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Science Nook: Habitual Preoperative Fiber Intake and Complications After CRC Surgery

by Jenna Koroly, MS, RD, CSOWM, CDN

With surgery being the most common treatment for those with colorectal cancer (CRC), decreasing risk of post-surgical complications is key [Brouwer et al., 2018 as cited in reference i]. Research suggests that post-surgical complications may in part be related to impaired gut health [Stavrou et al., 2017 and Schietroma et al., 2017 as cited in reference i]. Due to its relation to gut health, fiber intake presents a promising focus of study. In the below study, the authors explore the relationship between dietary fiber intake and postoperative complications in individuals with CRC [i].


Association of habitual preoperative dietary fiber intake with complications after colorectal cancer surgery

JAMA Surgery

This prospective cohort study included 1399 individuals from the Colorectal Longitudinal, Observational Study on Nutritional and Lifestyle Factors (COLON) study. Participants were from 11 hospitals in the Netherlands with CRC planning elective abdominal surgery. Participants completed FFQs after diagnosis on their dietary intake during the 1 month prior to diagnosis. Dietary fiber was looked at per 10 grams per day as well as in tertiles, and the source of fiber (fruits, vegetables, cereals, whole grains, refined grains) was also studied. Outcomes were any complications, surgical complications, and anastomotic leakage 30 days after CRC surgery [i].


The authors found:

1. Higher dietary fiber intake was associated with lower risk of any complications and surgical complications

2. There was no association between higher dietary fiber intake and anastomotic leakage

3. Higher dietary fiber intake was associated with lower risk of any complications in women, but no association was found in men

4. When looking at the different sources of fiber, the associations were the strongest with fiber coming from vegetables [i]

For the Patient and Caregiver

The recommendation for daily fiber intake in the United States is 21 grams for women over 50, 25 grams for women 50 and under, 30 grams for men over 50, and 38 grams for men 50 and under. Increasing fiber intake allows individuals to feel more satisfied after eating, as well as improve cholesterol levels, regulate blood sugar, and promote gut health. Add fiber to your eating pattern using our recipes. When looking at nutrition facts labels, 2 grams of fiber per serving is a good source, and 3 or more grams of fiber per serving is a great source. The below sample day provides 29 grams of fiber.

High Fiber Sample Day

Breakfast: Oatmeal made with ½ cup dry old fashioned oats (4 g fiber), ¾ cups water, 1 Tbsp almond butter (1.5 g fiber), ⅓ cup plain Greek yogurt, 1 cup frozen blueberries (6 g fiber), 1 tsp cinnamon

Lunch: Bento box with 2 hard boiled eggs, ⅓ avocado (3 g fiber), 1 oz mixed nuts (1 g fiber), 1 plum (1.5 g fiber)

Snack: 2 wasa crackers (6 g fiber), 1 oz cheese, 4 slices cucumber

Dinner: 3 oz grilled chicken, 1 cup baby spinach (1 g fiber), 2 Tbsp pumpkin seeds (1 g fiber), ½ sweet potato with the skin (2 g fiber), 2 Tbsp hummus (2 g fiber)

For the Healthcare Team

This research offers an opportunity to consider a preoperative protocol related to fiber intake for individuals with CRC. Further research is needed to elucidate how timing fiber intake may be the most beneficial for postoperative outcomes. For example, in this study, fiber intake in the 1 month prior to diagnosis was evaluated. However, it would be important to consider if outcomes could benefit if fiber intake was increased in the weeks leading up to surgery, even if fiber intake was lower previously.


[i] Kok DE, Arron MNN, Huibregtse T, Kruyt FM, Bac DJ, van Halteren HK…Kampman E (2021). Association of habitual preoperative dietary fiber intake with complications after colorectal cancer surgery. JAMA Surgery, 156(9):827-835. https://doi.org/10.1001/jamasurg.2021.2311

  1. Very interesting study Jenna. Also interesting that the vegetable source had more of an impact than whole grains. Why do you think that might be?

    1. Hi Marla, perhaps related to different phytochemicals and antioxidants in vegetables and whole grains. Thank you for reading!

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