Cancer Causes & Control

, Volume 14, Issue 10, pp 959–970 | Cite as

A prospective study of whole grains, fruits, vegetables and colon cancer risk

  • Marjorie L. McCullough
  • Andrea S. Robertson
  • Ann Chao
  • Eric J. Jacobs
  • Meir J. Stampfer
  • David R. Jacobs
  • William R. Diver
  • Eugenia E. Calle
  • Michael J. Thun


Objective: We examined the relation between whole grains, fruit, vegetables and dietary fiber and colon cancer risk in the prospective Cancer Prevention Study II Nutrition Cohort. Methods: In 1992–1993, 62,609 men and 70,554 women completed questionnaires on medical history, diet and lifestyle behaviors. After exclusions, we confirmed 298 cases of incident colon cancer among men and 210 among women through August 31, 1997. Results: Multivariate rate ratios (RR) and 95% confidence intervals (CI) for all dietary factors were null. However, a statistically non-significant 30% reduction in risk was observed for men with the highest vegetable intakes (RR = 0.69, CI = 0.47–1.03, top versus. bottom quintile, p trend = 0.10). Men with very low (lowest tertile within the lowest quintile) intakes of vegetables and dietary fiber were at increased risk compared to those in the highest four quintiles of intake (vegetables RR = 1.79, CI = 1.22–2.61, p trend = 0.04, and fiber RR = 1.96, CI = 1.24–3.10, p trend = 0.006). Women with very low intakes of fruit were also at increased risk (RR = 1.86, CI =1.18–2.94, p trend = 0.06). Conclusions: Higher intakes of plant foods or fiber were not related to lower risk of colon cancer. However, our data suggest that very low intakes of plant foods may increase risk, and that certain phytochemical subgroups may decrease risk.

colon neoplasms diet dietary fiber fruit vegetables whole grains 


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  1. 1.
    Byers T,Nestle M,McTiernan A, et al. (2002) American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 52: 92-119.Google Scholar
  2. 2.
    Michels KB,Giovannucci E,Joshipura KJ, et al. (2000) Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst 92: 1740-1752.Google Scholar
  3. 3.
    Fuchs CS,Giovannucci EL,Colditz GA, et al. (1999) Dietary fiber and the risk of colorectal cancer and adenoma in women. N Engl J Med 340: 169-176.Google Scholar
  4. 4.
    Schatzkin A,Lanza E,Corle, D et al. (2000) Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. N Engl J Med 342: 1149-1155.Google Scholar
  5. 5.
    Alberts DS,Martinez ME,Roe DJ, et al. (2000) Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. N Engl J Med 342: 1156-1162.Google Scholar
  6. 6.
    Phillips RL,Snowdon DA (1985) Dietary relationships with fatal colorectal cancer among Seventh-Day Adventists. J Natl Cancer Inst 74: 307-317.Google Scholar
  7. 7.
    Shibata A,Paganini-Hill A,Ross RK,Henderson BE (1992) Intake of vegetables, fruits, beta-carotene, vitamin C and vitamin supplements and cancer incidence among the elderly: a prospective study. Br J Cancer 66: 673-679.Google Scholar
  8. 8.
    Thun MJ,Calle EE,Namboodiri MM, et al. (1992) Risk factors for fatal colon cancer in a large prospective study. J Nat Cancer Inst 84: 1491-1500.Google Scholar
  9. 9.
    Steinmetz KA,Kushi LH,Bostick RM,Folsom AR,Potter JD (1994) Vegetables, fruit, and colon cancer in the Iowa Women's Health Study. Am J Epidemiol 139: 1-15.Google Scholar
  10. 10.
    Kato I,Akhmedkhanov A,Koenig K,Toniolo PG,Shore RE,Riboli E (1997) Prospective study of diet and female colorectal cancer: The New York University Women's Health Study. Nutr Cancer 28: 276-281.Google Scholar
  11. 11.
    Hsing AW,McLaughlin JK,Chow W, et al. (1998) Risk factors for colorectal cancer in a prospective study among U.S. white men. Int J Cancer 77: 549-553.Google Scholar
  12. 12.
    Singh PN,Fraser GE (1998) Dietary risk factors for colon cancer in a low-risk population. Am J Epidemiol 148: 761-774.Google Scholar
  13. 13.
    Pietinen P,Malila N,Virtanen M, et al. (1999) Diet and risk of colorectal cancer in a cohort of Finnish men. Cancer Causes Control 10: 387-396.Google Scholar
  14. 14.
    Voorrips LE,Goldbohm RA,van Poppel G,Sturmans F,Hermus RJJ,van den Brandt PA (2000) Vegetable and fruit consumption and risks of colon and rectal cancer in a prospective cohort study. Am J Epidemiol 152: 1081-1092.Google Scholar
  15. 15.
    Terry P,Giovannucci E,Michels KB, et al. (2001) Fruit, vegetables, dietary fiber, and risk of colorectal cancer. J Natl Cancer Inst 93: 525-533.Google Scholar
  16. 16.
    Flood A,Velie EM,Chaterjee N et al. (2002) Fruit and vegetable intakes and the risk of colorectal cancer in the Breast Cancer Detection Demonstration Project follow-up cohort. Am J Clin Nutr 75: 936-943.Google Scholar
  17. 17.
    Key TJ,Thorogood M,Appleby PN,Burr ML (1996) Dietary habits and mortality in 11,000 vegetarians and health conscious people: results of a 17 year follow up. BMJ 313: 775-779.Google Scholar
  18. 18.
    World Cancer Research Fund, and American Institute for Cancer Research(1997) Food, Nutrition, and the Prevention of Cancer: A Global Perspective. Washington, D.C.: American Institute for Cancer Research, 1997.Google Scholar
  19. 19.
    Calle EE,Rodriguez C,Jacobs EJ, et al. (2002) The American Cancer Society Cancer Prevention Study II Nutrition Cohort-Rationale, Study Design, and Baseline Characteristics. Cancer 94: 2490-2501.Google Scholar
  20. 20.
    Bergmann MM,Calle EE,Mervis CA,Miracle-McMahill HL,Thun MT,Heath C (1998) Validity of self-reported cancers in a prospective cohort study in comparison to data from state cancer registries. Am J Epidemiol 147: 556-562.Google Scholar
  21. 21.
    Calle EE,Terrell DD (1993) Utility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II participants. Am J Epidemiol 137: 235-241.Google Scholar
  22. 22.
    Block G,Hartman AM,Naughton D (1990) A reduced dietary questionnaire: development and validation. Epidemiol 1: 58-64.Google Scholar
  23. 23.
    U.S. Department of Agriculture(1998) Continuing Survey of Food Intakes by Individuals. Agricultural Research Service.Google Scholar
  24. 24.
    Smith SA,Campbell DR,Elmer PJ,Martini MC,Slavin JL,Potter JD (1995) The University of Minnesota Cancer Prevention Research Unit vegetable and fruit classification scheme (United States). Cancer Causes Control 6: 292-302.Google Scholar
  25. 25.
    Block G,Coyl L,Smucker R,Harlan LC (1989) Health Habits and History Questionnaire: diet history and other risk factors. Bethesda, MD: National Cancer Institute Division of Cancer Prevention and Control, National Institute of Health.Google Scholar
  26. 26.
    Flagg EW,Coates RJ,Calle EE,Potischman N,Thun MJ (2000) Validation of the American Cancer Society Cancer Prevention Study II Nutrition Survey Cohort Food Frequency Questionnaire. Epidemiology 11: 462-468.Google Scholar
  27. 27.
    McCullough MM,Robertson AS,Calle EE,Chao A,Jacobs EJ,Thun MJ (2001) Dietary factors and risk of fatal stomach cancer in a large prospective cohort of U.S. men and women. Cancer Epidemiol Biomarkers Prev 10-11: 1201-1205.Google Scholar
  28. 28.
    Cox DR (1972) Regression models and life-tables. J R Stat Soc [B] 34: 187-220.Google Scholar
  29. 29.
    McMichael AJ,Potter JD (1985) Host factors in carcinogenesis: Certain bile-acid metabolic profiles that selectively increase the risk of proximal colon cancer. J Natl Cancer Inst 75: 185-191.Google Scholar
  30. 30.
    Slattery ML,Jacobs DJ,Nichaman MA (1989) An assessment of caloric intake as an indicator of physical activity. Prev Med 18: 444-451.Google Scholar
  31. 31.
    Slattery ML,Potter J,Caan B, et al. (1997) Energy balance and colon cancer-beyond physical activity. Cancer Res 57: 75-80.Google Scholar
  32. 32.
    Arab L,Steck-Scott S,Bowen P (2001) Participation of lycopene and beta-carotene in carcinogenesis: defenders, aggressors, or passive bystanders? Epidemiol Rev 23: 211-230.Google Scholar
  33. 33.
    The alpha-tocopherol beta-carotene cancer prevention study group(1994) The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 330: 1029-1035.Google Scholar
  34. 34.
    Hennekens CH,Buring JE,Manson JE, et al. (1996) Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med 334: 1145-1149.Google Scholar
  35. 35.
    Jacobs DR,Marquart L,Slavin J,Kushi LH (1998) Whole-grain intake and cancer: An expanded review and meta-analysis. Nutr Cancer 30: 85-96.Google Scholar
  36. 36.
    Ferguson LR,Chavan RR,Harris PJ (2001) Changing concepts of dietary fiber: implications for carcinogenesis. Nutr Cancer 39: 155-169.Google Scholar
  37. 37.
    Goodlad RA (2001) Dietary fibre and the risk of colorectal cancer. Gut 48: 587-589.Google Scholar
  38. 38.
    Friedenreich CM,Brant RF,Riboli E (1994) Influence of methodologic factors in a pooled analysis of 13 case-control studies of colorectal cancer and dietary fiber. Epidemiology 5: 66-79.Google Scholar
  39. 39.
    Howe GR,Benito E,Castelleto R, et al. (1992) Dietary 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: 1887-1896.Google Scholar
  40. 40.
    Trock B,Lanza E,Greenwald P (1990) Dietary fiber, vegetables, and colon cancer: critical review and meta-analyses of the epidemiologic evidence. J Natl Cancer Inst 82: 650-661.Google Scholar
  41. 41.
    Willett WC,Stampfer MJ,Colditz GA,Rosner BA,Speizer FE (1990) Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women. N Engl J Med 323: 1664-1672.Google Scholar
  42. 42.
    Giovannucci E,Rimm EB,Stampfer MJ,Colditz GA,Ascherio A,Willett WC (1994) Intake of fat, meat, and fiber in relation to risk of colon cancer in men. Cancer Res 54: 2390-2397.Google Scholar
  43. 43.
    Bonithon-Kopp C,Kronborg O,Giocosa A,Rath U,Faivre J (2000) Calcium and fibre supplementation in the prevention of colorectal adenoma recurrence: a randomised intervention trial. Lancet 356: 1300-1306.Google Scholar
  44. 44.
    Bingham SA,Day NE,Luben R, 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.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Marjorie L. McCullough
    • 1
  • Andrea S. Robertson
    • 2
  • Ann Chao
    • 2
  • Eric J. Jacobs
    • 2
  • Meir J. Stampfer
    • 3
  • David R. Jacobs
    • 4
  • William R. Diver
    • 2
  • Eugenia E. Calle
    • 2
  • Michael J. Thun
    • 2
  1. 1.Epidemiology and Surveillance Research DepartmentAmerican Cancer SocietyAtlantaUSA
  2. 2.Epidemiology and Surveillance Research DepartmentAmerican Cancer SocietyAtlantaUSA
  3. 3.Harvard School of Public HealthBostonUSA
  4. 4.University of MinnesotaMinneapolisUSA

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