Association of Habitual Preoperative Dietary Fiber Intake With Complications After Colorectal Cancer Surgery

Dieuwertje E Kok, Melissa N N Arron, Tess Huibregtse, Flip M Kruyt, Dirk Jan Bac, Henk K van Halteren, Ewout A Kouwenhoven, Evertine Wesselink, Renate M Winkels, Moniek van Zutphen, Fränzel J B van Duijnhoven, Johannes H W de Wilt, Ellen Kampman, Dieuwertje E Kok, Melissa N N Arron, Tess Huibregtse, Flip M Kruyt, Dirk Jan Bac, Henk K van Halteren, Ewout A Kouwenhoven, Evertine Wesselink, Renate M Winkels, Moniek van Zutphen, Fränzel J B van Duijnhoven, Johannes H W de Wilt, Ellen Kampman

Abstract

Importance: Postoperative complications are associated with increased morbidity and mortality among patients with colorectal cancer. As a modifiable factor associated with gut health, dietary fiber intake is of interest with regard to the risk of complications after surgery for colorectal cancer.

Objective: To examine the association between preoperative dietary fiber intake and risk of complications after surgery for colorectal cancer.

Design, setting, and participants: This cohort study used data from the Colorectal Longitudinal, Observational Study on Nutritional and Lifestyle Factors (COLON) study, which recruited adult patients with colorectal cancer at any stage at diagnosis from 11 hospitals in the Netherlands between August 2010 and December 2017. The present study included patients with stage I to IV colorectal cancer who underwent elective abdominal surgery. Data were analyzed between December 2019 and September 2020.

Exposures: Habitual dietary fiber intake was assessed at diagnosis using a 204-item food frequency questionnaire.

Main outcomes and measures: Any complications, surgical complications, and anastomotic leakage occurring during the 30 days after surgery for colorectal cancer. The association between fiber intake and risk of postoperative complications was assessed using logistic regression analyses. Additional analyses stratified by sex, tumor location, and fiber source were performed.

Results: Among the 1399 patients included in the analysis, the median age at inclusion was 66 years (interquartile range, 61-72 years) and 896 (64%) were men. Any complications occurred in 397 patients (28%), and surgical complications occurred in 235 patients (17%). Of 1237 patients with an anastomosis, 67 (5%) experienced anastomotic leakage. Higher dietary fiber intake (per 10 g per day) was associated with a lower risk of any complications (odds ratio [OR], 0.75; 95% CI, 0.62-0.92) and surgical complications (OR, 0.76; 95% CI, 0.60-0.97), whereas no association with anastomotic leakage was found (OR, 0.97; 95% CI, 0.66-1.43). Among women, higher dietary intake was associated with any complications (OR, 0.64; 95% CI, 0.44-0.94), whereas there was no association among men (OR, 0.79; 95% CI, 0.63-1.01). Fiber intake from vegetables (per 1 g per day) was inversely associated with any (OR, 0.90; 95% CI, 0.83-0.99) and surgical (OR, 0.87; 95% CI, 0.78-0.97) complications.

Conclusions and relevance: In this cohort study, higher habitual dietary fiber intake before surgery was associated with a lower risk of postoperative complications among patients with colorectal cancer. The findings suggest that improving preoperative dietary fiber intake may be considered in future prehabilitation programs for patients undergoing surgery for colorectal cancer.

Conflict of interest statement

Conflict of Interest Disclosures: Mrs van Zutphen reported receiving grants from the Dutch Cancer Society outside the submitted work. Dr de Wilt reported receiving grants from the Dutch Cancer Society, the Netherlands Organisation for Health Research and Development, Roche, and Covidien outside the submitted work. No other disclosures were reported.

Figures

Figure 1.. Flow Diagram of Patients With…
Figure 1.. Flow Diagram of Patients With Colorectal Cancer Who Underwent Elective Abdominal Tumor Resection
COLON indicates Colorectal Longitudinal, Observational Study on Nutritional and Lifestyle Factors study; HIPEC, hyperthermic intraperitoneal chemotherapy. aOf 1250 patients with anastomosis.
Figure 2.. Associations Between Fiber Intake From…
Figure 2.. Associations Between Fiber Intake From Different Sources and Risk of Postoperative Complications
Analyses were adjusted for age, sex, smoking status, American Association of Anesthesiologists classification, and tumor location and were mutually adjusted for dietary fiber intake of other sources. Cereal fiber was further adjusted for fruit fiber and vegetable fiber. Whole grain fiber was further adjusted for refined grain fiber, fruit fiber, and vegetable fiber. Refined grain fiber was further adjusted for whole grain fiber, fruit fiber, and vegetable fiber. Fruit fiber was further adjusted for vegetable fiber, whole grain fiber, and refined grain fiber. Vegetable fiber was further adjusted for fruit fiber, whole grain fiber, and refined grain fiber. Markers indicate odds ratios per 1 g per day increase in fiber intake, with horizontal lines indicating 95% CIs.

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