Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas

被引:649
作者
Schatzkin, A [1 ]
Lanza, E
Corle, D
Lance, P
Iber, F
Caan, B
Shike, M
Weissfeld, J
Burt, R
Cooper, MR
Kikendall, JW
Cahill, J
Freedman, L
Marshall, J
Schoen, RE
Slattery, M
机构
[1] NCI, Bethesda, MD 20892 USA
[2] SUNY Buffalo, Sch Med & Biomed Sci, Buffalo, NY 14260 USA
[3] Vet Affairs Edward Hines Jr Hosp, Vet Affairs Med Ctr, Hines, IL USA
[4] Kaiser Fdn Res Inst, Oakland, CA USA
[5] Univ Pittsburgh, Pittsburgh, PA USA
[6] Univ Utah, Salt Lake City, UT USA
[7] Wake Forest Univ, Baptist Med Ctr, Winston Salem, NC 27109 USA
[8] Walter Reed Army Med Ctr, Washington, DC 20307 USA
[9] WESTAT Corp, Rockville, MD 20850 USA
[10] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA
[11] Univ Arizona, Tucson, AZ USA
关键词
D O I
10.1056/NEJM200004203421601
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: We tested the hypothesis that dietary intervention can inhibit the development of recurrent colorectal adenomas, which are precursors of most large-bowel cancers. Methods: We randomly assigned 2079 men and women who were 35 years of age or older and who had had one or more histologically confirmed colorectal adenomas removed within six months before randomization to one of two groups: an intervention group given intensive counseling and assigned to follow a diet that was low in fat (20 percent of total calories) and high in fiber (18 g of dietary fiber per 1000 kcal) and fruits and vegetables (3.5 servings per 1000 kcal), and a control group given a standard brochure on healthy eating and assigned to follow their usual diet. Subjects entered the study after undergoing complete colonoscopy and removal of adenomatous polyps; they remained in the study for approximately four years, undergoing colonoscopy one and four years after randomization. Results: A total of 1905 of the randomized subjects (91.6 percent) completed the study. Of the 958 subjects in the intervention group and the 947 in the control group who completed the study, 39.7 percent and 39.5 percent, respectively, had at least one recurrent adenoma; the unadjusted risk ratio was 1.00 (95 percent confidence interval, 0.90 to 1.12). Among subjects with recurrent adenomas, the mean (+/-SE) number of such lesions was 1.85+/-0.08 in the intervention group and 1.84+/-0.07 in the control group. The rate of recurrence of large adenomas (with a maximal diameter of at least 1 cm) and advanced adenomas (defined as lesions that had a maximal diameter of at least 1 cm or at least 25 percent villous elements or evidence of high-grade dysplasia, including carcinoma) did not differ significantly between the two groups. Conclusions: Adopting a diet that is low in fat and high in fiber, fruits, and vegetables does not influence the risk of recurrence of colorectal adenomas. (N Engl J Med 2000;342:1149-55.) (C) 2000, Massachusetts Medical Society.
引用
收藏
页码:1149 / 1155
页数:7
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