Abstract
Objective: Although animal studies suggest an inverse association between consumption of plant foods and risk of colorectal cancer, many observational data have failed to support such an association. We prospectively examined the association between dietary intakes of fruit, vegetables, and fiber and colorectal cancer risk in a large female cohort from the Women’s Health Study.
Methods: Among 39,876 healthy women aged ≥45 years at baseline, 36,976 with baseline self-reported information on dietary intakes and other risk factors for colorectal cancer were included in the analyses. During an average follow-up of 10 years, 223 women were diagnosed with colorectal cancer. Intakes of fruit, vegetables, and fiber were assessed by a baseline food-frequency questionnaire. The analyses were carried out using the Cox proportional hazards regression and all tests were two-sided.
Results: Intakes of fruit, vegetables, and the specific subgroups were not found to be associated with colorectal cancer risk. Multivariate relative risks (RRs) comparing the highest with lowest quintile were 0.79 (95% CI = 0.49–1.27,pfor trend = 0.30) for fruit intake, and 0.88 (95% CI=0.56–1.38,pfor trend=0.30) for vegetables intake. Similarly, intake of total fiber was not associated with colorectal cancer risk; the RR for the highest relative to lowest quintile was 0.75 (95% CI=0.48–1.17,pfor trend=0.12). However, higher intake of legume fiber was associated with a lower risk of colorectal cancer; the RR for the highestversuslowest quintile was 0.60 (95% CI=0.40–0.91,pfor trend=0.02).
Conclusions: Our data offer little support for associations between intakes of fruit, vegetables, and fiber, and colorectal cancer risk. However, our data suggest that legume fiber and/or other related sources may reduce risk of colorectal cancer.
Similar content being viewed by others
References
DJ Kim DH Shin B Ahn et al. (2003) ArticleTitleChemoprevention of colon cancer by Korean food plant components Mutat Res 523-524 99–107 Occurrence Handle1:CAS:528:DC%2BD3sXhs1Cntbk%3D Occurrence Handle12628507
A Sengupta S Ghosh S Das (2003) ArticleTitleTomato and garlic can modulate azoxymethane-induced colon carcinogenesis in rats Eur J Cancer Prev 12 IssueID3 195–200 Occurrence Handle10.1097/00008469-200306000-00005 Occurrence Handle1:STN:280:DC%2BD3s3kslCrsQ%3D%3D Occurrence Handle12771557
MJ Wargovich (1997) ArticleTitleExperimental evidence for cancer preventive elements in foods Cancer Lett 114 IssueID1–2 11–17 Occurrence Handle10.1016/S0304-3835(97)04616-8 Occurrence Handle1:CAS:528:DyaK2sXit1ehs7o%3D Occurrence Handle9103245
MT Huang EE Deschner HL Newmark ZY Wang TA Ferraro AH Conney (1992) ArticleTitleEffect of dietary curcumin and ascorbyl palmitate on azoxymethanol-induced colonic epithelial cell proliferation and focal areas of dysplasia Cancer Lett 64 IssueID2 117–121 Occurrence Handle10.1016/0304-3835(92)90071-3 Occurrence Handle1:CAS:528:DyaK38XkvV2jsrs%3D Occurrence Handle1611594
PJ Rijken WG Timmer AJ Kooij Particlevan de et al. (1999) ArticleTitleEffect of vegetable and carotenoid consumption on aberrant crypt multiplicity, a surrogate end-point marker for colorectal cancer in azoxymethane-induced rats Carcinogenesis 20 IssueID12 2267–2272 Occurrence Handle10.1093/carcin/20.12.2267 Occurrence Handle1:CAS:528:DC%2BD3cXkt1Sntg%3D%3D Occurrence Handle10590218
B Frei JV Higdon (2003) ArticleTitleAntioxidant activity of tea polyphenols in vivo: evidence from animal studies J Nutr 133 IssueID10 3275S–3284S Occurrence Handle1:CAS:528:DC%2BD3sXotFKrtbo%3D Occurrence Handle14519826
D Kritchevsky (1995) ArticleTitleEpidemiology of fibre, resistant starch and colorectal cancer Eur J Cancer Prev 4 IssueID5 345–352 Occurrence Handle1:STN:280:BymD1Mfkt1w%3D Occurrence Handle7496322
E Giovannucci WC Willett (1994) ArticleTitleDietary factors and risk of colon cancer Ann Med 26 IssueID6 443–452 Occurrence Handle1:STN:280:ByqB3cbot10%3D Occurrence Handle7695871
KA Steinmetz JD Potter (1996) ArticleTitleVegetables, fruit, and cancer prevention: a review J Am Diet Assoc 96 IssueID10 1027–1039 Occurrence Handle10.1016/S0002-8223(96)00273-8 Occurrence Handle1:STN:280:BymH3sfotlQ%3D Occurrence Handle8841165
KB Michels G Edward KJ Joshipura et al. (2000) ArticleTitleProspective study of fruit and vegetable consumption and incidence of colon and rectal cancers J Natl Cancer Inst 92 IssueID21 1740–1752 Occurrence Handle10.1093/jnci/92.21.1740 Occurrence Handle1:STN:280:DC%2BD3M%2Fkt1Gmtw%3D%3D Occurrence Handle11058617
RL Phillips DA Snowdon (1998) ArticleTitleDietary relationships with fatal colorectal cancer among Seventh-Day Adventists J Natl Cancer Inst 74 IssueID2 307–317
PN Singh GE Fraser (1998) ArticleTitleDietary risk factors for colon cancer in a low-risk population Am J Epidemiol 148 IssueID8 761–774 Occurrence Handle1:STN:280:DyaK1M%2FgtVWksg%3D%3D Occurrence Handle9786231
KA Steinmetz LH Kushi RM Bostick AR Folsom JD Potter (1994) ArticleTitleVegetables, fruit, and colon cancer in the Iowa Women’s Health Study Am J Epidemiol 139 IssueID1 1–15 Occurrence Handle8296768
MJ Thun EE Calle MM Namboodiri et al. (1992) ArticleTitleRisk factors for fatal colon cancer in a large prospective study J Natl Cancer Inst 84 IssueID19 1491–1500 Occurrence Handle1:STN:280:ByyD2Mbkt1U%3D Occurrence Handle1433333
ML McCullough AS Robertson A Chao et al. (2003) ArticleTitleA prospective study of whole grains, fruits, vegetables and colon cancer risk Cancer Causes Control 14 IssueID10 959–970 Occurrence Handle10.1023/B:CACO.0000007983.16045.a1 Occurrence Handle14750535
A Shibata A Paganini-Hill RK Ross BE Henderson (1992) ArticleTitleIntake of vegetables, fruits, beta-carotene, vitamin C and vitamin supplements and cancer incidence among the elderly: a prospective study Br J Cancer 66 IssueID4 673–679 Occurrence Handle1:STN:280:ByyD2c%2FpvF0%3D Occurrence Handle1419605
P Terry E Giovannucci KB Michels et al. (2001) ArticleTitleFruit, vegetables, dietary fiber, and risk of colorectal cancer J Natl Cancer Inst 93 IssueID7 525–533
LE Voorrips RA Goldbohm G Poppel Particlevan F Sturmans RJ Hermus PA Brandt Particlevan den (2000) ArticleTitleVegetable and fruit consumption and risks of colon and rectal cancer in a prospective cohort study: The Netherlands Cohort Study on Diet and Cancer Am J Epidemiol 152 IssueID11 1081–1092 Occurrence Handle10.1093/aje/152.11.1081 Occurrence Handle1:STN:280:DC%2BD3M%2FntVGjtQ%3D%3D Occurrence Handle11117618
SA Bingham NE Day R Luben et al. (2003) ArticleTitleDietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study Lancet 361 IssueID9368 1496–1501 Occurrence Handle10.1016/S0140-6736(03)13174-1 Occurrence Handle12737858
U Peters R Sinha N Chatterjee et al. (2003) ArticleTitleDietary fibre and colorectal adenoma in a colorectal cancer early detection programme Lancet 361 IssueID9368 1491–1495 Occurrence Handle10.1016/S0140-6736(03)13173-X Occurrence Handle12737857
CS Fuchs EL Giovannucci GA Colditz et al. (1999) ArticleTitleDietary fiber and the risk of colorectal cancer and adenoma in women N Engl J Med 340 IssueID3 169–176 Occurrence Handle10.1056/NEJM199901213400301 Occurrence Handle1:STN:280:DyaK1M7gtFylsA%3D%3D Occurrence Handle9895396
KA Steinmetz JD Potter (1993) ArticleTitleFood-group consumption and colon cancer in the Adelaide Case–control Study. II. Meat, poultry, seafood, dairy foods and eggs Int J Cancer 53 IssueID5 720–727 Occurrence Handle1:STN:280:ByyC1MvjvVY%3D Occurrence Handle8449595
E Giovannucci EB Rimm MJ Stampfer GA Colditz A Ascherio WC Willett (1994) ArticleTitleIntake of fat, meat, and fiber in relation to risk of colon cancer in men Cancer Res 54 IssueID9 2390–2397 Occurrence Handle1:STN:280:ByuB3MrhslI%3D Occurrence Handle8162586
V Mai A Flood U Peters JV Lacey SuffixJr. C Schairer A Schatzkin (2003) ArticleTitleDietary fibre and risk of colorectal cancer in the Breast Cancer Detection Demonstration Project (BCDDP) follow-up cohort Int J Epidemiol 32 IssueID2 234–239 Occurrence Handle10.1093/ije/dyg052 Occurrence Handle12714542
A Schatzkin E Lanza D Corle et al. (2000) ArticleTitleLack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas.Polyp Prevention Trial Study Group N Engl J Med 342 IssueID16 1149–1155 Occurrence Handle10.1056/NEJM200004203421601 Occurrence Handle1:STN:280:DC%2BD3c3hvVKjsg%3D%3D Occurrence Handle10770979
C Bonithon-Kopp O Kronborg A Giacosa U Rath J Faivre (2000) ArticleTitleCalcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group Lancet 356 IssueID9238 1300–1306 Occurrence Handle10.1016/S0140-6736(00)02813-0 Occurrence Handle1:CAS:528:DC%2BD3cXotVOgt70%3D Occurrence Handle11073017
DS Alberts ME Martinez DJ Roe et al. (2000) ArticleTitleLack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas.Phoenix Colon Cancer Prevention Physicians’ Network N Engl J Med 342 IssueID16 1156–1162 Occurrence Handle10.1056/NEJM200004203421602 Occurrence Handle1:STN:280:DC%2BD3c3hvVKjsw%3D%3D Occurrence Handle10770980
KM Rexrode IM Lee NR Cook CH Hennekens JE Buring (2000) ArticleTitleBaseline characteristics of participants in the Women’s Health Study J Womens Health Gend Based Med 9 IssueID1 19–27 Occurrence Handle10.1089/152460900318911 Occurrence Handle1:STN:280:DC%2BD3c7otFChuw%3D%3D Occurrence Handle10718501
U.S. Department of Agriculture ARS. USDA Nutrient DataBase for Standard Reference, Release 10: Nutrient Data Laboratory Home Page, http://www.nal.usda.gov/fnic/foodcomp, (1993).
L Prosky NG Asp I Furda JW DeVries TF Schweizer BF Harland (1985) ArticleTitleDetermination of total dietary fiber in foods and food products: collaborative study J Assoc Off Anal Chem 68 IssueID4 677–679 Occurrence Handle1:STN:280:BiqB1cfptVI%3D Occurrence Handle2993226
L Prosky NG Asp TF Schweizer JW DeVries I Furda (1988) ArticleTitleDetermination of insoluble, soluble, and total dietary fiber in foods and food products: interlaboratory study J Assoc Off Anal Chem 71 IssueID5 1017–1023 Occurrence Handle1:CAS:528:DyaL1cXlvVyqs7s%3D Occurrence Handle2853153
W Willett (1998) Nutritional Epidemiology EditionNumber2 Oxford University Press New York
S Salvini DJ Hunter L Sampson et al. (1989) ArticleTitleFood-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption Int J Epidemiol 18 IssueID4 858–867 Occurrence Handle1:STN:280:By%2BC2Mzgt1I%3D Occurrence Handle2621022
W Willett M Stampfer NF Chu D Spiegelman M Holmes E Rimm (2001) ArticleTitleAssessment of questionnaire validity for measuring total fat intake using plasma lipid levels as criteria Am J Epidemiol 154 IssueID12 1107–1112 Occurrence Handle1:STN:280:DC%2BD38%2FivFSrtw%3D%3D Occurrence Handle11744515
RJ Landis ER Heyman G.G Koch (1978) ArticleTitleAverage partial association in three-way contingency tables: a review and discussion of alternative tests In Stat Rev 46 237–254
RD. Bock (1975) Multivariate Statistical Methods in Behavioral Research McGraw-Hill New York
S Higginbotham ZF Zhang IM Lee et al. (2004) ArticleTitleDietary glycemic load and risk of colorectal cancer in the Women’s Health Study J Natl Cancer Inst 96 IssueID3 229–233 Occurrence Handle1:CAS:528:DC%2BD2cXhtVKkurk%3D Occurrence Handle14759990
M Sato DJ Ahnen (1992) ArticleTitleRegional variability of colonocyte growth and differentiation in the rat Anat Rec 233 IssueID3 409–414 Occurrence Handle1:STN:280:By2A3cznvVw%3D Occurrence Handle1376970
KA Brackett SF Townsend (1980) ArticleTitleOrganogenesis of the colon in rats J Morphol 163 IssueID2 191–201 Occurrence Handle1:STN:280:Bi%2BC283osFw%3D Occurrence Handle7365799
B Iacopetta (2002) ArticleTitleAre there two sides to colorectal cancer? Int J Cancer 101 IssueID5 403–408 Occurrence Handle1:CAS:528:DC%2BD38Xnt1ehsrw%3D Occurrence Handle12216066
B Trock E Lanza P Greenwald (1990) ArticleTitleDietary fiber, vegetables, and colon cancer: critical review and meta-analyses of the epidemiologic evidence J Natl Cancer Inst 82 IssueID8 650–661 Occurrence Handle1:STN:280:By%2BB3cvlslU%3D Occurrence Handle2157027
E Giovannucci (2002) ArticleTitleModifiable risk factors for colon cancer Gastroenterol Clin North Am 31 IssueID4 925–943 Occurrence Handle10.1016/S0889-8553(02)00057-2 Occurrence Handle12489270
P Pietinen N Malila M Virtanen et al. (1999) ArticleTitleDiet and risk of colorectal cancer in a cohort of Finnish men Cancer Causes Control 10 IssueID5 387–396 Occurrence Handle10.1023/A:1008962219408 Occurrence Handle1:STN:280:DyaK1MvlvVWqsw%3D%3D Occurrence Handle10530608
GR Howe E Benito R Castelleto et al. (1992) ArticleTitleDietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence from the combined analysis of 13 case–control studies J Natl Cancer Inst 84 IssueID24 1887–1896 Occurrence Handle1:STN:280:ByyD1Mrht1M%3D Occurrence Handle1334153
DA Lieberman S Prindiville DG Weiss W Willett (2003) ArticleTitleRisk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals Jama 290 IssueID22 2959–2967 Occurrence Handle10.1001/jama.290.22.2959 Occurrence Handle14665657
SE Fleming AU O’Donnell JA Perman (1985) ArticleTitleInfluence of frequent and long-term bean consumption on colonic function and fermentation Am J Clin Nutr 41 IssueID5 909–918 Occurrence Handle1:CAS:528:DyaL2MXitF2qtrc%3D Occurrence Handle2986447
SA Bingham (1990) ArticleTitleMechanisms and experimental and epidemiological evidence relating dietary fibre (non-starch polysaccharides) and starch to protection against large bowel cancer Proc Nutr Soc 49 IssueID2 153–171 Occurrence Handle1:STN:280:By6D2cngs1A%3D Occurrence Handle2172992
LH Augenlicht JM Mariadason A Wilson et al. (2002) ArticleTitleShort chain fatty acids and colon cancer J Nutr 132 IssueID12 3804S–3808S Occurrence Handle12468628
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lin, J., Zhang, S.M., Cook, N.R. et al. Dietary intakes of fruit, vegetables, and fiber, and risk of colorectal cancer in a prospective cohort of women (United States). Cancer Causes Control 16, 225–233 (2005). https://doi.org/10.1007/s10552-004-4025-1
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10552-004-4025-1