Fiber Intake Tied to Fewer Complications After Colorectal Cancer Surgery

(Reuters Health) – Colorectal cancer patients with higher dietary fiber intake at diagnosis may be less likely to experience complications after colorectal cancer surgery, a recent study suggests.

Researchers examined data on 1,399 patients (mean age 66 years) who were diagnosed with colorectal cancer and underwent elective abdominal surgery at one of 11 hospitals in the Netherlands. Median habitual fiber intake over the 30 days prior to diagnosis was 29.6 grams/day, as determined via a 204-item food frequency questionnaire.

Overall, a total of 397 patients (28%) experienced any complications and 235 patients (17%) experienced surgical complications.

Each additional 10 grams/day of habitual fiber intake was associated with a significantly lower risk of any complications (odds ratio 0.75) and surgical complications (OR 0.76), the researchers report in JAMA Surgery.

“A healthier gut might tolerate an invasive procedure like colorectal cancer surgery better, and dietary fiber intake is one the factors that can help to improve gut health,” said lead study author Dr. Dieuwertje Kok of Wageningen University & Research in the Netherlands.

“From this perspective, the finding was not surprising, although we were glad to see that we were indeed able to confirm this hypothesis and that the findings were consistent and robust across all the analyses that we performed,” Dr. Kok said by email.

Among the 1,237 patients who had an anastomosis, 67 (5%) experienced anastomic leakage, the study found. There was no association between higher habitual fiber intake and the risk of anastomic leakage.

When researchers looked separately at men and women, they found higher habitual fiber intake significantly associated with a lower risk of any complications among women (OR 0.64) but not among men.

Vegetable fiber in particular was associated with a significantly lower risk of any complications (OR 0.90) and of surgical complications (OR 0.87).

One limitation of the study is that the small number of events, particularly for surgical complications, may have limited the statistical power of the analysis, the authors note. They were unable to examine individual surgical complications with the exception of anastomic leakage.

Another limitation is that the focus on fiber intake over the 30 days prior to diagnosis may not reflect eating habits over a longer period, which might, in turn, play a role in gut health.

While it’s possible that fiber may contribute to a healthy microbiome, it’s also possible that people who consume more fiber in their diets are healthier in other ways than people who don’t consume as much, said Dr. Daniel Freedberg, a professor of medicine and epidemiology at Columbia University Irving Medical Center in New York City.

“Fiber was protective but the protection was very small,” Dr. Freedberg, who wasn’t involved in the study, said by email. “The difference in fiber intake between those who had complications and those who did not was minimal – just 2 grams/day of fiber difference.”

Randomized studies should be done to test whether putting people on a high-fiber diet truly improves surgical outcomes after colorectal cancer surgery, Dr. Freedberg said. But it still makes sense for clinicians to recommend that patients get more fiber in their diets.

“For patients, there is probably little downside to eating more fiber” Dr. Freedberg said. “Most Americans eat pitifully low fiber diets.”

SOURCE: JAMA Surgery, online June 16, 2021.

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