TY - JOUR
T1 - DIETARY CHOLESTEROL, FAT, AND FIBRE, AND COLON-CANCER MORTALITY. An Analysis of International Data
AU - Liu, Kiang
AU - Moss, Dorothy
AU - Persky, Victoria
AU - Stamler, Jeremiah
AU - Garside, Dan
AU - Soltero, Ivan
N1 - Funding Information:
For socioeconomic reasons12.13 diets of individuals (e.g., in case-control studies) or groups (e.g., in interna- tional comparisons) that are high in cholesterol are like- ly to be high in fat and low in fibre. Thus, by univariate analysis, it is very difficult to distinguish which is the true risk factor (or factors). In our study, two methods helped to clarify this problem. The hypothesis was that dietary cholesterol was the true risk factor. Therefore, the relationship between each dietary factor and colon cancer was considered bivariately by controlling for cho- lesterol consumption. Results from partial correlation analyses and cross-classification analyses both supported the hypothesis. Most other studies of this problem did not take the latent period into account. For example, in published in- ternational comparison studies, the food-consumption data and the colon-cancer mortality-rates were from the same period of time.19 In the case-control studies, the dietary data were collected by the frequency method which measures the dietary habit in the near past anc not the dietary habit of the distant past which might have affected the current colon-cancer incidence. 18,20,26 In our study, the 10-year time lag between the food-dis- appearance data and the mortality data attempted, at least in part, to deal with the latent period. results, others,8,27 support the Our view that cholesterol in accord with intake those is more of important in the aetiology of colon cancer than is dietary fat or fibre in- take. Our study, however, has limitations. International data alone cannot provide conclusive information on the causal relationship. It is possible that the cholesterol and colon-cancer relatiQnship reflects other unknown xtiolo- gical factors. Moreover, it is not certain that the latent time of colon cancer was taken fully into account. The data on dietary fibre were estimated from total con- sumption of fruits, grains, legumes, and non-starchy or starchy vegetables, and may not have been sufficiently accurate. Only certain types of fibre may have protective effects on colon cancer,7.28.29 and so we cannot conclude that fibre is not related to the aetiology of colon cancer. Finally, it is not clear why the mortality is related to die tary cholesterol level for countries with a low but not a high level of polyunsaturated fat. Despite all these defi- ciencies, this study provides leads for future studies in this area. The possible causal relationship between cho- lesterol intake and colon cancer deserves more attention. Next to lung and breast cancer, colon cancer has the third highest cancer mortality-rate in the United States.28,30 Although its causation is not fully under- stood, reasonable approaches to prevention of the dis- ease seem possible. It is generally believed that the more sterol secretion in the bowel, the greater the risk of colon cancer. Thus, prevention could be aided if the usual American diet became lower in total fat (e.g., 20—30% of the total caloric intake), saturated fat, and cholesterol and higher in fibre-a type of diet widely recommended for the lowering of serum cholesterol levels and preven- tion of coronary heart-disease.13 Rose suggestedet al.l that the negative correlation coefficient between serum cholesterol and colon cancer may in part be due to an associated higher intake of polyunsaturated fatty acids, since this leads to an excretion of bile salt (although in an unpublished study our group has not confirmed this inverse association). For a similar reason, Oliver31 has suggested that the serum-cholesterol lowering drug, clo- contrast, fibrate, may the diet recommended increase the risk for prophylaxis of colon cancer. of bothIn colon cancer and coronary heart-disease would expose the intestinal mucosa to less bile acid and total sterol. Furthermore higher intake of fibre can be expected to decrease transit time through the gut. Both mechanisms should operate to reduce risk of colon cancer. This work was done while K.L. was a postdoctoral trainee in Car- diovascular Epidemiology, Biostatistics, Nutrition, and Preventive Cardiology, supported by the National Heart, Lung, and Blood Insti- tute (grant no. 5T32-HL0113).
PY - 1979/10/13
Y1 - 1979/10/13
N2 - It has been suggested that high fat, high cholesterol, and low fibre intakes play a role in the causation of colon cancer, but since they are highly intercorrelated, it is difficult to determine which (if any) variable is truly related to colon cancer. Food disappearance data for 1954-65 and mortality data for 1967-73 from 20 industrialised countries were used to assess which variables are independently related to colon cancer. Simple correlation analysis indicated that intake of total fat, saturated fat, monounsaturated fat, cholesterol, and fibre are each highly correlated with mortality-rate for colon cancer. The partial correlation of dietary cholesterol with colon cancer remains highly significant when fat or fibre is controlled. However, the partial correlations of fat or of fibre with colon cancer are no longer significant when cholesterol is controlled. Cross-classification showed a highly significant main effect for cholesterol, but not for fat or fibre. The findings support the possibility of a causal relationship between cholesterol intake and colon cancer.
AB - It has been suggested that high fat, high cholesterol, and low fibre intakes play a role in the causation of colon cancer, but since they are highly intercorrelated, it is difficult to determine which (if any) variable is truly related to colon cancer. Food disappearance data for 1954-65 and mortality data for 1967-73 from 20 industrialised countries were used to assess which variables are independently related to colon cancer. Simple correlation analysis indicated that intake of total fat, saturated fat, monounsaturated fat, cholesterol, and fibre are each highly correlated with mortality-rate for colon cancer. The partial correlation of dietary cholesterol with colon cancer remains highly significant when fat or fibre is controlled. However, the partial correlations of fat or of fibre with colon cancer are no longer significant when cholesterol is controlled. Cross-classification showed a highly significant main effect for cholesterol, but not for fat or fibre. The findings support the possibility of a causal relationship between cholesterol intake and colon cancer.
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U2 - 10.1016/S0140-6736(79)92126-3
DO - 10.1016/S0140-6736(79)92126-3
M3 - Short survey
C2 - 90870
AN - SCOPUS:0018721441
SN - 0140-6736
VL - 314
SP - 782
EP - 785
JO - The Lancet
JF - The Lancet
IS - 8146
ER -
