Dietary intake of fiber, whole grains and risk of colorectal cancer: An updated analysis according to food sources, tumor location and molecular subtypes in two large US cohorts.

Epidemiologic evidence relating fiber intake to colorectal cancer (CRC) remains inconclusive and data are limited on different food sources of fiber and heterogeneity by tumor subsite and molecular profile. We prospectively followed for CRC incidence 90,869 women from the Nurses' Health Study (1980–2012) and 47,924 men from the Health Professionals Follow‐up Study (1986–2012), who completed a validated food frequency questionnaire every 4 years. Cox proportional hazards regression was used to examine the associations with CRC risk for total, cereal, fruit and vegetable fiber and whole grains. We also assessed the associations according to tumor subsites (proximal colon, distal colon and rectum) and molecular markers (microsatellite instability, BRAF mutation, CpG island methylator phenotype and KRAS mutation). We documented 3,178 CRC cases during 3,685,903 person‐years of follow‐up in the NHS and HPFS. Intake of total dietary fiber was not associated with CRC risk after multivariable adjustment in either women (hazard ratio [HR] comparing extreme deciles, 1.17; 95% CI, 0.92–1.48, ptrend = 0.55) or men (HR, 0.90; 95% CI, 0.67–1.21, ptrend = 0.47). Higher intake of cereal fiber and whole grains was associated with lower CRC risk in men with an HR of 0.75 (95% CI, 0.57–1.00) and 0.72 (95% CI, 0.54–0.96), respectively. No heterogeneity was detected by tumor subsite or molecular markers (pheterogeneity > 0.05). Higher intake of total dietary fiber within the range of a typical American diet is unlikely to substantially reduce CRC risk. The potential benefit of cereal fiber and whole grains in men warrants further confirmation. What's new? Epidemiologic evidence relating fiber intake to colorectal cancer (CRC) remains inconclusive and data are still limited on different food sources and heterogeneity by tumor subsite and molecular profile. Here, total dietary fiber intake within the range of a typical American diet was not found to be associated with CRC risk after adjusting for other dietary and lifestyle factors. Higher intake of cereal fiber and whole grains was associated with lower CRC risk in men. Associations of dietary fiber and CRC did not vary by tumor subsites and molecular markers (microsatellite instability, BRAF mutation, CpG island methylator phenotype, and KRAS mutation). [ABSTRACT FROM AUTHOR]