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High fiber intake is associated amongst improved survival amid patients diagnosed amongst colorectal cancer (CRC), fifty-fifty amid those who increment their fiber intake later the diagnosis, the results of an analysis of 2 prospective studies indicate.
In a study that included to a greater extent than than 1500 healthcare professionals who had been diagnosed amongst CRC, researchers found that each v g/d increment inward fiber intake was linked to a 22% reduction inward cancer-specific mortality together with a 16% reduction inward overall mortality, amongst the greatest outcome seen amongst whole-grain foods. Notably, no association was seen amongst daily fruit fiber intake.
The study, which was published online November 1 in JAMA Oncology, found that the survival make goodness occurred fifty-fifty amid those patients who increased their fiber intake later diagnosis. The maximum outcome seen for patients who consumed close 24 g/d.
Study writer Andrew T. Chan, MD, MPH, of Massachusetts General Hospital together with Harvard Medical School, Boston, said that the findings may influence advice given to CRC patients every bit good every bit our agreement of the disease.
The possibility that fiber or related substances may endure protective "does give us some interesting biological insights into the procedure yesteryear which colon cancer may spread, together with every bit result, it may render us some novel targets for novel illness interventions," he told Medscape Medical News.
"The machinery could endure related to some of the effects that fiber has, for example, on insulin pathways, together with this may endure a potential target for handling inward the future. It's likewise possible that fiber may cast a substrate for bacteria inward the gut to create anti-inflammatory compounds together with metabolites," said Dr Chan.
Previous studies direct hold indicated that dietary fiber protects against the evolution of CRC. Potential mechanisms include a reduction inward exposure to intestinal carcinogens; systemic benefits on insulin sensitivity together with metabolic regulation; together with the fermentation of fiber inward the gut into short-chain obese acids that direct hold tumor-suppressive effects.
However, no studies direct hold examined the acquit on of fiber intake on survival inward patients already diagnosed amongst CRC.
The researchers collated information from the prospective Nurses' Health Study (NHS) together with the Health Professionals Follow-up Study (HPFS). The NHS recruited 121,700 U.S. of A. of America registered woman individual nurses aged thirty to 55 years inward 1976; the HPFS enrolled 51,529 U.S. of A. of America manful individual healthcare professionals aged xl to 75 years inward 1986.
In both studies, the participants completed a medical history together with lifestyle questionnaire, which included information on CRC status, at baseline together with hence every 2 years. Dietary information were likewise collected, together with a nutrient frequency questionnaire was completed every four years.
For those reporting a CRC diagnosis, the squad asked for consent to instruct their medical records together with pathologic testify reports. H5N1 total of 1575 individuals diagnosed amongst phase I-III CRC completed the questionnaire, including 963 women from the NHS together with 612 men from the HPFS.
The hateful historic menses of the patients was 68.6 years. During a median follow-up menses of 8 years, at that spot were 773 deaths, of which 174 (22.5%) were deemed to endure CRC specific. The overall 5-year survival charge per unit of measurement was 83% for phase I disease, 82% for phase II disease, together with 72% for phase III CRC.
After taking into concern human relationship potential confounding factors, fiber intake was inversely associated amongst mortality, at a multivariate adventure ratio (HR) per v g/d increment inward intake of 0.78 for CRC-specific mortality (P = .006) together with 0.86 for all-cause mortality (P < .001).
The squad likewise found that mortality was lower for patients who increased their fiber intake later diagnosis: each v g/d increment was associated amongst an 18% reduction inward CRC-specific mortality (P = .002) together with a 14% reduction inward all-cause mortality (P < .001).
The human relationship betwixt fiber intake later diagnosis together with CRC-specific mortality was linear, reaching a maximum at only about 24 g/d, beyond which at that spot was no farther mortality reduction.
Consumption of fiber from cereals was associated amongst a pregnant reduction inward CRC-specific mortality, at an HR for each v g/d increment of 0.67 (P = .007 for trend), together with all-cause mortality, at an HR of 0.78 ( P < .001 for trend).
There was no association betwixt daily fruit fiber intake together with CRC-specific or all-cause mortality. Vegetable fiber intake was associated amongst a pregnant reduction entirely inward all-cause mortality, at an HR per v g/d of 0.83 increment (P = .009 for trend).
Whole-grain consumption was linked to lower CRC-specific mortality, at an HR per xx g/d increment of 0.72 (P = .002 for trend). This was attenuated later taking into concern human relationship total fiber intake, at an HR of 0.77 (P = .02). H5N1 similar outcome was seen for all-cause mortality.
The researchers write: "Our introduce study adds to the existing literature together with suggests that the outcome of high fiber intake may extend beyond protection against cancer incidence together with contribute to ameliorate prognosis later cancer is established."
While acknowledging that at that spot are a issue of potential limitations to their study, including the self-reported nature of the information on fiber intake together with sources together with lack of detailed handling data, they authorities annotation that the findings are inward accord amongst those of previous studies.
They conclude: "Our findings render back upward for the nutritional recommendations of maintaining sufficient fiber intake amid CRC survivors."
Is It Fiber or Phytochemicals?
Approached for comment, Elizabeth Ryan, PhD, assistant professor, College of Veterinary Medicine together with Biomedical Sciences at Colorado State University inward Fort Collins, said that at that spot direct hold been many studies of the intake of fiber from diverse nutrient sources, but the results direct hold been mixed.
She told Medscape Medical News that i of the major limitations of such studies is their reliance on diet logs, which are silent to endure fully validated.
Dr Ryan explained: "There are non a lot of biomarkers that I could hold off at inward your blood or my blood together with say: 'You've eaten oats today.' It's based on your writing, 'I ate oats yesterday,' together with that's sometimes hard when nosotros desire to brand certain nosotros desire to agree people accountable for reporting what they're eating."
Nevertheless, she said that inward the electrical flow analysis, the researchers address the limitations of their methodology together with that the results back upward what is already known close the beneficial effects of fiber, especially fiber from whole grains.
For Dr Ryan, the outstanding interrogation is, "Do nosotros propose i exceptional type of whole grain over another? Because, is it only close coming together the [recommended] fiber intake, or are at that spot other phytochemicals inward those foods that [are also] protective against colorectal cancer?"
Do nosotros propose i exceptional type of whole grain over another? Dr Elizabeth Ryan
She believes that the best approach would endure to ensure that patients eat a multifariousness of cereals, rather than rely on a fiber supplement. However, the lack of information to back upward that recommendation agency that the film for patients is "confusing."
Dr Ryan likewise believes that private patients are probable to answer differently to unlike levels of fiber intake: "Maybe I direct hold colorectal cancer together with I increment yesteryear v g/d. How am I going to discovery out if peradventure it should direct hold been 10 g/d for me, because I didn't answer every bit good to the v g/d?"
She added: "There may endure a lot of private variation inward how nosotros would answer to increased fiber intake."
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