Re: Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies
Dietary fibre, whole grains, and risk of colorectal cancer: Historical perspective, Continental variation & Scientific evidence
Colorectal cancer is the second most common cause of cancer mortality (10.4%) in the UK . Aune et al report up to a 20% reduction if 90g of whole grain is consumed daily. This clearly has significant public health benefits: with 5 year survival rates being less than 50%, the cost of bowel cancer is estimated to be £1.1bn per year (in the UK).
The EPIC study suggests that doubling the amount of dietary fibre from 15g to 35g can reduce the risk of colorectal cancer by 40%, with greatest effect seen on the left colon.
However, Chiu et al suggest that fruit and vegetables are more important for reducing risk due to high concentrations of vitamin C, vitamin E and carotene.
In 2005, Norat et al report up to a 1.71% increase in absolute risk of developing cancer in those with a high intake of red meat, especially processed meat. The incidence of colorectal cancer is <1:100,000 in native Africans compared to 60:100,000 in African Americans.
A western diet (high in saturated fat and low in fibre) has often been implicated for the rising rates of cancer. India, which has one of the lowest rates of colorectal cancer worldwide shows an interesting variation in the geographic distribution of colorectal cancer. The incidence of colorectal cancer in rural areas is almost half that of urban areas and Mohandas et al report a 3% annual increase in Mumbai since 1982.
Rastogi et al looked at cancer rates in Indians residing in UK, USA, Singapore and India. They found that colorectal cancer rates were almost eight times higher in US whites, about three times higher among US and UK Asians than in India, and almost twice as high among Singapore Indians.
1. University of York, news and Events New report examines costs and outcomes of treatment for bowel cancer, 15th oct 2007. http://www.york.ac.uk/news-and-events/news/2007/bowel-cancer/
2. Br J Cancer. 2004 Jan 12;90(1):118-21.Nutrition, lifestyle and colorectal cancer incidence: a prospective investigation of 10998 vegetarians and non-vegetarians in the United Kingdom.Sanjoaquin MA, Appleby PN, Thorogood M, Mann JI, Key TJ.
3. Lancet. 2003 May 3;361(9368):1496-501.
Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study.
Bingham SA, Day NE, Luben R, Ferrari P, Slimani N, Norat T, Clavel-Chapelon F, Kesse E, Nieters A, Boeing H, Tjønneland A, Overvad K, Martinez C, Dorronsoro M, Gonzalez CA, Key TJ, Trichopoulou A, Naska A, Vineis P, Tumino R, Krogh V, Bueno-de-Mesquita HB, Peeters PH, Berglund G, Hallmans G, Lund E, Skeie G, Kaaks R, Riboli E; European Prospective Investigation into Cancer and Nutrition.
4. J Natl Cancer Inst. 2005 Jun 15;97(12):906-16.
Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition.
Norat T, Bingham S, Ferrari P, Slimani N, Jenab M, Mazuir M, Overvad K, Olsen A, Tjønneland A, Clavel F, Boutron-Ruault MC, Kesse E, Boeing H, Bergmann MM, Nieters A, Linseisen J, Trichopoulou A, Trichopoulos D, Tountas Y, Berrino F, Palli D, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Engeset D, Lund E, Skeie G, Ardanaz E, González C, Navarro C, Quirós JR, Sanchez MJ, Berglund G, Mattisson I, Hallmans G, Palmqvist R, Day NE, Khaw KT, Key TJ, San Joaquin M, Hémon B, Saracci R, Kaaks R, Riboli E.
5. Indian J Gastroenterol. 1999 Jul-Sep;18(3):118-21.
Epidemiology of digestive tract cancers in India. V. Large and small bowel.
Mohandas KM, Desai DC.
6. Int J Epidemiol. 2008 Feb;37(1):147-60. Epub 2007 Dec 19.
Cancer incidence rates among South Asians in four geographic regions: India, Singapore, UK and US.
Rastogi T, Devesa S, Mangtani P, Mathew A, Cooper N, Kao R, Sinha R.
7. J Nutr. 2007 Jan;137(1 Suppl):175S-182S.
Why do African Americans get more colon cancer than Native Africans?
O'Keefe SJ, Chung D, Mahmoud N, Sepulveda AR, Manafe M, Arch J, Adada H, van der Merwe T.
Miss Manaswini Choudhary
Medical student
Guy's King's & Thomas's Medical School
London
Mr Rajesh K Choudhary MS FRCS
Associate Specialist(Colorectal)
Department of General Surgery
Darlington Memorial Hospital
Hollyhurst Road
Darlington
DL3 6HX
Rapid Response:
Re: Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies
Dietary fibre, whole grains, and risk of colorectal cancer: Historical perspective, Continental variation & Scientific evidence
Colorectal cancer is the second most common cause of cancer mortality (10.4%) in the UK . Aune et al report up to a 20% reduction if 90g of whole grain is consumed daily. This clearly has significant public health benefits: with 5 year survival rates being less than 50%, the cost of bowel cancer is estimated to be £1.1bn per year (in the UK).
The EPIC study suggests that doubling the amount of dietary fibre from 15g to 35g can reduce the risk of colorectal cancer by 40%, with greatest effect seen on the left colon.
However, Chiu et al suggest that fruit and vegetables are more important for reducing risk due to high concentrations of vitamin C, vitamin E and carotene.
In 2005, Norat et al report up to a 1.71% increase in absolute risk of developing cancer in those with a high intake of red meat, especially processed meat. The incidence of colorectal cancer is <1:100,000 in native Africans compared to 60:100,000 in African Americans.
A western diet (high in saturated fat and low in fibre) has often been implicated for the rising rates of cancer. India, which has one of the lowest rates of colorectal cancer worldwide shows an interesting variation in the geographic distribution of colorectal cancer. The incidence of colorectal cancer in rural areas is almost half that of urban areas and Mohandas et al report a 3% annual increase in Mumbai since 1982.
Rastogi et al looked at cancer rates in Indians residing in UK, USA, Singapore and India. They found that colorectal cancer rates were almost eight times higher in US whites, about three times higher among US and UK Asians than in India, and almost twice as high among Singapore Indians.
1. University of York, news and Events New report examines costs and outcomes of treatment for bowel cancer, 15th oct 2007. http://www.york.ac.uk/news-and-events/news/2007/bowel-cancer/
2. Br J Cancer. 2004 Jan 12;90(1):118-21.Nutrition, lifestyle and colorectal cancer incidence: a prospective investigation of 10998 vegetarians and non-vegetarians in the United Kingdom.Sanjoaquin MA, Appleby PN, Thorogood M, Mann JI, Key TJ.
3. Lancet. 2003 May 3;361(9368):1496-501.
Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study.
Bingham SA, Day NE, Luben R, Ferrari P, Slimani N, Norat T, Clavel-Chapelon F, Kesse E, Nieters A, Boeing H, Tjønneland A, Overvad K, Martinez C, Dorronsoro M, Gonzalez CA, Key TJ, Trichopoulou A, Naska A, Vineis P, Tumino R, Krogh V, Bueno-de-Mesquita HB, Peeters PH, Berglund G, Hallmans G, Lund E, Skeie G, Kaaks R, Riboli E; European Prospective Investigation into Cancer and Nutrition.
4. J Natl Cancer Inst. 2005 Jun 15;97(12):906-16.
Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition.
Norat T, Bingham S, Ferrari P, Slimani N, Jenab M, Mazuir M, Overvad K, Olsen A, Tjønneland A, Clavel F, Boutron-Ruault MC, Kesse E, Boeing H, Bergmann MM, Nieters A, Linseisen J, Trichopoulou A, Trichopoulos D, Tountas Y, Berrino F, Palli D, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Engeset D, Lund E, Skeie G, Ardanaz E, González C, Navarro C, Quirós JR, Sanchez MJ, Berglund G, Mattisson I, Hallmans G, Palmqvist R, Day NE, Khaw KT, Key TJ, San Joaquin M, Hémon B, Saracci R, Kaaks R, Riboli E.
5. Indian J Gastroenterol. 1999 Jul-Sep;18(3):118-21.
Epidemiology of digestive tract cancers in India. V. Large and small bowel.
Mohandas KM, Desai DC.
6. Int J Epidemiol. 2008 Feb;37(1):147-60. Epub 2007 Dec 19.
Cancer incidence rates among South Asians in four geographic regions: India, Singapore, UK and US.
Rastogi T, Devesa S, Mangtani P, Mathew A, Cooper N, Kao R, Sinha R.
7. J Nutr. 2007 Jan;137(1 Suppl):175S-182S.
Why do African Americans get more colon cancer than Native Africans?
O'Keefe SJ, Chung D, Mahmoud N, Sepulveda AR, Manafe M, Arch J, Adada H, van der Merwe T.
Miss Manaswini Choudhary
Medical student
Guy's King's & Thomas's Medical School
London
Mr Rajesh K Choudhary MS FRCS
Associate Specialist(Colorectal)
Department of General Surgery
Darlington Memorial Hospital
Hollyhurst Road
Darlington
DL3 6HX
Competing interests: No competing interests