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Original Investigation
June 16, 2021

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

Author Affiliations
  • 1Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
  • 2Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
  • 3Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands
  • 4Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, the Netherlands
  • 5Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, the Netherlands
  • 6Department of Surgery, Hospital Group Twente ZGT, Almelo, the Netherlands
JAMA Surg. 2021;156(9):827-835. doi:10.1001/jamasurg.2021.2311
Key Points

Question  Is habitual preoperative dietary fiber intake associated with risk of complications after surgery for colorectal cancer?

Findings  In this cohort study of 1399 patients with colorectal cancer who underwent surgery, higher habitual dietary fiber intake before surgery was associated with a lower risk of any postoperative complications and surgical postoperative complications. Among patients with an anastomosis, dietary fiber intake was not associated with risk of anastomotic leakage.

Meaning  The findings suggest that improving preoperative dietary fiber intake may be considered as a strategy in future prehabilitation programs for patients undergoing surgery for colorectal cancer.

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.

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