Dietary Fiber and Human Cancer: Critique of the Literature

  • David M. Klurfeld
  • David Kritchevsky


The relationship between dietary fiber consumption and risk of gastrointestinal cancer in humans is examined using representative studies of several types: international and intranational correlations, case-control analyses, metabolic investigations, cohort studies, and migrant studies. The strongest statistical association between diet and cancer is found in international studies in which numerous environmental variables differ. Studies on smaller groups within a single culture have not given strong support to the findings of international comparisons. Colon cancer rates within regions of the U.S. and other countries vary with sufficient magnitude that diet is unlikely to account for more than a minor proportion of risk. The evidence that a diet containing fiber-rich foods reduces risk of colon cancer must be considered tentative. Foods high in starch and fiber are statistically associated with a high rate of stomach cancer. Examination of the combined rates of colon and gastric cancer shows that the U.S. risk is low relative to countries in which a diet higher in fiber is consumed. It would be premature to suggest that a high fiber diet will confer protection against gastrointestinal cancer.


Colon Cancer Cancer Mortality Gastrointestinal Cancer Stomach Cancer Fiber Intake 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Seventh-Day Adventist


coronary heart disease


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    D. Kritchevsky, Dietary fiber: What it is and what it does, Ann. N.Y. Acad. Sci. 300:283 (1977).CrossRefGoogle Scholar
  2. 2.
    I. Furda, ed., “Unconventional Sources of Dietary Fiber,“ American Chemical Society, Washington, D.C. (1983).Google Scholar
  3. 3.
    W. P. T. James and O. Theander, eds., “The Analysis of Dietary Fiber in Food,“ Marcel Dekker, New York (1981).Google Scholar
  4. 4.
    L. Page and B. Friend, The changing United States diet, Bioscience 28:192 (1978).CrossRefGoogle Scholar
  5. 5.
    Committee on Dietary Allowances, Food and Nutrition Board, “Recommended Dietary Allowances, 9th ed.,“ National Academy of Sciences, Washington, D.C. (1980).Google Scholar
  6. 6.
    D. M. Parkin, J. Stjernsward, and C. S. Muir, Estimates of the worldwide frequency of twelve major cancers, Bull. W.H.O. 62:163 (1984).Google Scholar
  7. 7.
    0. Gregor, R. Toman, and F. Prusova, Gastrointestinal cancer and nutrition, Gut 10:1031 (1969).CrossRefGoogle Scholar
  8. 8.
    B. Armstrong and R. Doll, Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices, Int. J. Cancer 15:617 (1975).CrossRefGoogle Scholar
  9. 9.
    A. J. McMichael, J. D. Potter, and B. S. Hetzel, Time trends in colorectal cancer mortality in relation to food and alcohol consumption, United States, United Kingdom, Australia and New Zealand, Int. J. Epidemiol. 8:295 (1979).CrossRefGoogle Scholar
  10. 10.
    D. J. P. Barker and K. M. Godfrey, Geographical variations in the incidence of colorectal cancer in Britain, Br. J. Cancer 50:693 (1984).CrossRefGoogle Scholar
  11. 11.
    W. A. Gortner, Nutrition in the United States, 1900–1974, Cancer Res. 35:3246 (1975).Google Scholar
  12. 12.
    T. Byers and S. Graham, The epidemiology of diet and cancer, Adv. Cancer Res. 41:1 (1984).CrossRefGoogle Scholar
  13. 13.
    W. C. Willett and B. MacMahon, Diet and cancer-an overview. N. Engl. J. Med. 310:633 (1984).CrossRefGoogle Scholar
  14. 14.
    M. Hakama and E. A. Saxen, Cereal consumption and gastric cancer, Int. J. Cancer 2:265 (1967).CrossRefGoogle Scholar
  15. 15.
    M. A. Howell, Factor analysis of international cancer mortality data and per capita food consumption, Br. J. Cancer 29:328 (1974).CrossRefGoogle Scholar
  16. 16.
    M. A. Howell, Diet as an etiological factor in the development of cancers of the colon and rectum, J. Chronic Dis. 28:67 (1975).CrossRefGoogle Scholar
  17. 17.
    B. S. Drasar and D. Irving, Environmental factors and cancer of the colon and breast, Br. J. Cancer 27:167 (1973).CrossRefGoogle Scholar
  18. 18.
    D. Irving and B. S. Drasar, Fibre and cancer of the colon, Br. J. Cancer 28:462 (1973).CrossRefGoogle Scholar
  19. 19.
    K. Liu, J. Stamler, D. Moss, et al., Dietary cholesterol, fat, and fibre, and colon-cancer mortality. An analysis of international data, Lancet 2:782 (1979).CrossRefGoogle Scholar
  20. 20.
    P. Correa, Epidemiological correlations between diet and cancer frequency, Cancer Res. 41:3685 (1981).Google Scholar
  21. 21.
    W. J. Blot, J. F. Fraumeni, Jr., B. J. Stone, et al., Geographic patterns of large bowel cancer in the United States, J. Natl. Cancer Inst. 57:1225 (1976).Google Scholar
  22. 22.
    M. J. Hill, R. MacLennan, and K. Newcombe, Diet and large-bowel cancer in three socioeconomic groups in Hong Kong, Lancet 1:436 (1979).CrossRefGoogle Scholar
  23. 23.
    S. Bingham, D. R. R. Williams, T. J. Cole, et al., Dietary fibre and regional large-bowel cancer mortality in Britain, Br. J. Cancer 40:456 (1979).CrossRefGoogle Scholar
  24. 24.
    P. Stocks and M. K. Karns, A cooperative study of the habits, homelife, dietary and family histories of 450 cancer patients and of an equal number of control patients, Ann. Eugen. 5:237 (1933).CrossRefGoogle Scholar
  25. 25.
    W. Haenszel, J. W. Berg, M. Segi, et al., Large-bowel cancer in Hawaiian Japanese, J. Natl. Cancer Inst. 51:1765 (1973).Google Scholar
  26. 26.
    B. Modan, F. Lubin, V. Barell, et al., The role of starches in the etiology of gastric cancer, Cancer 34:2087 (1974).Google Scholar
  27. 27.
    B. Modan, V. Barell, F. Lubin, et al., Low-fiber intake as an etiologic factor in cancer of the colon, J. Natl. Cancer Inst. 55:15 (1975).Google Scholar
  28. 28.
    R. L. Phillips, Role of life-style and dietary habits in risk of cancer among Seventh-Day Adventists, Cancer Res. 35:3513 (1975).Google Scholar
  29. 29.
    S. Graham, H. Dayal, M. Swanson, et al., Diet in the epidemiology of cancer of the colon and rectum, J. Natl. Cancer Inst. 61:709 (1978).Google Scholar
  30. 30.
    L. G. Dales, G. D. Friedman, H. K. Ury, et al., A case-control study of relationships of diet and other traits to colorectal cancer in American blacks, Am. J. Epidemiol. 109:132 (1979).Google Scholar
  31. 31.
    M. Moskovitz, C. White, R. N. Barnett, et al., Diet, fecal bile acids, and neutral sterols in carcinoma of the colon, Dig. Dis. Sci. 24:746 (1979).CrossRefGoogle Scholar
  32. 32.
    M. Jain, G. M. Cook, F. G. Davis, et al., A case-control study of diet and colo-rectal cancer, Int. J. Cancer 26:757 (1980).CrossRefGoogle Scholar
  33. 33.
    J. C. Paymaster, L. D. Sanghvi, and P. Gangadharan, Cancer in the gastrointestinal tract in Western India: Epidemiologic study, Cancer 21:279 (1968).CrossRefGoogle Scholar
  34. 34.
    A. B. Miller, G. R. Howe, M. Jain, et al., Food items and food groups as risk factors in a case-control study of diet and colo-rectal cancer, Int. J. Cancer 32:155 (1983).CrossRefGoogle Scholar
  35. 35.
    International Agency for Research on Cancer Intestinal Microecology Group, Dietary fibre, transit-time, faecal bacteria, steroids, and colon cancer in two Scandinavian populations, Lancet 2:207 (1977).Google Scholar
  36. 36.
    B. S. Reddy, C. W. Martin, and E. L. Wynder, Fecal bile acids and cholesterol metabolites of patients with ulcerative colitis, a high-risk group for development of colon cancer, Cancer Res. 37:1697 (1977).Google Scholar
  37. 37.
    H. F. Mower, R. M. Ray, R. Shoff, et al., Fecal bile acids in two Japanese populations with different colon cancer risks, Cancer Res. 39:328 (1979).Google Scholar
  38. 38.
    B. S. Reddy, C. Sharma, L. Darby, et al., Metabolic epidemiology of large bowel cancer. Fecal mutagens in high-and low-risk populations for colon cancer, Mutat. Res. 72:511 (1980).CrossRefGoogle Scholar
  39. 39.
    B. R. Goldin, L. Swenson, J. Dwyer, et al., Effect of diet and Lactobacillus acidophilus supplements on human fecal bacterial enzymes, J. Natl. Cancer Inst. 64:255 (1980).Google Scholar
  40. 40.
    0. M. Jensen, R. MacLennan, and J. Wahrendorf, Diet, bowel function, fecal characteristics, and large bowel cancer in Denmark and Finland, Nutr. Cancer 4:5 (1982).CrossRefGoogle Scholar
  41. 41.
    H. N. Englyst, S. A. Bingham, H. S. Wiggins, et al., Nonstarch polysaccharide consumption in four Scandinavian populations, Nutr. Cancer 4:50 (1982).CrossRefGoogle Scholar
  42. 42.
    L. Domellof, L. Darby, D. Hanson, et al., Fecal sterols and bacterial β-glucuronidase activity: A preliminary metabolic epidemiology study of healthy volunteers from Umea, Sweden, and metropolitan New York, Nutr. Cancer 4:120 (1982).CrossRefGoogle Scholar
  43. 43.
    W. van Dokkum, B. C. J. de Boer, A. van Faassen, et al., Diet, faecal pH and colorectal cancer, Br. J. Cancer 48:109 (1983).CrossRefGoogle Scholar
  44. 44.
    P. Rozen, S. M. Hellerstein, and C. Horwitz, The low incidence of colorectal cancer in a “high-risk” population: Its correlation with dietary habits, Cancer 48:2692 (1981).CrossRefGoogle Scholar
  45. 45.
    L. J. Kinlen, Meat and fat consumption and cancer mortality: A study of strict religious orders in Britain, Lancet 1:946 (1982).CrossRefGoogle Scholar
  46. 46.
    D. Kromhout, E. B. Bosschieter, and C. de Lezenne Coulander, Dietary fibre and 10-year mortality from coronary heart disease, cancer, and all causes: The Zutphen study, Lancet 2:518 (1982).CrossRefGoogle Scholar
  47. 47.
    W. Haenszel and M. Kurihara, Studies of Japanese migrants. I. Mortality from cancer and other diseases among Japanese in the United States, J. Natl. Cancer Inst. 40:43 (1968).Google Scholar
  48. 48.
    W. Haenszel, Cancer mortality among the foreign-born in the United States, J. Natl. Cancer Inst. 26:37 (1961).Google Scholar
  49. 49.
    A. J. McMichael, M. G. McCall, J. M. Hartshorne, et al., Patterns of gastrointestinal cancer in European migrants to Australia: The role of dietary change, Int. J. Cancer 25:431 (1980).CrossRefGoogle Scholar
  50. 50.
    T. L. Cleave, “The Saccharine Disease,“ Keats Publishing, New Canaan, Conn. (1975).Google Scholar
  51. 51.
    D. P. Burkitt, A. R. P. Walker, and N. S. Painter, Effect of dietary fibre on stools and transit-time, and its role in the causation of disease, Lancet 2:1408 (1972).CrossRefGoogle Scholar
  52. 52.
    D. Kritchevsky, Fiber, steroids, and cancer, Cancer Res. 43:2491s (1983).Google Scholar
  53. 53.
    H. Adlercreutz, Does fiber-rich food containing animal lignan precursors protect against both colon and breast cancer? An extension of the “fiber hypothesis,“ Gastroenterology 86:761 (1984).Google Scholar
  54. 54.
    A. J. McMichael and J. D. Potter, Reproduction, endogenous and exogenous sex hormones, and colon cancer: A review and hypothesis, J. Natl. Cancer Inst. 65:1201 (1980).Google Scholar
  55. 55.
    M. J. Hill, Colon cancer: A disease of fibre depletion or of dietary excess? Digestion 11:289 (1974).CrossRefGoogle Scholar
  56. 56.
    R. Doll and R. Peto, The causes of cancer: Quantitative estimates of avoidable risks of cancer in the United States today, J. Natl. Cancer Inst. 66:1191 (1981).Google Scholar
  57. 57.
    Committee on Diet, Nutrition, and Cancer, Assembly of Life Sciences, National Research Council, “Diet, Nutrition, and Cancer,“ National Academy Press, Washington, D.C. (1982).Google Scholar
  58. 58.
    M. W. Pariza, A perspective of diet, nutrition, and cancer, J.A.M.A. 251:1455 (1984).CrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1986

Authors and Affiliations

  • David M. Klurfeld
    • 1
  • David Kritchevsky
    • 1
  1. 1.The Wistar Institute of Anatomy and BiologyPhiladelphiaUSA

Personalised recommendations