Higher Dietary Fiber Intake Before Surgery Associated With Lower Risk for Postoperative Complications in CRC Patients

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Researchers evaluated the association between preoperative dietary fiber intake and risk for complications following surgery for colorectal cancer.

Among patients with colorectal cancer (CRC), higher habitual dietary fiber intake before surgery was associated with a lower risk for postoperative complications, according to study results published in JAMA Surgery.

A team of investigators from the Netherlands conducted a cohort study on patients with CRC (N=1399) evaluating the association between preoperative dietary fiber intake and risk for complications following surgery for CRC.

The researchers used data from the Colorectal Longitudinal, Observational Study on Nutritional and Lifestyle Factors (COLON) study. Between August 2010 and December 2017, adult patients with CRC (at any stage of diagnosis) were recruited from 11 hospitals in the Netherlands for the COLON study. In this current study, the study cohort consisted of patients with stage I to IV CRC who underwent elective abdominal surgery. Data were analyzed between December 2019 and September 2020.

Habitual dietary fiber intake was assessed via a self-administered and semi-quantitative 204-item food frequency questionnaire (FFQ). The FFQ was completed shortly after cancer diagnosis. For this study, the main outcomes were any complications, surgical postoperative complications, and anastomotic leakage.

The median age of the study participants was 66 years (interquartile range [IQR], 61-72 years), and 896 (64%) were men. The majority of the patients had a diagnosis of colon cancer (956 patients; 68%) vs rectal cancer (443 patients; 32%).

The researchers found that any complications occurred in 397 patients (28%) and surgical complications occurred in 235 patients (17%). Among the 1237 patients with an anastomosis, anastomotic leaks occurred in 67 patients (5%).

In adjusted logistic regression analyses, higher dietary fiber intake (per 10 g per day) was associated with a lower risk for 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). In patients with an anastomosis, intake of fiber was not associated with occurrence of anastomotic leakage (OR, 0.97; 95% CI, 0.66-1.43).  

In stratified analyses, higher dietary fiber intake was associated with a lower risk for any postoperative complications among women (OR, 0.64; 95% CI, 0.44-0.94), but 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 determined to be 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.

This study had several limitations. There were a modest number of events, particularly for surgical complications and anastomotic leakage. Thus, statistical power to conduct stratified and sensitivity analyses for these outcomes was limited. Additionally, for some patients, data on dietary exposure (fiber intake n=125) or clinical outcomes (complications n=70) were not found. Finally, the possibility of residual confounding cannot be ruled out due to the observational design of the study.

According to the data, higher habitual dietary fiber intake prior to surgery was associated with a reduced risk for any or surgical postoperative complications in patients with CRC. Dietary fiber intake was not associated with an increased risk for anastomotic leakage in patients with anastomosis.

According to the study authors, “The findings suggest that improving preoperative dietary fiber intake may be considered in future prehabilitation programs for patients undergoing surgery for CRC.”  

Disclosure: Some study authors declared affiliations with the industry. Please see the original reference for a full list of authors’ disclosures.

Disclosure: This research was supported by multiple sources. Please see the original reference for a full list of disclosures.


Kok DE, Arron MNN, Huibregtse T, et al. Association of habitual preoperative dietary fiber intake with complications after colorectal cancer surgery. JAMA Surg. Published on June 16, 2021. doi:10.1001/jamasurg.2021.2311