caa a22 4500 397564449 CHVBK 20180308164824.0 cr unu---uuuuu 161202e19960117xx s 000 0 eng 10.1093/jnci/88.2.81 doi (NATIONALLICENCE)oxford-10.1093/jnci/88.2.81 Randomized, Double-Blinded, Placebo-Controlled Study of Effect of Wheat Bran Fiber and Calcium on Fecal Bile Acids in Patients With Resected Adenomatous Colon Polyps [Elektronische Daten] [David S. Alberts, Cheryl Ritenbaugh, Jon A. Story, Mikel Aickin, Shirley Rees-McGee, Mary Klein Buller, Jan Atwood, John Phelps, P. S. Ramanujam, Sharad Bellapravalu, Jagdish Patel, Lawrence Bettinger, Larry Clark] Background: Ongoing epidemiologic and nutritional studies suggest that colorectal carcinogenesis is consistent with complex interactions between genetic susceptibility and environmental and dietary factors. Among the dietary components found to reduce colon cancer risk are high intakes of dietary fiber and calcium. Purpose: We designed and conducted a randomized, double-blinded, placebo-controlled trial involving supplementation of the customary dietary intake with fiber and calcium and measurements of fecal bile acids to examine the potential mechanisms by which added dietary interventions might reduce colorectal cancer risk. Methods: In a randomized, double-blinded, phase II study, we used a factorial design to measure the effects of dietary wheat bran fiber (2.0 or 13.5 g/day) in the form of cereal and supplemental calcium carbonate (250 or 1500 mg/day elemental calcium) taken as a tablet on fecal bile acid concentrations and excretion rates. Measurements were made at base-line randomization (i.e., after a 3-month placebo run-in period using 2.0 g wheat bran fiber plus 250 mg calcium carbonate) and after 3 and 9 months on treatment in a randomly selected 52-patient subsample of the 95 fully assessable study participants who had a history of colon adenoma resection. Concentrations of fecal bile acids, total, primary (i.e., chenodeoxycholic and cholic), and secondary (i.e., deoxycholic, lithocholic, and ursodeoxycholic), were measured in 72-hour stool samples by gas-liquid chromatography. All P values resulted from two-sided tests. Results: All geometric mean fecal bile acid concentrations and excretion rates were lower at 9 months than at 0 months or 3 months on treatment in the high-dose fiber, high-dose calcium, and high-dose fiber/high-dose calcium treatment groups. The high-dose fiber effect at 9 months of supplementation was statistically significant with respect to virtually all geometric mean fecal bile acid concentrations and excretion rates. For example at 9 months versus 0 months, high-dose fiber supplementation caused a reduction in fecal concentrations of total bile acids (52% reduction; P = .001) and deoxycholic acid (48% reduction; P = .003). High-dose calcium supplementation also had a significant, but lower, effect at 9 months versus 0 months on the geometric mean total bile acid (35% reduction; P = .044) and deoxycholic fecal bile acid (36% reduction; P = .052) concentrations. Conclusions: High-dose wheat bran fiber and calcium carbonate supplements given for 9 months are associated with statistically significant reductions in both total and secondary fecal bile acid concentrations and excretion rates in patients with resected colon adenomas. This study supports the hypothesis that one of the important ways in which a high intake of wheat bran fiber and calcium may reduce the risk of colorectal neoplasia and cancer is by reduction of the concentrations of fecal bile acids. Implication: Phase III studies of these agents in the prevention of adenoma recurrence are necessary to confirm this hypothesis and have now been initiated at multiple institutions. [J Natl Cancer Inst 1996; 88: 81-92] © Oxford University Press ARTICLES nationallicence Alberts David S. Department of Medicine and Arizona Cancer Center, University of Arizona Tucson aut Ritenbaugh Cheryl Department of Family and Community Medicine and Arizona Cancer Center, University of Arizona Tucson aut Story Jon A. Departments of Foods and Nutrition, Purdue University Lafayette, IN aut Aickin Mikel Department of Family and Community Medicine and Arizona Cancer Center, University of Arizona Tucson aut Rees-McGee Shirley College of Nursing, Arizona State University Tempe aut Buller Mary Klein Arizona Cancer Center, University of Arizona Tucson aut Atwood Jan School of Public Health, University of North Carolina Chapel Hill aut Phelps John Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ aut Ramanujam P. S. Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ aut Bellapravalu Sharad Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ aut Patel Jagdish Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ aut Bettinger Lawrence Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ aut Clark Larry Department of Family and Community Medicine and Arizona Cancer Center, University of Arizona Tucson aut JNCI: Journal of the National Cancer Institute Oxford University Press 88/2(1996-01-17), 81-92 0027-8874 88:2<81 1996 88 jnci https://doi.org/10.1093/jnci/88.2.81 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/jnci/88.2.81 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Alberts David S. Department of Medicine and Arizona Cancer Center, University of Arizona Tucson aut NATIONALLICENCE 700 1- Ritenbaugh Cheryl Department of Family and Community Medicine and Arizona Cancer Center, University of Arizona Tucson aut NATIONALLICENCE 700 1- Story Jon A. Departments of Foods and Nutrition, Purdue University Lafayette, IN aut NATIONALLICENCE 700 1- Aickin Mikel Department of Family and Community Medicine and Arizona Cancer Center, University of Arizona Tucson aut NATIONALLICENCE 700 1- Rees-McGee Shirley College of Nursing, Arizona State University Tempe aut NATIONALLICENCE 700 1- Buller Mary Klein Arizona Cancer Center, University of Arizona Tucson aut NATIONALLICENCE 700 1- Atwood Jan School of Public Health, University of North Carolina Chapel Hill aut NATIONALLICENCE 700 1- Phelps John Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ aut NATIONALLICENCE 700 1- Ramanujam P. S. Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ aut NATIONALLICENCE 700 1- Bellapravalu Sharad Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ aut NATIONALLICENCE 700 1- Patel Jagdish Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ aut NATIONALLICENCE 700 1- Bettinger Lawrence Gastroenterology Laboratory, Walter O. Boswell Memorial Hospital Sun City, AZ aut NATIONALLICENCE 700 1- Clark Larry Department of Family and Community Medicine and Arizona Cancer Center, University of Arizona Tucson aut NATIONALLICENCE 773 0- JNCI: Journal of the National Cancer Institute Oxford University Press 88/2(1996-01-17), 81-92 0027-8874 88:2<81 1996 88 jnci Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford