Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas
Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas
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DOI：
10.1056/nejm200004203421602
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发表时间：
2000-04-20
影响因子：
158.5
通讯作者：
Fales, L
中科院分区：
文献类型：
--
作者：
Alberts, DS;Martínez, ME;Fales, L
背景：大肠癌和大肠腺瘤是大肠癌的前体病变，其发病风险被认为受饮食因素的影响。流行病学证据表明，谷物纤维可以预防结直肠癌是模棱两可的。我们进行了一项随机试验，以确定饮食中补充麦麸纤维是否能降低结直肠腺瘤的复发率。方法：我们将1429名年龄在40至80岁之间，在招募前三个月内切除过一个或多个组织学证实的结直肠腺瘤的男性和女性随机分配到一个有监督的饮食补充计划中，（每天13.5克）或少量（每天2克）麦麸纤维。主要终点是随访结肠镜检查时是否有新的腺瘤。受试者和医生，包括结肠镜检查，不知道组assignments.Results：在1303名受试者谁完成了研究，719人被随机分配到高纤维组和584低纤维组。高纤维组从随机化到最后一次随访结肠镜检查的中位时间为34个月，低纤维组为36个月。到最后一次随访结肠镜检查时，在高纤维组的338名受试者（47.0%）和低纤维组的299名受试者（51.2%）中至少发现了一个腺瘤。与低纤维组相比，高纤维组腺瘤复发的多变量校正比值比为0.88（95%置信区间为0.70 ~ 1.11; P=0.28），根据腺瘤数量，高纤维组与低纤维组相比，复发的相对风险为0.99（95%可信区间，0.71 ~ 1.36; P=0.93）结论：在本研究中，膳食补充麦麸纤维不能预防结直肠腺瘤复发。（N Engl J Med 2000;342：1156-62。）(C)2000年，马萨诸塞州医学会。
Background: The risks of colorectal cancer and adenoma, the precursor lesion, are believed to be influenced by dietary factors. Epidemiologic evidence that cereal fiber protects against colorectal cancer is equivocal. We conducted a randomized trial to determine whether dietary supplementation with wheat-bran fiber reduces the rate of recurrence of colorectal adenomas.Methods: We randomly assigned 1429 men and women who were 40 to 80 years of age and who had had one or more histologically confirmed colorectal adenomas removed within three months before recruitment to a supervised program of dietary supplementation with either high amounts (13.5 g per day) or low amounts (2 g per day) of wheat-bran fiber. The primary end point was the presence or absence of new adenomas at the time of follow-up colonoscopy. Subjects and physicians, including colonoscopists, were unaware of the group assignments.Results: Of the 1303 subjects who completed the study, 719 had been randomly assigned to the high-fiber group and 584 to the low-fiber group. The median times from randomization to the last follow-up colonoscopy were 34 months in the high-fiber group and 36 months in the low-fiber group. By the time of the last follow-up colonoscopy, at least one adenoma had been identified in 338 subjects in the high-fiber group (47.0 percent) and in 299 subjects in the low-fiber group (51.2 percent). The multivariate adjusted odds ratio for recurrent adenoma in the high-fiber group, as compared with the low-fiber group, was 0.88 (95 percent confidence interval, 0.70 to 1.11; P=0.28), and the relative risk of recurrence according to the number of adenomas, in the high-fiber group as compared with the low-fiber group, was 0.99 (95 percent confidence interval, 0.71 to 1.36; P=0.93).Conclusions: As used in this study, a dietary supplement of wheat-bran fiber does not protect against recurrent colorectal adenomas. (N Engl J Med 2000;342:1156-62.) (C) 2000, Massachusetts Medical Society.