Cited by 198Nutritional Studies and DietFood composition and propertiesColorectal Cancer Screening and Detection

The DOI matches its Crossref record; 68 of the 71 references it cites were found in a registry or an index; none of the 23 sources its claims cite is checked for support yet.

Fiber Intake and Survival After Colorectal Cancer Diagnosis

Open access

Abstract

IMPORTANCE: Although high dietary fiber intake has been associated with a lower risk of colorectal cancer (CRC), it remains unknown whether fiber benefits CRC survivors. OBJECTIVE: To assess the association of postdiagnostic fiber intake with mortality. DESIGN, SETTING, AND PARTICIPANTS: A total of 1575 health care professionals with stage I to III CRC were evaluated in 2 prospective cohorts, Nurses' Health Study and Health Professionals Follow-up Study. Colorectal cancer-specific and overall mortality were determined after adjusting for other potential predictors for cancer survival. The study was conducted from December 23, 2016, to August 23, 2017. EXPOSURES: Consumption of total fiber and different sources of fiber and whole grains assessed by a validated food frequency questionnaire between 6 months and 4 years after CRC diagnosis. MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) and 95% CIs of CRC-specific and overall mortality after adjusting for other potential predictors for cancer survival. RESULTS: Of the 1575 participants, 963 (61.1%) were women; mean (SD) age was 68.6 (8.9) years. During a median of 8 years of follow-up, 773 deaths were documented, including 174 from CRC. High intake of total fiber after diagnosis was associated with lower mortality. The multivariable HR per each 5-g increment in intake per day was 0.78 (95% CI, 0.65-0.93; P = .006) for CRC-specific mortality and 0.86 (95% CI, 0.79-0.93; P < .001) for all-cause mortality. Patients who increased their fiber intake after diagnosis from levels before diagnosis had a lower mortality, and each 5-g/d increase in intake was associated with 18% lower CRC-specific mortality (95% CI, 7%-28%; P = .002) and 14% lower all-cause mortality (95% CI, 8%-19%; P < .001). According to the source of fiber, cereal fiber was associated with lower CRC-specific mortality (HR per 5-g/d increment, 0.67; 95% CI, 0.50-0.90; P = .007) and all-cause mortality (HR, 0.78; 95% CI, 0.68-0.90; P < .001); vegetable fiber was associated with lower all-cause mortality (HR, 0.83; 95% CI, 0.72-0.96; P = .009) but not CRC-specific mortality (HR, 0.82; 95% CI, 0.60-1.13; P = .22); no association was found for fruit fiber. Whole grain intake was associated with lower CRC-specific mortality (HR per 20-g/d increment, 0.72; 95% CI, 0.59-0.88; P = .002), and this beneficial association was attenuated after adjusting for fiber intake (HR, 0.77; 95% CI, 0.62-0.96; P = .02). CONCLUSIONS AND RELEVANCE: Higher fiber intake after the diagnosis of nonmetastatic CRC is associated with lower CRC-specific and overall mortality. Increasing fiber consumption after diagnosis may confer additional benefits to patients with CRC.

Overview

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Crossref · 10.1001/jamaoncol.2017.3684

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68 of 68 references verified0 citation errors · 0 not checkable

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  • It may state two separate claims as one. 10
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  • The authors state this as an assumption.

    Before this study, no prior study had examined the association between fiber intake and survival among colorectal cancer patients.

    “Despite these data, to our knowledge no study has yet examined the association between fiber intake and survival of CRC patients.”
  • The authors state this as an assumption.

    This study is the first prospective study to examine the prognostic influence of fiber intake among colorectal cancer patients.

    “To our knowledge, this is the first prospective study examining the prognostic influence of fiber intake among CRC patients.”
  • The paper relies on this without support.

    During the study period, adjuvant treatment was largely standardized and primarily correlated with disease stage.

    “Moreover, during the time period of the study, adjuvant treatment was largely standardized and primarily correlated with disease stage.”
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  1. Prosky, 1985, Determination of total dietary fiber in foods and food products., J Assoc Off Anal Chem, 68, 677

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Metadata

Authors
Song, M., Wu, K., Meyerhardt, J. A., Ogino, S., Wang, M., Fuchs, C. S., Giovannucci, E. L., & Chan, A. T.
Affiliations
  • Harvard University (US)
  • Brigham and Women's Hospital (US)
  • Yale Cancer Center (US)
  • Broad Institute (US)
Corresponding author
Chan, Andrew T.
Venue
JAMA Oncology
Published
2018-01-01
Volume
4
Issue
1
Pages
71
ISSN
2374-2437 (ISSN-L)
OpenAlex
W2766404639
Cited by
197
References
71
Citations by year
2026: 13 · 2025: 25 · 2024: 25 · 2023: 24 · 2022: 29 · 2021: 20 · 2020: 25 · 2019: 17 · 2018: 19
FWCI
15.64
Type
journal article
Language
en
Open access
Locations
  • JAMA Oncology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR001863)
  • National Cancer Institute (R01CA176272, P50CA127003, R01CA202704, R01CA151993, R01CA118553, R01CA137178, R35CA197735, P01CA087969, R01CA169141, P01CA055075, UM1CA186107, UM1CA167552, U01CA176726, U01CA167552)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K24DK098311)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
Keywords
dietary fiber intake, colorectal cancer, cancer survivors, mortality, colorectal cancer-specific mortality, all-cause mortality, cereal fiber, whole grains, Nurses' Health Study, Health Professionals Follow-up Study, healthcare workers
MeSH terms
Cancer Survivors, Adult, Aged, Diet Surveys, Dietary Fiber, Eating, Feeding Behavior, Female, Follow-Up Studies, Health Occupations, Humans, Male, Middle Aged, Prospective Studies, Colorectal Neoplasms, Cohort Studies

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