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Dietary Risk Factors for the Incidence and Recurrence of Colorectal Adenomatous Polyps: A Case-Control Study

Alfred I. Neugut, MD, PhD; Gail C. Garbowski, MPH; Won Chul Lee, MD; Todd Murray, BA; Jeri W. Nieves, MS; Kenneth A. Forde, MD; Michael R. Treat, MD; Jerome D. Waye, MD; and Cecilia Fenoglio-Preiser, MD
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From the College of Physicians and Surgeons, Columbia University, and the Mount Sinai School of Medicine, New York, New York; University of Cincinnati Medical Center, Cincinnati, Ohio. Requests for Reprints: Alfred I. Neugut, MD, PhD, Division of Oncology, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032. Grant Support: In part by grants from the National Cancer Institute (RO1-CA37196) and the Aaron Diamond Foundation. Dr. Neugut was the recipient of a Preventive Oncology Academic Award (KO7-CA01211) from the National Institutes of Health and was a Fellow of the Andrew Mellon Foundation Program in Epidemiology and Medicine at Columbia University.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(2):91-95. doi:10.7326/0003-4819-118-2-199301150-00002
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Objective: To investigate the association of dietary factors with the incidence and recurrence of colorectal adenomatous polyps.

Design: Two case–control studies.

Setting: Three university-based colonoscopy practices in New York City.

Patients: For the incidence study, 286 patients with pathologically confirmed incident adenomatous polyps (162 men and 124 women) were compared with 480 controls (210 men and 270 women) with no current or previous neoplasia. For the recurrence study, 186 patients with recurrent polyps (130 men and 56 women) were compared with 330 controls (187 men and 143 women). These patients had a history of polyps but no current neoplasia.

Measurements: Structured interviews using the Block food frequency questionnaire were conducted on all participants and were compared over quartiles of crude nutrient intake of total and saturated fat; fiber; protein; carbohydrates; carotene; vitamins A, C, and E; and various food groups. Data were adjusted for age, Quetelet index, and caloric intake by multiple logistic regression for men and women separately.

Results: For incident polyps, elevated adjusted odds ratios (high to low quartile) for women were found for saturated fat (odds ratio, 2.3; 95% CI, 0.9 to 5.8) and the ratio of red meat to chicken and fish intake (odds ratio, 1.9; CI, 1.0 to 3.6). Protective associations were observed for fish and chicken (odds ratio, 0.6; CI, 0.3 to 1.2) and vitamin A intake (odds ratio, 0.4; CI, 0.2 to 0.9). Among women, recurrent polyps showed an association with total dietary fat (odds ratio, 4.4; CI, 1.0 to 19.5), saturated fat (odds ratio, 3.8; CI, 1.0 to 14.9; P = 0.15 for the trend), and total fiber (odds ratio, 0.2; CI, 0.1 to 0.5; P = 0.01) and a borderline association with carbohydrates (odds ratio, 0.3; CI, 0.1 to 1.3; P = 0.10). No consistent relations were observed for men, although increased caloric intake increased the risk for incidence and recurrence in both men and women.

Conclusions: These findings are consistent with previously described relations between diet and the incidence of colon cancer and suggest that, at least in women, dietary modification may be warranted in patients diagnosed with polyps.





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