risk: A meta-analytical approach. International Journal of Cancer 113 825–828.CrossRefGoogle Scholar
Schatzkin, A & Kipnis, V (2004) Could exposure assessment problems give us wrong answers to nutrition and cancer questions? Journal of the National Cancer Institute 96 1564–1565.CrossRefGoogle ScholarPubMed
Schatzkin, A, Lanza, E, Corle, D, Lance, P, Iber, F, Caan, B et al. (2000) Lack of effect of low fat high fibre diet on the recurrence of colorectal adenomas. New England Journal of Medicine 342 1149–1155.CrossRefGoogle ScholarPubMed
Slimani, N, Kaaks, R, Ferrari, P, Casagrande, C, Clavel-Chapelon, F, Lotze, G et al. (2002) EPIC Calibration Study: Rationale, design and population characteristics. Public Health Nutrition 5 1125–1146.CrossRefGoogle Scholar
Terry, P, Giovannucci, E, Michels, KB, Bergkvist, L, Hansen, H, Holmberg, L, Wolk, A (2001) Fruit, vegetables, dietary fibre, and risk of colorectal cancer. Journal of the National Cancer Institute 93 525–533.CrossRefGoogle ScholarPubMed
Wirfalt, E, McTaggart, A, Pala, V, Gullberg, B, Frasca, G, Panico, S et al. (2002) Food sources of carbohydrates in a European cohort of adults. Public Health Nutrition 5 1197–1216.CrossRefGoogle Scholar
World Cancer Research Fund/American Institute for Cancer Research (1997) Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: AICR.Google Scholar