Consumption of whole grains and cereal fiber in relation to cancer risk: a systematic review of longitudinal studies

Context: Evidence from previous reviews is supportive of the hypothesis that whole grains may protect against various cancers. However, the reviews did not report risk estimates for both whole grains and cereal fiber and only case–control studies were evaluated. It is unclear whether longitudinal studies support this conclusion. Objective: To evaluate associations between whole grains and cereal fiber in relation to risk of lifestyle-related cancers data from longitudinal studies was evaluated. Data Sources: The following 3 databases were systematically searched: PubMed, EMBASE, and Cochrane CENTRAL. Study Selection: A total of 43 longitudinal studies conducted in Europe and North America that reported multivariable-adjusted risk estimates for whole grains (n = 14), cereal fiber (n = 23), or both (n = 6) in relation to lifestyle-related cancers were included. Data Extraction: Information on study location, cohort name, follow-up duration, sample characteristics, dietary assessment method, risk estimates, and confounders was extracted. Data Synthesis: Of 20 studies examining whole grains and cancer, 6 studies reported a statistically significant 6%–47% reduction in risk, but 14 studies showed no association. Of 29 studies examining cereal fiber intake in relation to cancer, 8 showed a statistically significant 6%–49% reduction in risk, whereas 21 studies reported no association. Conclusions: This systematic review concludes that most studies were suggestive of a null association. Whole grains and cereal fiber may protect against gastrointestinal cancers, but these findings require confirmation in additional studies.