A Case–Control Study Examining the Association of Fiber, Fruit, and Vegetable Intake and the Risk of Colorectal Cancer in a Palestinian Population
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Data Collection
2.3. Statistical Analyses
3. Results
3.1. Participation
3.2. Participant Characteristics
3.3. Fibers and CRC Risk
3.4. FV and CRC Risk
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Sung, H.; Ferlay, J.; Siegel, R.L.; Laversanne, M.; Soerjomataram, I.; Jemal, A.; Bray, F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA A Cancer J. Clin. 2021, 71, 209–249. [Google Scholar] [CrossRef]
- Favoriti, P.; Carbone, G.; Greco, M.; Pirozzi, F.; Pirozzi, R.E.M.; Corcione, F. Worldwide Burden of Colorectal Cancer: A Review. Updates Surg. 2016, 68, 7–11. [Google Scholar] [CrossRef] [PubMed]
- Torre, L.A.; Bray, F.; Siegel, R.L.; Ferlay, J.; Lortet-Tieulent, J.; Jemal, A. Global Cancer Statistics, 2012. CA A Cancer J. Clin. 2015, 65, 87–108. [Google Scholar] [CrossRef] [PubMed]
- Arnold, M.; Sierra, M.; Laversanne, M.; Soerjomataram, I.; Jemal, A.; Bray, F. Global Patterns and Trends in Colorectal Cancer Incidence and Mortality. Gut 2016, 66, 683–691. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Health (Palestine). Health Annual Report Palestine 2020. 2020, pp. 44–46. Available online: http://site.moh.ps/Content/Books/mv2fIO4XVF1TbERz9cwytaKoWKAsRfslLobNuOmj7OPSAJOw2FvOCI_DQYaIXdf2i8gCmPHbCsav29dIHqW26gZu9qJDiW2QsifZt6FrdS4H2.pdf (accessed on 10 October 2021).
- Ministry of Health (Palestine). Health Annual Report Palestine 2017. 2017, pp. 97–101. Available online: http://site.moh.ps/Content/Books/38pf7Q9KpsHKGjWZxroQEuJ1OZeOJw8mhssgDKBJGnoAu5C4oKFpoW_kUFGingMuntfG2fm4rVu2grDremJD77xH9P5xgfSFQPvvxcOPgeyD7.pdf (accessed on 10 October 2021).
- Salemme, E.; Salemme, E. List of Annexes. Enforcing European Competition Law through Leniency Programmes in the Light of Fundamental Rights; Nomos Publishing House: Baden-Baden, Germany, 2019; pp. 433–438. [Google Scholar] [CrossRef]
- Ministry of Health (Palestine). Annual Health Report Palestine 2016. Available online: https://www.site.moh.ps/Content/Books/ZxRcynmiUofNqt66u4CrHRgmJR6Uv7z77srjjIEAho6xnz5V3rgLTu_RhO7xf2j2VusNiIvWkjwp84yXHLdGleB97gKrHHI5iZ9oPJ25owGEN.pdf (accessed on 3 May 2022).
- Halahleh, K.; Gale, R.P. Cancer Care in the Palestinian Territories. Lancet Oncol. 2018, 19, e359–e364. [Google Scholar] [CrossRef]
- American Cancer Society. Colorectal Cancer Risk Factors|Hereditary Colorectal Risk Factors. 2020. Available online: https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/risk-factors.html?_ga=2.252543689.1520783277.1654668246-956303421.1654668246 (accessed on 8 June 2022).
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. What Are the Risk Factors for Colorectal Cancer? Division of Cancer Prevention and Control, Centers for Disease Control and Prevention: Atlanta, GA, USA, 2020.
- Qumseya, B.; Tayem, Y.; Dasa, O.; Nahhal, K.; Abu-Limon, I.; Hmidat, A.; Al-Shareif, A.; Hamadneh, M.; Riegert-Johnson, D.; Wallace, M. Colorectal Cancer Screening in Palestine: A National Study in a Medically Underserved Population. Clin. Gastroenterol. Hepatol. Off. Clin. Pract. J. Am. Gastroenterol. Assoc. 2013, 12. [Google Scholar] [CrossRef]
- WHO. Palestine STEPS Survey 2010–2011 Palestine STEPS Survey 2010–2011. 2011. No. March, 2–3. Available online: https://www.who.int/ (accessed on 22 June 2021).
- Sharara, E.; Akik, C.; Ghattas, H.; Makhlouf Obermeyer, C. Physical Inactivity, Gender and Culture in Arab Countries: A Systematic Assessment of the Literature. BMC Public Health 2018, 18, 639. [Google Scholar] [CrossRef]
- Mikki, N.; Abdul-Rahim, H.F.; Shi, Z.; Holmboe-Ottesen, G. Dietary Habits of Palestinian Adolescents and Associated Sociodemographic Characteristics in Ramallah, Nablus and Hebron Governorates. Public Health Nutr. 2010, 13, 1419–1429. [Google Scholar] [CrossRef]
- Block, G.; Gillespie, C.; Rosenbaum, E.H.; Jenson, C. A Rapid Food Screener to Assess Fat and Fruit and Vegetable Intake. Am. J. Prev. Med. 2000, 18, 284–288. [Google Scholar] [CrossRef]
- Free Assessment Tools For Individuals–Wellness–NutritionQuest. Available online: https://www.nutritionquest.com/wellness/free-assessment-tools-for-individuals/fruit-vegetable-fiber-screener/ (accessed on 22 June 2021).
- Degroot, A.M.B.; Dannenburg, L.; Vanhell, J.G. Forward and Backward Word Translation by Bilinguals. J. Mem. Lang. 1994, 33, 600–629. [Google Scholar] [CrossRef]
- Keum, N.N.; Giovannucci, E. Global Burden of Colorectal Cancer: Emerging Trends, Risk Factors and Prevention Strategies. Nat. Rev. Gastroenterol. Hepatol. 2019, 16, 713–732. [Google Scholar] [CrossRef]
- World Cancer Research Fund/American Institute of Cancer Research. Diet, Nutrition, Physical Activity and Colorectal Cancer. Continuous Update Project 2020. Available online: https://www.aicr.org/research/the-continuous-update-project/colorectal-cancer/ (accessed on 22 April 2022).
- Shams-white, M.M.; Brockton, N.T.; Mitrou, P.; Romaguera, D.; Brown, S.; Bender, A.; Kahle, L.L.; Reedy, J. Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations: A Standardized Scoring System. Nutrients 2018, 11, 1572. [Google Scholar] [CrossRef]
- Nucci, D.; Fatigoni, C.; Salvatori, T.; Nardi, M.; Realdon, S.; Gianfredi, V. Association between Dietary Fibre Intake and Colorectal Adenoma: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 4168. [Google Scholar] [CrossRef]
- Hullings, A.G.; Sinha, R.; Liao, L.M.; Freedman, N.D.; Graubard, B.I.; Loftfield, E. Whole Grain and Dietary Fiber Intake and Risk of Colorectal Cancer in the NIH-AARP Diet and Health Study Cohort. Am. J. Clin. Nutr. 2020, 112, 603–612. [Google Scholar] [CrossRef] [PubMed]
- David, L.A.; Maurice, C.F.; Carmody, R.N.; Gootenberg, D.B.; Button, J.E.; Wolfe, B.E.; Ling, A.V.; Devlin, A.S.; Varma, Y.; Fischbach, M.A.; et al. Diet Rapidly and Reproducibly Alters the Human Gut Microbiome. Nature 2014, 505, 559–563. [Google Scholar] [CrossRef] [PubMed]
- Lupton, J.R.; Turner, N.D. Potential Protective Mechanisms of Wheat Bran Fiber. Am. J. Med. 1999, 106, 24S–27S. [Google Scholar] [CrossRef]
- O’Keefe, S.J.D. Diet, Microorganisms and Their Metabolites, and Colon Cancer. Nature reviews. Gastroenterol. Hepatol. 2016, 13, 691–706. [Google Scholar] [CrossRef]
- Wu, G.D.; Chen, J.; Hoffmann, C.; Bittinger, K.; Chen, Y.-Y.; Keilbaugh, S.A.; Bewtra, M.; Knights, D.; Walters, W.A.; Knight, R.; et al. Linking Long-Term Dietary Patterns with Gut Microbial Enterotypes. Science 2011, 334, 105–108. [Google Scholar] [CrossRef]
- Slavin, J.L. Mechanisms for the Impact of Whole Grain Foods on Cancer Risk. J. Am. Coll. Nutr. 2000, 19 (Suppl. S3), 300S–307S. [Google Scholar] [CrossRef]
- Lattimer, J.M.; Haub, M.D. Effects of Dietary Fiber and Its Components on Metabolic Health. Nutrients 2010, 2, 1266–1289. [Google Scholar] [CrossRef]
- Raninen, K.; Lappi, J.; Mykkänen, H.; Poutanen, K. Dietary Fiber Type Reflects Physiological Functionality: Comparison of Grain Fiber, Inulin, and Polydextrose. Nutr. Rev. 2011, 69, 9–21. [Google Scholar] [CrossRef] [PubMed]
- Ruhee, R.T. Dietary Fiber and Its Effect on Obesity: A Review Article. Adv. Med. Res. 2018. [Google Scholar] [CrossRef]
- Terry, P.; Giovannucci, E.; Michels, K.B.; Bergkvist, L.; Hansen, H.; Holmberg, L.; Wolk, A. Fruit, Vegetables, Dietary Fiber, and Risk of Colorectal Cancer. JNCI J. Natl. Cancer Inst. 2001, 93, 525–533. [Google Scholar] [CrossRef]
- Bradbury, K.E.; Appleby, P.N.; Key, T.J. Fruit, Vegetable, and Fiber Intake in Relation to Cancer Risk: Findings from the European Prospective Investigation into Cancer and Nutrition (EPIC). Am. J. Clin. Nutr. 2014, 100 (Suppl. S1), 394S–398S. [Google Scholar] [CrossRef]
- Oh, H.; Kim, H.; Lee, D.H.; Lee, A.; Giovannucci, E.L.; Kang, S.; Keum, N. Different Dietary Fibre Sources and Risks of Colorectal Cancer and Adenoma: A Dose–Response Meta-Analysis of Prospective Studies. Br. J. Nutr. 2019, 22, 605–615. [Google Scholar] [CrossRef] [PubMed]
- WHO. Europe Nutrition-Promoting Fruit and Vegetable Consumption. Available online: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/activities/technical-support-to-member-states/promoting-fruit-and-vegetable-consumption (accessed on 22 April 2022).
- Palestinian, I.T.; Bank, W.; Palestinian, T. Palestinian Household Consumption Trends for Agro-Commodities Study Summary. Available online: https://yplus.ps/wp-content/uploads/2021/01/ARIJ-Palestinian-Agricultural-Production-and-Marketing-between-Reality-and-Challenges.pdf (accessed on 22 April 2022).
Variable | Characteristics | Total Study Population (%) | Cases (%) N = 118 | Controls (%) N = 410 | p-Value |
---|---|---|---|---|---|
Sex | 527 4 | 118 | 409 | ||
Female | 304 (57.7) | 55 (46.6) | 249 (60.9) | 0.006 7 | |
Male | 223 (42.3) | 63 (53.4) | 160 (39.1) | ||
Age (years) | 528 | 118 | 410 | ||
<40 | 159 (30.1) | 11 (9.3) | 148 (36.1) | ||
40–49 | 93 (17.6) | 32 (27.1) | 61 (14.9) | <0.0001 8 | |
50–59 | 148 (28.0) | 37 (31.4) | 111 (27.1) | ||
60–69 | 101 (19.1) | 25 (21.2) | 76 (18.5) | ||
70+ | 27 (5.1) | 13 (11.0) | 14 (3.4) | ||
Smoking status | 527 4 | 117 | 410 | ||
Never | 381 (72.3) | 75 (64.1) | 306 (74.6) | ||
Former | 46 (8.7) | 16 (13.7) | 30 (7.3) | 0.04 8 | |
Current | 100 (19.0) | 26 (22.2) | 74 (18.0) | ||
IBD | 527 4 | 117 | 410 | ||
Yes | 60 (11.4) | 32 (27.4) | 28 (6.8) | <0.0001 7 | |
No | 467 (88.6) | 85 (72.6) | 382 (93.2) | ||
Family history of CRC | 528 | 118 | 410 | ||
Yes | 36 (6.8) | 21 (17.8) | 15 (3.7) | <0.0001 7 | |
No | 492 (93.2) | 97 (82.2) | 395 (96.3) | ||
BMI (kg/m2) | 505 5 | 115 | 390 | ||
Underweight | 4 (0.8) | 0 (0) | 4 (1.0) | ||
Normal | 150 (29.7) | 33 (28.7) | 117 (30.0) | 0.56 8 | |
Overweight | 161 (31.9) | 41 (35.7) | 120 (30.8) | ||
Obese | 190 (37.6) | 41 (35.7) | 149 (38.2) | ||
Years of education | 517 6 | 113 | 404 | ||
≤14 | 137 (26.5) | 33 (29.2) | 104 (25.7) | 0.11 8 | |
15–16 | 87 (16.8) | 25 (22.1) | 62 (15.3) | ||
≥17 | 293 (56.7) | 55 (48.7) | 238 (58.9) | ||
Type II diabetes | 528 | 118 | 410 | ||
Yes | 227 (43.0) | 24 (20.3) | 203 (49.5) | <0.0001 7 | |
No | 301 (57.0) | 94 (79.7) | 207 (50.5) | ||
Physical activity (PA) | 528 | 118 | 410 | ||
Poor | 286 (54.2) | 66 (55.9) | 220 (53.7) | ||
Moderate | 208 (39.4) | 45 (38.1) | 163 (39.8) | 0.90 8 | |
Good | 34 (6.4) | 7 (5.9) | 27 (6.6) | ||
Fruit and vegetable (FV) intake 1 | 527 4 | 118 | 409 | ||
Very low (0–2 servings/d) | 216 (41.0) | 43 (36.4) | 173 (42.3) | ||
Low (3 servings/d) | 88 (16.7) | 21 (17.8) | 67 (16.4) | 0.73 8 | |
Medium (4–5 servings/d) | 104 (19.7) | 25 (21.2) | 79 (19.3) | ||
Adequate (>5 servings/d) | 119 (22.6) | 29 (24.6) | 90 (22.0) | ||
Fiber intake | 527 4 | 118 | 409 | ||
Q1 (6–12 g/d) | 147 (27.9) | 36 (30.5) | 111 (27.1) | ||
Q2 (13–14 g/d) | 102 (19.4) | 23 (19.5) | 79 (19.3) | 0.41 8 | |
Q3 (15–17 g/d) | 140 (26.6) | 35 (29.7) | 105 (25.7) | ||
Q4 (18–39) | 138 (26.2) | 24 (20.3) | 114 (27.9) | ||
Group | 528 | ||||
Cases 2: Diagnosed with CRC | 118 (22.3) | ||||
Controls 3: Not diagnosed with CRC | 410 (77.7) |
Age (>50), y 1 | Male % | Current/ Former Smoker % | IBD % | Family History of CRC % | BMI (Overweight and Obese %) | Education (>17 Years) % | PA (Good) % | |
---|---|---|---|---|---|---|---|---|
Fiber intake | N = 276 1 | N = 223 2 | N = 146 | N = 60 | N = 36 | N = 351 2 | N = 293 | N = 34 1 |
Q1 | 33.09 | 3.60 | 5.48 | 33.33 | 44.44 | 30.86 | 19.11 | 6.06 |
Q2 | 22.55 | 11.26 | 12.33 | 13.33 | 13.89 | 20.00 | 16.04 | 6.06 |
Q3 | 24.00 | 38.29 | 40.41 | 30.00 | 16.67 | 26.00 | 29.01 | 36.36 |
Q4 | 20.36 | 46.85 | 41.78 | 23.33 | 25.00 | 23.14 | 35.84 | 51.52 |
p-value | 0.016 * | <0.0001 * | <0.0001 * | 0.13 | 0.04 * | 0.03 * | <0.0001 * | <0.0001 * |
FV intake | N = 276 2 | N = 223 2 | N = 146 | N = 60 | N = 36 | N = 351 2 | N = 293 | N = 34 1 |
Q1 | 37.82 | 38.29 | 41.10 | 41.67 | 52.78 | 42.57 | 38.57 | 21.21 |
Q2 | 18.18 | 15.32 | 18.49 | 13.33 | 11.11 | 15.43 | 15.02 | 21.21 |
Q3 | 18.55 | 23.42 | 16.44 | 20.00 | 13.89 | 18.00 | 23.21 | 27.27 |
Q4 | 25.45 | 22.97 | 23.97 | 25.00 | 22.22 | 24.00 | 23.21 | 30.30 |
p-value | <0.0001 * | <0.0001 * | <0.0001 * | 0.01 * | 0.001 * | <0.0001 * | <0.0001 * | 0.85 |
Model 1 1 | OR | 95% CI |
---|---|---|
Q 1 | 1.00 | - |
Q 2 | 0.72 | 0.38–1.36 |
Q 3 | 0.65 | 0.33–1.28 |
Q 4 | 0.40 | 0.19–0.85 |
p-value | 0.12 | |
p-trend | 0.02 * | |
Model 2 2 | OR | 95% CI |
Q 1 | 1.00 | - |
Q 2 | 0. 92 | 0.47–1.81 |
Q 3 | 0.79 | 0.39–1.63 |
Q 4 | 0.48 | 0.22–1.06 |
p-value | 0.25 | |
p-trend | 0.07 | |
Model 3 3 | OR | 95% CI |
Q 1 | 1.00 | - |
Q 2 | 0.99 | 0.49–2.01 |
Q 3 | 0.76 | 0.36–1.61 |
Q 4 | 0.36 | 0.15–0.86 |
p-value | 0.07 | |
p-trend | 0.02 * |
Model 1 1 | OR | 95% CI |
---|---|---|
Q 1 | 1.00 | - |
Q 2 | 0.72 | 0.38–1.36 |
Q 3 | 0.66 | 0.33–1.30 |
Q 4 | 0.34 | 0.15–0.75 |
p-value | 0.06 | |
p-trend | 0.009 * | |
Model 2 2 | OR | 95% CI |
Q 1 | 1.00 | - |
Q 2 | 1.49 | 0.78–2.83 |
Q 3 | 1.41 | 0.7–2.61 |
Q 4 | 1.30 | 0.72–2.33 |
p-value | 0.56 | |
p-trend | 0.20 | |
Model 3 3 | OR | 95% CI |
Q 1 | 1.00 | - |
Q 2 | 1.47 | 0.75–2.92 |
Q 3 | 1.52 | 0.80–2.91 |
Q 4 | 1.18 | 0.62–2.25 |
p-value | 0.55 | |
p-Trend | 0.15 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Taha, H.M.; Slade, A.N.; Schwartz, B.; Arthur, A.E. A Case–Control Study Examining the Association of Fiber, Fruit, and Vegetable Intake and the Risk of Colorectal Cancer in a Palestinian Population. Int. J. Environ. Res. Public Health 2022, 19, 7181. https://doi.org/10.3390/ijerph19127181
Taha HM, Slade AN, Schwartz B, Arthur AE. A Case–Control Study Examining the Association of Fiber, Fruit, and Vegetable Intake and the Risk of Colorectal Cancer in a Palestinian Population. International Journal of Environmental Research and Public Health. 2022; 19(12):7181. https://doi.org/10.3390/ijerph19127181
Chicago/Turabian StyleTaha, Hania M., Alexander N. Slade, Betty Schwartz, and Anna E. Arthur. 2022. "A Case–Control Study Examining the Association of Fiber, Fruit, and Vegetable Intake and the Risk of Colorectal Cancer in a Palestinian Population" International Journal of Environmental Research and Public Health 19, no. 12: 7181. https://doi.org/10.3390/ijerph19127181