Intake of dietary fibre and lifetime non-steroidal anti-inflammatory drug (NSAID) use and the incidence of colorectal polyps in a population screened for colorectal cancer

Abstract

BackgroundThere is suggestive evidence that increased intake of dietary fibre and the use of non-steroidal anti-inflammatory drugs (NSAIDs) are generally associated with decreased colorectal cancer risk. However, the effects on precursors of colorectal cancer, such as adenomatous polyps, are mixed. We present the associations between dietary fibre intake and NSAID use on the presence and type of colorectal polyps in a screening population.MethodsA cross-sectional study of 2548 individuals undergoing colonoscopy at the Forzani & MacPhail Colon Cancer Screening Centre (Calgary, Canada) was conducted. Dietary fibre intake and NSAID use were assessed using the Diet History Questionnaire I or II and the Health and Lifestyle Questionnaire. Colorectal outcomes were documented as a polyp or high-risk adenomatous polyp (HRAP; villous histology, high-grade dysplasia, ≥10 mm or ≥3 adenomas). Crude and ORs and 95% CIs were estimated using unconditional logistic regression.ResultsThere were 1450 negative colonoscopies and 1098 patients with polyps, of which 189 patients had HRAPs. Total dietary fibre intake was associated with a decreased presence of HRAPs (OR=0.50, 95% CI: 0.29 to 0.86) when comparing the highest to lowest quartiles and was observed with both soluble (OR=0.51, 95% CI: 0.30 to 0.88) and insoluble (OR=0.51, 95% CI: 0.30 to 0.86) fibres. Ever use of NSAIDs was also inversely associated with HRAPs (OR=0.65, 95% CI: 0.47 to 0.89), observed with monthly (OR=0.60, 95% CI: 0.37 to 0.95) and daily (OR=0.53, 95% CI: 0.32 to 0.86) use.ConclusionsDietary fibre intake and NSAID use were associated with a decreased risk of having a HRAP at screening.

Association between Dietary Fibre Intake and Colorectal Adenoma: A Systematic Review and Meta-Analysis

“…Figure 1 depicts the flow diagram reporting the selection process. At the end of the screening process, 21 articles were included in the quantitative analysis [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]; however, because four papers reported separate data based on the adenoma site (colorectal, colon and rectal) [ 29 , 37 , 44 , 45 ], one paper reported the results for both incident and recurrent adenoma [ 37 ], another used a different control group (general population and hospital-based patients) [ 29 ], and two papers reported data stratified by sex [ 36 , 46 ], these were considered to be independent studies. Lastly, five studies [ 30 , 35 , 36 , 45 , 49 ] did not report the association between dietary fibre intake and colorectal adenoma as a risk, but as a number of events among those with higher and lower intake.…”

“…Almost all the included studies were conducted in the United States of America (USA), but one was conducted in Israel [ 39 ] and two in Europe (Germany [ 29 ] and Norway [ 36 ], respectively). As regards the study design, 13 studies were case-control [ 29 , 30 , 31 , 34 , 36 , 38 , 39 , 40 , 41 , 42 , 44 , 46 , 49 ], seven were cohort studies [ 32 , 33 , 35 , 37 , 43 , 45 , 48 ], and one was a cross-sectional study [ 47 ]. Only considering cohort studies, the follow-up (FU) period ranged between 2 years to 26 years [ 43 ].…”

“…The sample size ranged between 100 [ 36 ] and 37,562 participants [ 44 ], with a population age ranging from 18 to 79 years. More than half of the included studies ( n = 13) used a validated self- administered Food Frequency Questionnaire (FFQ) to assess dietary fibre intake [ 30 , 31 , 32 , 33 , 34 , 35 , 37 , 41 , 42 , 43 , 44 , 45 , 49 ], one study used a diet history questionnaire [ 47 ], and another used the food diary [ 36 ]. Furthermore, five studies performed an interview [ 29 , 38 , 39 , 40 , 46 ], however three studies did not provide information on validation [ 40 , 44 , 48 ].…”

Carbohydrate Nutrition and the Risk of Cancer

“…In a meta-analysis of 11 European and American prospective cohort studies examining the associations of fiber with subsite-specific CRCs, Ma et al demonstrated significant risk reduction with high intake for proximal and distal CRC tumors [62••]. In a cross-sectional sample of individuals undergoing colonoscopy screening, Shaw et al demonstrated a significant inverse association between total fiber and risk of adenomatous polyps [63]. Associations did not differ when assessing soluble and insoluble fiber separately.…”

Precision Medicine for CRC Patients in the Veteran Population: State-of-the-Art, Challenges and Research Directions

“…Additional risk factors that have been described include fatty liver [ 58 ], hepatitis C [ 59 ], and Agent Orange exposure [ 60 ]; the latter is very relevant to Vietnam Veterans. Modifying known dietary and lifestyle risk factors and chemoprevention with aspirin and nonsteroidal anti-inflammatory drug (NSAID) use are associated with reduced risk for colon polyps and CRC [ 61 ]. In relation to the role of the diet and intestinal microbiome in CRC pathogenesis, the microbiome of subjects consuming a Western diet (WD) was compared to that of subjects consuming a high-protein diet (HPD) [ 62 ] (Fig.…”