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Clinical Nutrition

The effects of nutritional interventions on recurrence in survivors of colorectal adenomas and cancer: a systematic review of randomised controlled trials

European Journal of Clinical Nutrition volume 70, pages 566–573 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

Nutrition and dietary supplementation may modulate outcomes in colorectal cancer (CRC) survivors. However, no recent systematic review has focused on randomised controlled trials (RCTs). The aim of this systematic review was to examine the effects of nutritional RCTs in survivors of colorectal adenomas and cancer.

Subjects/Methods:

Medline, Embase, Scopus, Web of Science and the Cochrane Library were searched to identify research between April 2006 and January 2014. The primary outcomes were colorectal adenoma and cancer recurrence. Each included study was assessed for risk of bias. A meta-analysis using a random-effects model was performed, in which two or more RCTs investigated the same dietary intervention.

Results:

Eight completed RCTs, all in colorectal adenoma survivors, were identified, with four investigating the effect of folic acid. A meta-analysis of the four folic acid RCTs showed no statistically significant effect of folic acid on colorectal adenoma recurrence (relative risks=0.93; 95% confidence interval: 0.69, 1.25). The impact of the remaining completed RCTs, investigating antioxidant supplementation, green tea extract, prebiotic fibre and phytooestrogens/insoluble fibre, could not be reliably estimated because of the limited number and heterogeneity of the interventions. In addition, three heterogeneous ongoing RCTs were identified, investigating green tea (n=1) and eicosapentaenoic acid (n=1) in colorectal adenoma survivors and dietary modifications (n=1) in CRC survivors in remission.

Conclusions:

Overall, this systematic review highlights the need for further research, especially in CRC survivors, as we identified no completed and only one ongoing RCT in this population.

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References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127: 2893–2917.

    Article  CAS  Google Scholar 

  2. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang X-S et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2014; 385: 977–1010.

    Article  Google Scholar 

  3. Scholefield JH, Steele RJ . Guidelines for follow up after resection of colorectal cancer. Gut 2002; 51: v3–v5.

    Article  Google Scholar 

  4. World Cancer Research Fund/American Institute for Cancer Research Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. American Institute for Cancer Research: Washington, DC, USA, 2007.

  5. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz Al et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 2012; 62: 242–274.

    Article  Google Scholar 

  6. Bekkering T, Beynon R, Davey Smith G, Davies A, Harbord R, Sterne J et al A systematic review of randomized controlled trials investigating the effect of nutritional and physical activity interventions on cancer survival, updated report World Cancer Research Fund, 2006. Available at www.dietandcancerreport.org/cancer_resource_center/downloads/SLR/Cancer_survivors_SLR.pdf (accessed on 28 March 2014).

  7. World Cancer Research Fund/American Institute for Cancer Research Continuous Update Project Report. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. American Institute for Cancer Research: Washington, DC, USA, 2011.

  8. Vrieling A, Kampman E . The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature. Am J Clin Nutr 2010; 92: 471–479.

    Article  CAS  Google Scholar 

  9. van Meer S, Leufkens AM, Bueno-de-Musquita HB, van Duijnhovan FJB, van Oijen MGH, Siersema PD . Role of dietary factors in survival and mortality of colorectal cancer: a systematic review. Nutr Rev 2013; 71: 631–641.

    Article  Google Scholar 

  10. Pekmezi D, Demark-Wahnefried W . Updated evidence in support of diet and exercise interventions in cancer survivors. Acta Oncol 2011; 50: 167–178.

    Article  Google Scholar 

  11. Davies NJ, Batehup L, Thomas R . The role of diet and physical activity in breast, colorectal and prostate cancer survivorship: a review of the literature. Br J Cancer 2011; 05: S52–S73.

    Article  Google Scholar 

  12. Davies N, Thomas R, Batehup L . Advising Cancer Survivors About Lifestyle: A Selective Review of the Evidence, 2010. Available at www.ncsi.org.uk/wp-content/uploads/Lifestyle-Review.pdf (accessed on 28 March 2014).

  13. Leslie A, Carey FA, Pratt NR, Steele RJ . The colorectal adenoma-carcinoma sequence. Br J Surg 2002; 89: 845–860.

    Article  CAS  Google Scholar 

  14. Velicier CM, Ulrich CM . Vitamin and mineral supplement use among US adults after cancer diagnosis: a systematic review. J Clin Oncol 2008; 26: 665–667.

    Article  Google Scholar 

  15. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Ann Intern Med 2009; 151: W-65–W-94.

    Article  Google Scholar 

  16. Higgins JPT, Green S . Cochrane handbook for systematic reviews of interventions version 5.1. 0 [updated March 2011]. Available at http://handbook.cochrane.org/ (accessed on 28 March 2014).

  17. Review Manager (RevMan). [Computer Programme]. Version 5.3. The Nordic Cochrane Centre, The Cochrane Collaboration: Copenhagen, Denmark, 2014.

  18. Cole BF, Baron JA, Sandler RS, Haile RW, Ahnen DG, Bresalier RS et al. Folic acid for the prevention of colorectal adenomas: a randomized clinical trial. JAMA 2007; 297: 2351–2359.

    Article  CAS  Google Scholar 

  19. Logan RFA, Grainge MJ, Shepherd VC, Armitage NC, Muir KR . Aspirin and folic acid for the prevention of recurrent colorectal adenomas. Gastroenterology 2008; 134: 29–38.

    Article  CAS  Google Scholar 

  20. Jaszewski R, Misra S, Tobi M, Ullah N, Naumoff JA, Kucuk O et al. Folic acid supplementation inhibits recurrence of colorectal adenomas: a randomized chemoprevention trial. World J Gastroenterol 2008; 14: 4492–4498.

    Article  CAS  Google Scholar 

  21. Wu K, Platz EA, Willett WC, Fuchs CS, Selhub J, Rosner BA et al. A randomized trial on folic acid supplementation and risk of recurrent colorectal adenoma. Am J Clin Nutr 2009; 90: 1623–1631.

    Article  CAS  Google Scholar 

  22. Bonelli L, Puntoni M, Gatteschi B, Massa P, Missale G, Munizzi F et al. Antioxidant supplement and long-term reduction of recurrent adenomas of the large bowel. A double-blind randomized trial. J Gastroenterol 2013; 48: 698–705.

    Article  CAS  Google Scholar 

  23. Shimizu M, Fukutomi Y, Ninomiya M, Nagura K, Kato T, Araki H et al. Green tea extracts for the prevention of metachronous colorectal adenomas: a pilot study. Cancer Epidemiol Biomarkers Prev 2008; 17: 3020–3025.

    Article  CAS  Google Scholar 

  24. Limburg PJ, Mahoney MR, Allen Ziegler KL, Sontag SJ, Schoen RE, Benya R et al. Randomized phase II trial of sulindac, atorvastatin, and prebiotic dietary fiber for colorectal cancer chemoprevention. Cancer Prev Res 2011; 4: 259–269.

    Article  CAS  Google Scholar 

  25. Principi M, Leo AD, Pricci M, Scavo MP, Guido R, Tanzi S et al. Phytoestrogens/insoluble fibers and colonic estrogen receptor β: randomized, double-blind, placebo-controlled study. World J Gastroenterol 2013; 19: 4325–4333.

    Article  Google Scholar 

  26. Stingl JC, Ettrich T, Muche R, Wiedom M, Brockmöller J, Seeringer A et al. Protocol for minimizing the risk of metachronous adenomas of the colorectum with green tea extract (MIRACLE): a randomised controlled trial of green tea extract versus placebo for nutriprevention of metachronous colon adenomas in the elderly population. BMC Cancer 2011; 11: 360.

    Article  CAS  Google Scholar 

  27. Hull MA, Sandell AC, Montgomery AA, Logan RFA, Clifford GM, Rees CJ et al. A randomized controlled trial of eicosapentaenoic acid and/or aspirin for colorectal adenoma prevention during colonoscopic surveillance in the NHS Bowel Cancer Screening Programme (The seAFOod Polyp Prevention Trial): study protocol for a randomized controlled trial. Trials 2013; 14: 237.

    Article  CAS  Google Scholar 

  28. Ho JWC, Lee AM, MacFarlane DJ, Fong DYT, Leung S, Cerin E et al. Study protocol for "Moving Bright, Eating Smart" - a phase 2 clinical trial on the acceptability and feasibility of a diet and physical activity intervention to prevent recurrence in colorectal cancer survivors. BMC Public Health 2013; 13: 487.

    Article  Google Scholar 

  29. Carroll C, Cooper K, Papaioannou D, Hind D, Tappenden P, Pilgrim H et al. Meta-analysis: folic acid in the chemoprevention of colorectal adenomas and colorectal cancer. Aliment Pharmacol Ther 2010; 31: 708–718.

    Article  CAS  Google Scholar 

  30. Figueirdo JC, Mott LA, Giovannucci E, Wu K, Cole B, Grainge MJ et al. Folic acid and prevention of colorectal adenomas: a combined analysis of randomized clinical trials. Int J Cancer 2011; 129: 192–203.

    Article  Google Scholar 

  31. Fife J, Raniga S, Hider PN, Frizelle FA . Folic acid supplementation and colorectal cancer risk: a meta-analysis. Colorectal Dis 2010; 13: 132–137.

    Article  Google Scholar 

  32. Ju J, Hong J, Zhou JN, Pan Z, Bose M, Liao J et al. Inhibition of intestinal tumorigenesis in Apcmin/+ mice by (-)-epigallocatechin-3-gallate, the major catechin in green tea. Cancer Res 2005; 65: 10623–10631.

    Article  CAS  Google Scholar 

  33. Issa AY, Volate SR, Muga SJ, Nitcheva D, Smith T, Wargovich MJ . Green tea selectively targets initial stages of intestinal carcinogenesis in the AOM-Apcmin mouse model. Carcinogenesis 2007; 28: 1978–1984.

    Article  CAS  Google Scholar 

  34. Boehm K, Borrelli F, Ernst E, Habacher G, Hung SK, Milazzo S et alGreen tea (Camellias sinensis for the prevention of cancer. Cochrane Database Syst Rev 2009; (8): CD005004.

  35. Sun CL, Yuan JM, Koh WP, Yu MC . Green tea, black tea and colorectal cancer risk: a meta-analysis of epidemiological studies. Carcinogenesis 2006; 27: 1301–1309.

    Article  CAS  Google Scholar 

  36. Martinez ME, Jacobs ET, Baron JA, Marshall JR, Byers T . Dietary supplements and cancer prevention: balancing potential benefits against proven harms. J Natl Cancer Inst 2012; 104: 732–773.

    Article  CAS  Google Scholar 

  37. Kim YI . Folate and carcinogenesis: evidence, mechanisms and implications. J Nutr Biochem 1999; 10: 66–88.

    Article  CAS  Google Scholar 

  38. Egger M, Juni P, Bartlett C, Holenstein F, Sterne J . How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Executive Summary. Health Technol Assess 2003; 7: 1.

    CAS  PubMed  Google Scholar 

  39. WCRF/IARC. Systematic Literature Review Specification Manual (version 15) (no date). Available at http://www.dietandcancerreport.org/cancer_resource_center/downloads/SLR_Manual.pdf (accessed on 28 April 2014).

  40. Greenhalgh T . How to read a paper: getting your bearings (deciding what the paper is about). BMJ 1997; 315: 234–246.

    Google Scholar 

  41. Fung T, Hu FB, Fuchs C, Giovannucci E, Hunter DJ, Stampfer MJ et al. Major dietary patterns and the risk of colorectal cancer in women. Arch Intern Med 2003; 163: 309–314.

    Article  Google Scholar 

  42. Wu K, Hu FB, Fuchs C, Rimm EB, Willett WC, Giovannucci E . Dietary patterns and risk of colon cancer and adenoma in a cohort of men (United States). Cancer Causes Control 2004; 15: 853–862.

    Article  Google Scholar 

  43. Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Hu FB, Mayer RJ et al. Association of dietary patterns with cancer recurrence and survival in patients with stage II colon cancer. JAMA 2007; 298: 754–764.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Diabetes and Nutritional Sciences Division, King’s College London, School of Medicine, Franklin-Wilkins Building, London, UK

    M van Dijk & G K Pot

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  1. M van Dijk
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Correspondence to G K Pot.

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van Dijk, M., Pot, G. The effects of nutritional interventions on recurrence in survivors of colorectal adenomas and cancer: a systematic review of randomised controlled trials. Eur J Clin Nutr 70, 566–573 (2016). https://doi.org/10.1038/ejcn.2015.210

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