Whole grain and dietary fiber intake and risk of colorectal cancer in the NIH-AARP Diet and Health Study cohort.

Background Whole grains and other foods containing fiber are thought to be inversely related to colorectal cancer (CRC). However, whether these associations reflect fiber or fiber source remains unclear. Objectives We evaluated associations of whole grain and dietary fiber intake with CRC risk in the large NIH-AARP Diet and Health Study. Methods We used Cox proportional hazard models to estimate HRs and 95% CIs for whole grain and dietary fiber intake and risk of CRC among 478,994 US adults, aged 50–71 y. Diet was assessed using a self-administered FFQ at baseline in 1995–1996, and 10,200 incident CRC cases occurred over 16 y and 6,464,527 person-years of follow-up. We used 24-h dietary recall data, collected on a subset of participants, to evaluate the impact of measurement error on risk estimates. Results After multivariable adjustment for potential confounders, including folate, we observed an inverse association for intake of whole grains (HR_{Q5 vs.Q1} : 0.84; 95% CI: 0.79, 0.90; P -trend < 0.001), but not dietary fiber (HR_{Q5 vs. Q1}: 0.96; 95% CI: 0.88, 1.04; P -trend = 0.40), with CRC incidence. Intake of whole grains was inversely associated with all CRC cancer subsites, particularly rectal cancer (HR_{Q5 vs. Q1}: 0.76; 95% CI: 0.67, 0.87; P -trend < 0.001). Fiber from grains, but not other sources, was associated with lower incidence of CRC (HR_{Q5 vs. Q1}: 0.89; 95% CI: 0.83, 0.96; P -trend < 0.001), particularly distal colon (HR_{Q5 vs. Q1}: 0.84; 95% CI: 0.73, 0.96; P -trend = 0.005) and rectal cancer (HR_{Q5 vs. Q1}: 0.77; 95% CI: 0.66, 0.88; P- trend < 0.001). Conclusions Dietary guidance for CRC prevention should focus on intake of whole grains as a source of fiber. [ABSTRACT FROM AUTHOR]