LETTER
Diet and Colorectal Adenomatous Polyps
Ajay Anand
15 August 1993 | Volume 119 Issue 4 | Page 343
TO THE EDITOR:
The study by Neugut and colleagues [1] represents an important advance in our understanding of the role of diet in the multistep progression to colorectal cancer.
The investigators state that three case–control studies have explored the association of adenomatous polyps with diet. I would like to draw their attention to a study by Kune and colleagues [2] that compared 49 patients who had one or more histologically confirmed adenomatous polyps larger than 1 cm in diameter with a community control group. Those with adenomatous polyps were found to have a low fiber and vegetable intake (P = 0.04); in men, a high intake of beef (P = 0.04), milk drinks (P = 0.01), and beer (P = 0.05) was noted. The authors concluded that both dietary factors and alcohol consumption may play a role in the development of colorectal adenomatous polyps and that these factors are similar to dietary risk factors for colorectal cancer.
Furthermore, dietary modifications have been shown to affect the proliferation rate of colonic mucosal cells [3]. Another study [4] has shown that modification of fat intake in humans can affect cell proliferation, as measured by mucosal cell thymidine uptake and ornithine decarboxylase activity. An interesting recent report [5] showed that fecal diglycerides, normally present in the colonic lumen, enhance mitogenesis in adenoma and carcinoma cells but have no effect on normal colonic mucosa. This finding may indicate that the carcinogenic effect of dietary factors may depend, at least in part, on an inherited predisposition that makes the normal mucosa susceptible to the carcinogenic effects of the diet.
1. Neugut AI, Garbowski GC, Lee WC, Murray T, Nieves JW, Forde KA, et al. Dietary risk factors for the incidence and recurrence of colorectal adenomatous polyps: a case–control study. Ann Intern Med. 1993; 118:91-5.
2. Kune GA, Kune S, Read A, MacGowan K, Penfold C, Watson LF. Colorectal polyps, diet, alcohol and family history of colorectal cancer: a case–control study. Nutr Cancer. 1991; 16:25-30.
3. Lipkin M, Newmark H. Effect of added dietary calcium on colonic epithelial-cell proliferation in subjects at high risk for familial colonic cancer. N Engl J Med. 1985; 313:1381-4.
4. Shike M, Al-Sabbagh MR, Friedman E, et al. The effect of dietary fat on human colonic cell proliferation. Gastroenterology. 1991; 100: A401.
5. Friedman E, Isaksson P, Rafter J, Marian B, Winawer S, Newmark K. Fecal diglycerides as selective endogenous mitogens for premalignant and malignant human colonic epithelial cells. Cancer Res. 1989; 49:544-8.
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