Abstract
Dietary factors have an important influence on colorectal cancer (CRC) and colorectal adenoma (CRA) risk. Examples of known or suspected dietary-related CRC or CRA risk factors are higher intake of alcohol and red meat; lower intakes of dietary fiber, calcium, and folate; and elevated BMI.
The 1970s fiber hypothesis stimulated a surge of observational and intervention studies, but the early findings were inconsistent due to differences in the type and amount of fiber consumed, study populations (e.g., US vs European), length of follow-up time, poor dietary compliance, and tumor site heterogeneity. Despite these early inconsistencies, there is now convincing evidence that higher intake of fiber-rich foods reduces CRC risk and that low fiber intake is associated with an increased risk of CRC.
Dose-response meta-analyses found that each daily 10 g increase in total or cereal fiber reduced CRC risk by 10% (in prospective studies) and reduced CRA risk by 9% and 30% for total fiber and cereal fiber, respectively (primarily in case-control studies).
Two large US-based randomized controlled trials (RCTs), the Wheat Bran Fiber Trial and the Polyp Prevention Trial, indicated that increased intake of fiber-rich foods did not significantly lower the risk of CRA recurrence , but there were several trial limitations including relatively poor dietary compliance and short duration (2–4 years). However, a pooled analysis of these two trials found that increased intake of dietary fiber significantly reduced the risk of CRA recurrence in men by 19%, and a reanalysis of the US Polyp Prevention Trial found that subjects with the highest fiber intake had a significantly 32% lower risk of CRAs compared with low fiber controls.
CRC-protective mechanisms depend on the fiber’s properties: (1) soluble fermentable fiber lowers colonic pH, inhibiting pathogenic bacteria and increasing butyrogenic bacteria to promote healthy colonic mucosal cells, reduces colon inflammation, and inhibits cancer cell proliferation and facilitates apoptosis; and (2) insoluble fiber dilutes or inactivates potential carcinogens by bulking stools and binding carcinogens to reduce their exposure to the colon and rectum. Also, fiber-rich foods tend to be lower in energy density compared to more processed foods for better weight control, and they are major contributors of potential cancer-protective nutrients such as folate, antioxidant nutrients such as vitamins C and E, and phytochemicals such as phenolics and carotenoids.
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Appendix 1. Fifty High Fiber Foods Ranked by Amount of Fiber Per Standard Food Portiona
Appendix 1. Fifty High Fiber Foods Ranked by Amount of Fiber Per Standard Food Portiona
Food | Standard portion size | Dietary fiber (g) | Calories (kcal) | Energy density (calories/g) |
|---|---|---|---|---|
High fiber bran ready-to-eat cereal | 1/3–3/4 cup (30 g) | 9.1–14.3 | 60–80 | 2.0–2.6 |
Navy beans, cooked | 1/2 cup cooked (90 g) | 9.6 | 127 | 1.4 |
Small white beans, cooked | 1/2 cup (90 g) | 9.3 | 127 | 1.4 |
Shredded wheat ready-to-eat cereal | 1–1 1/4 cup (50–60 g) | 5.0–9.0 | 155–220 | 3.2–3.7 |
Black bean soup, canned | 1/2 cup (130 g) | 8.8 | 117 | 0.9 |
French beans, cooked | 1/2 cup (90 g) | 8.3 | 114 | 1.3 |
Split peas, cooked | 1/2 cup (100 g) | 8.2 | 114 | 1.2 |
Chickpeas (Garbanzo) beans, canned | 1/2 cup (120 g) | 8.1 | 176 | 1.4 |
Lentils, cooked | 1/2 cup (100 g) | 7.8 | 115 | 1.2 |
Pinto beans, cooked | 1/2 cup (90 g) | 7.7 | 122 | 1.4 |
Black beans, cooked | 1/2 cup (90 g) | 7.5 | 114 | 1.3 |
Artichoke, global or French, cooked | 1/2 cup (84 g) | 7.2 | 45 | 0.5 |
Lima beans, cooked | 1/2 cup (90 g) | 6.6 | 108 | 1.2 |
White beans, canned | 1/2 cup (130 g) | 6.3 | 149 | 1.1 |
Wheat bran flakes ready-to-eat cereal | 3/4 cup (30 g) | 4.9–5.5 | 90–98 | 3.1–3.3 |
Pear with skin | 1 medium (180 g) | 5.5 | 100 | 0.6 |
Pumpkin seeds. Whole, roasted | 1 ounce (about 28 g) | 5.3 | 126 | 4.5 |
Baked beans, canned, plain | 1/2 cup (125 g) | 5.2 | 120 | 0.9 |
Soybeans, cooked | 1/2 cup (90 g) | 5.2 | 150 | 1.7 |
Plain rye wafer crackers | 2 wafers (22 g) | 5.0 | 73 | 3.3 |
Avocado, Hass | 1/2 fruit (68 g) | 4.6 | 114 | 1.7 |
Apple, with skin | 1 medium (180 g) | 4.4 | 95 | 0.5 |
Green peas, cooked (fresh, frozen, canned) | 1/2 cup (80 g) | 3.5–4.4 | 59–67 | 0.7–0.8 |
Refried beans, canned | 1/2 cup (120 g) | 4.4 | 107 | 0.9 |
Mixed vegetables, cooked from frozen | 1/2 cup (45 g) | 4.0 | 59 | 1.3 |
Raspberries | 1/2 cup (65 g) | 3.8 | 32 | 0.5 |
Blackberries | 1/2 cup (65 g) | 3.8 | 31 | 0.4 |
Collards, cooked | 1/2 cup (95 g) | 3.8 | 32 | 0.3 |
Soybeans, green, cooked | 1/2 cup (75 g) | 3.8 | 127 | 1.4 |
Prunes, pitted, stewed | 1/2 cup (125 g) | 3.8 | 133 | 1.1 |
Sweet potato, baked | 1 medium (114 g) | 3.8 | 103 | 0.9 |
Multi-grain bread | 2 slices regular (52 g) | 3.8 | 140 | 2.7 |
Figs, dried | 1/4 cup (about 38 g) | 3.7 | 93 | 2.5 |
Potato baked, with skin | 1 medium (173 g) | 3.6 | 163 | 0.9 |
Popcorn, air-popped | 3 cups (24 g) | 3.5 | 93 | 3.9 |
Almonds | 1 ounce (about 28 g) | 3.5 | 164 | 5.8 |
Whole wheat spaghetti, cooked | 1/2 cup (70 g) | 3.2 | 87 | 1.2 |
Sunflower seed kernels, dry roasted | 1 ounce (about 28 g) | 3.1 | 165 | 5.8 |
Orange | 1 medium (130 g) | 3.1 | 69 | 0.5 |
Banana | 1 medium (118 g) | 3.1 | 105 | 0.9 |
Oat bran muffin | 1 small (66 g) | 3.0 | 178 | 2.7 |
Vegetable soup | 1 cup (245 g) | 2.9 | 91 | 0.4 |
Dates | 1/4 cup (about 38 g) | 2.9 | 104 | 2.8 |
Pistachios, dry roasted | 1 ounce (about 28 g) | 2.8 | 161 | 5.7 |
Hazelnuts or filberts | 1 ounce (about 28 g) | 2.7 | 178 | 6.3 |
Peanuts, oil roasted | 1 ounce (about 28 g) | 2.7 | 170 | 6.0 |
Quinoa, cooked | 1/2 cup (90 g) | 2.7 | 92 | 1.0 |
Broccoli, cooked | 1/2 cup (78 g) | 2.6 | 27 | 0.3 |
Potato baked, without skin | 1 medium (145 g) | 2.3 | 145 | 1.0 |
Baby spinach leaves | 3 ounces (90 g) | 2.1 | 20 | 0.2 |
Blueberries | 1/2 cup (74 g) | 1.8 | 42 | 0.6 |
Carrot, raw or cooked | 1 medium (60 g) | 1.7 | 25 | 0.4 |
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Dreher, M.L. (2018). Fiber and Colorectal Cancer. In: Dietary Fiber in Health and Disease. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-50557-2_17
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