Position statement - Fibre, wholegrain cereals and cancer

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Position statement - Fibre, wholegrain cereals and cancer

Key messages

  • Consumption of fibre and wholegrain cereal foods are associated with a lower risk of common lifestyle diseases such as obesity, type 2 diabetes and cardiovascular disease. Evidence is now building for the importance of including wholegrain foods regularly in a cancer prevention diet.
  • There is convincing evidence that dietary fibre decreases the risk of bowel cancer, and there is limited suggestive evidence it may also be associated with a lower risk of oesophageal cancer. There is insufficient evidence on dietary fibre to make a conclusion regarding a link with other cancers such as breast, prostate and ovarian.
  • Dietary fibre occurs naturally in foods such as wholegrain cereals, fruit, vegetables, seeds, nuts and legumes. Fibre is the edible part of plants resistant to digestion and absorption in the small bowel of humans. Dietary fibre can also be added to foods such as white bread to increase their fibre content.
  • Wholegrain and wholemeal cereal foods are those that include the outer layers of the grain, including the bran and germ. Products made from wholegrains such as wheat, brown rice, corn, oats, rye, barley, millet and sorghum are an important part of a healthy diet as they are excellent sources of vitamins, minerals, protein, dietary fibre and protective phytochemicals.
  • Dietary fibre is encouraged as part of a varied and nutritious diet. Current recommendations are for women to eat four to six serves of grain foods per day, mostly wholegrain and/or high fibre varieties per day (higher when pregnant or breastfeeding), and for men to eat six serves per day.
  • Cancer Council recommends people eat at least four serves of wholegrain or wholemeal foods every day (or ensure about half their daily serves of breads and cereals are wholegrain or wholemeal varieties) and to eat at least two serves of fruit per day and five serves of vegetables per day including legumes. This advice is consistent with the Australian Dietary Guidelines.
  • As the benefits of fibre may be from the combination of nutrients working together, it is recommended that whole foods be consumed rather than a dietary fibre supplement.


Dietary fibre is found in foods such as wholegrain cereals, fruit, vegetables, seeds, nuts and legumes such as peas, beans and lentils (see Table 1)[1].

Table 1. Average fibre content of different foods{{Cite footnote|Citation:Food Standards Australia and New Zealand 2006}

Food Fibre (g) per 100 g Food Fibre (g) per 100 g
Wheat bran 45.4 Oat bran 15.9
Sunflower seeds, raw 10.8 Date, dried 9.7
Rolled oats 9.5 Almond, raw 8.8
Apricot, dried 7.7 Dark rye bread 7.1
Red kidney bean, canned 6.5 Cashew, raw 5.9
Wholemeal pasta, boiled 5.3 Wholemeal bread 5.0
Wholegrain bread 4.8 Sultanas 4.4
Lentil, boiled 3.7 Broccoli 3.6
White bread 2.8 White pasta, boiled 2.7
Pear, unpeeled 2.4 Apple 2.3
Pumpkin, peeled 1.8 Brown rice, boiled 1.5
White rice, boiled 0.4

The Australia New Zealand Food Standards Code defines fibre as the fraction of the edible parts of plants or their extracts, or synthetic analogues, that are resistant to digestion and absorption in the small bowel, usually with complete or partial fermentation in the large bowel[2].

Dietary fibre includes polysaccharides, oligosaccharides and lignins, and promotes one or more of the following beneficial physiological effects: laxation; reduction in blood cholesterol; and modulation of blood glucose[2]. Dietary fibre can be added to foods such as white bread to increase their fibre content.

Fibre can be categorised into soluble and insoluble fibre. Insoluble fibre, mostly from wheat and wheat products, acts to increase faecal bulk thereby aiding laxation[3]. Soluble fibre, which is found in oats, fruit and vegetables, slows down the release of nutrients thereby helping to modulate glucose absorption[4]. Soluble fibre also stimulates bile acid excretion which can lower cholesterol levels[5].

Dietary fibre, especially soluble non-starch polysaccharides and resistant starch, also promotes anaerobic fermentation in the large bowel resulting in the production of short chain fatty acids and gases such as carbon dioxide, hydrogen and methane[6]. Short chain fatty acids are believed to enhance colonic function and protect against chronic disease. In addition, fibre decreases intracolonic pH, which influences the growth of bacterial populations and this may reduce absorption of carcinogens[7].

Resistant starch, a type of dietary fibre, is that fraction of ingested starch which survives digestion in the human small bowel and passes to the large bowel where it is fermented by the resident microorganisms[7]. Resistant starch is found in certain foods such as beans, cold cooked potatoes, brown rice, green bananas and food ingredients such as wholegrains and high amylose starches[7].

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Wholegrain cereals

Wholegrain and wholemeal cereal foods are generally high in dietary fibre. These are foods that include all fractions (including the bran, germ and endosperm) of grains such as wheat, rice, corn, oats, rye, barley and millet[8].

Examples of wholegrains, consistent with the definition in the Australia New Zealand Food Standards Code are[2]:

  • Whole and intact grains as found in some bread and crisp breads
  • Puffed or flaked grains in some breakfast cereals
  • Coarsely milled or kibbled wheat found in breads such as pumpernickel
  • Ground grains such as whole wheat flour used to make wholemeal bread.

Wholemeal foods are made from wholegrains which have been milled to a finer texture rather than leaving them whole in the final product. Nutritionally, wholegrain and wholemeal foods are similar but wholegrain foods are generally higher in resistant starch.

Wholegrain products contain more fibre, vitamins and minerals, and protective phytochemicals than refined cereal grain foods because many of the potentially beneficial nutrients and phytochemicals occur in the outer layers of grains.

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There is good evidence that the consumption of fibre and wholegrain cereal foods is associated with a lower risk of common lifestyle diseases such as obesity, type 2 diabetes and cardiovascular disease[9].

Cancer risk can be influenced by lifestyle factors such as body weight, physical activity and diet. See the Overweight and Obesity, Physical Activity and Nutrition chapter of the National Cancer Prevention Policy for more information. Evidence is building for the importance of eating a diet high in dietary fibre, including resistant starch and wholegrain foods, in order to help lower the risk of certain cancers.

There has been some confusion regarding the role of fibre in cancer prevention, particularly fibre’s role in the prevention of bowel cancer. Descriptive studies about the role of wholegrain foods in cancer protection date back to the 1930s when a protective association was found between a range of foods, including wholemeal bread, and cancer risk in a UK population[10].

In the 1970s it was hypothesised that dietary fibre protected against bowel cancer, when low rates of the disease were observed in Africa, where fibre intakes were believed to be very high and refined carbohydrate intakes very low[11]. However, subsequent analyses of the diets of African populations at low risk suggest that their intakes of total dietary fibre are not high by international standards but consumption of resistant starch was high[12].

Since then some large observational studies and randomised controlled trials (RCTs) have supported the dietary fibre hypothesis, but others have not. Ecological and animal studies have also shown support for a role of dietary fibre in cancer, specifically bowel cancer prevention.

Methods for measuring cereal food intake have improved over the last decade, and this has provided more reliable epidemiological evidence.

Therefore, it is important for the Cancer Council to evaluate the current evidence regarding dietary fibre and wholegrains, and make clear recommendations based on the available scientific evidence. The evidence for the role of fibre in cancer mostly relates to bowel cancer, and also to breast, prostate, ovarian and oesophageal cancers.

Fruit and vegetables, another good source of dietary fibre, have been assessed in a separate position statement by the Cancer Council: Position statement - Fruit, vegetables and cancer prevention.

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Views on fibre in cancer prevention reports

A comprehensive report from the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) in 2007 analysed the evidence for links between food, nutrition and physical activity, and cancer risk[13]. This report found probable evidence that fibre decreased the risk of bowel cancer (see Figure 1 and Figure 2), and limited suggestive evidence that fibre decreased the risk of oesophageal cancer[13].

The Continuous Update Project, designed to update the findings of the WCRF report with the current body of evidence upgraded the findings to reflect that there is now convincing evidence that dietary fibre decreases bowel cancer risk[14] – the highest level of evidence. In 2009, WCRF estimated that 11–12% of bowel cancer was attributed to low consumption of dietary fibre[15].

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Epidemiological evidence

Bowel cancer

A meta-analysis of 25 prospective studies found that high intake of dietary fibre, particularly cereal fibre and wholegrains, was associated with reduced bowl cancer risk. Ten grams daily of total dietary fibre reduced bowel cancer risk (RR= 0.90, 95% CI= 0.86-0.94), similarly for cereal fibre (RR= 0.90, 95% CI= 0.83-0.97)[16]. Similarly, a second meta-analysis of 40 case-control studies on 20 cancers found an inverse association in nine out of 10 studies for wholegrain intake and risk of bowel cancer or polyps[17].

However, a Cochrane review of RCTs[18] and a cohort study in male smokers[19] found no association between dietary fibre intake and the risk of bowel cancer.

Results from RCTs and observational studies have been mixed for dietary fibre and bowel cancer. Most cohort studies show that dietary fibre decreases the risk of bowel cancer,[20][21][22][23][24][25] while an RCT found a weak protective association between dietary fibre intake and adenomas, the precursors of colon cancer[26].

Figure 1. Results from cohort studies on dietary fibre, for highest versus lowest exposure category, and colorectal cancer reported by WCRF[13]


Figure 2. Results from cohort studies on dietary fibre per 10 g per day, and colorectal cancer reported by WCRF[13]


The European Prospective Investigation into Cancer (EPIC) study found a significant dose dependent inverse association between bowel cancer risk and population specific measures of dietary fibre intake[27]. A pooled analysis of 13 other cohort studies found a weak inverse association between dietary fibre and bowel cancer risk[28]. Female based cohort studies have found a weak inverse association between bowel cancer and dietary fibre[29] and an inverse association for colon cancer and wholegrain consumption[30].

One RCT found a weak positive association between colorectal cancer recurrence and a high fibre diet[31]. A pooled analysis of two other RCTs demonstrated no association between dietary fibre and the risk of adenomas[32].

There have been a few other studies that have not supported the dietary fibre hypothesis[10]. However, in these studies there have been a number of difficulties with the results, including subject compliance with a high fibre diet, failure to separate cereal fibre from legume fibre, and difficulties in drawing relevant conclusions relating to cereal fibre due to differences in fibre content of supplements versus wholefoods.

Some studies have shown that fibre supplements do not protect against recurrent bowel adenomas, and the reason for this is unclear. The Australian Polyp Prevention Trial suggested wheat-bran supplementation was associated with an increased risk of recurrence for adenomas of any size[33]. In addition, a multi-centre study that tested the effect of diet supplementation with ispaghula husk found that it significantly increased the risk of adenoma recurrence[34]. Another trial found that wheat-bran supplementation had no significant protective effect against recurrent bowel adenomas[35].

However, a protective effect of fibre supplementation in the later stages of carcinogenesis cannot be ruled out. In addition, these studies may be showing a differential role for different components of dietary fibre in anti-carcinogenesis that may be worthy of further investigation. Hence further studies are required to address these issues.

In summary, it is reasonable to conclude from the current epidemiological evidence that dietary fibre from food sources convincingly decreases the risk of bowel cancer, in line with WCRF findings[14].

Oesophageal cancer

Results from a single cohort study[36] and several case-control studies[37][38][39][40] indicate that dietary fibre decreases the risk of oesophageal cancer. Another two case-control studies show wholegrain cereal consumption is linked to a lower risk of oesophageal cancer[41][42].

Overall, the limited number of studies on oesophageal cancer show that there is a suggestive link between fibre intake and decreased oesophageal cancer risk.

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Breast cancer

Case-control studies initially indicated an association between dietary fibre and breast cancer risk. Two meta-analyses of prospective studies have confirmed that increased dietary fibre is associated with lower breast cancer risk.

A meta-analysis of 16 prospective studies indicated that high intake of dietary fibre is associated with decreased breast cancer risk (RR= 0.93, 95% CI= 0.89-0.98)[43]. The second meta-analysis of 10 prospective studies demonstrated similar findings, with a lower risk of breast cancer associated with high dietary fibre intake (RR= 0.89, 95% CI= 0.83-0.96)[44].

WCRF conclude that there is limited evidence for a link between dietary fibre and breast cancer risk, with no conclusion possible from current evidence[45].

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Prostate cancer

The EPIC study evaluated the association between dietary fibre intake and prostate cancer risk and found no association (RR per 10 g fiber=0.91, 95% CI= 0.81-1.02)[46]. This is the only prospective study to analyse the link between dietary fibre and prostate cancer.

A multi-centre case-control study in Italy found no association between total fibre and prostate cancer risk[47]. Another case-control study showed that wholemeal bread was marginally protective against prostate cancer in men less than 70 years[48].

Current epidemiological evidence is insufficient to make a conclusion regarding prostate cancer risk and consumption of dietary fibre.

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Ovarian cancer

The relationship between types of fibre and ovarian cancer risk was investigated in an Italian case-control study[49]. A significant protective effect on ovarian cancer incidence was observed in the highest quintile of total fibre intake[49]. An inverse relationship to ovarian cancer risk was found for vegetable fibre, while no effect of fruit fibre was observed and a positive relationship was found for grain fibre[49]. However, the presence of other components in these foods means these results are not a good indication of fibre and cancer risk alone.

As not many epidemiological studies have examined the association, there is insufficient evidence to make a conclusion about ovarian cancer and dietary fibre.

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Potential mechanisms of action

It is likely that the various components of dietary fibre and their associated phytochemicals work in combination to protect against cancer. Possible mechanisms related to fibre and how it may be providing cancer protection include:[10]

  • Increasing stool bulk, which decreases transit time thereby reducing possible exposure of the colonic epithelium to potential carcinogens.
  • Binding toxic or mutagenic metabolites, which may promote cell proliferation.
  • Lowering faecal pH, which prevents the conversion of primary bile acids into secondary acids which are potential carcinogens.
  • Altering bacterial fermentation and increasing short chain fatty acid production (such as butyrate) which promote a normal phenotype in colonocytes.
  • Lowering insulin levels, thereby preventing insulin resistance, as elevated circulating plasma insulin has been associated with bowel and breast cancers.

Other suggested mechanisms include:

  • Antioxidant properties of phytochemicals such as phytates and phenolics, which can prevent the production of active oxygen species and reduce the effects of free radical damage on DNA[10].
  • Cancer inhibitory action of phytosterols, which can help boost immune recognition of cancer, influence hormonal dependent growth of endocrine tumours and alter sterol biosynthesis[50]. In addition, phytosterols can directly inhibit tumour growth by slowing down cell cycle progression, inducing apoptosis and inhibiting tumour metastasis[50].
  • Effect of high fibre wholegrain foods on controlling energy intake and body weight, as they are low in fat and can help increase satiety[8]. Overweight and obesity have been linked to an increased risk of cancer of the endometrium, kidney, breast (only in post-menopausal women), bowel, oesophagus and pancreas[13]. Other cancers also thought to be associated with body weight include cancer of the gallbladder and liver[13].

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Potential adverse effects of consumption

Potential adverse effects of wholegrain foods must be taken in context with the rest of the diet. In theory, wholegrains may reduce the availability of minerals due to the binding of fibre and phytic acid to minerals. However, the consumption of wholegrains within recommended fibre intakes has not shown adverse effects on nutrient mineral status[51].

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As there is evidence for a protective role of dietary fibre and bowel cancer risk, dietary fibre should be encouraged as part of a varied and nutritious diet. Current recommendations in the Nutrient Reference Values from the National Health and Medical Research Council are for women to eat 25 g of dietary fibre per day and men to eat 30 g per day[52].

Substituting wholegrain and wholemeal cereal foods for refined cereal foods in at least half the daily bread and cereal serves could achieve the dietary fibre intake goal*, increase intakes of protective phytochemicals found in the outer grain layers, and therefore contribute to bowel cancer risk reduction. Increasing intake of fruit, vegetables and legumes could also help achieve the dietary fibre intake goal and provide additional important phytochemicals.

Therefore the Cancer Council recommends people aim to:

  • Eat at least four serves of wholegrain or wholemeal foods every day. This means ensuring about half their daily serves of breads and cereals are wholegrain or wholemeal varieties.
  • Eat at least two serves of fruit and five serves of vegetables, including legumes, daily.

This advice is consistent with national recommendations from the National Health and Medical Research Council’s Australian Dietary Guidelines, which recommends people "eat plenty of cereals (including breads, rice, pasta and noodles), preferably wholegrain” and “eat plenty of vegetables, legumes and fruits”[8]. Table 2 shows the number of recommended serves per day of cereal foods for Australian adults.

As the benefits of fibre may be from the combination of nutrients working together, it is recommended that whole foods be consumed rather than a dietary fibre supplement.

Table 2. Number of serves per day of cereal foods (including breads, rice, pasta and noodles) recommended for Australian men and women[8]

Age/status Men Women
19–70 years 6 serves 4–6 serves
70+ years 4½ serves 3 serves
Pregnant or breastfeeding - 8–9 serves

What is a serve?

One serve of cereal or bread equals[8]:

  • 1 slice of bread or ½ a medium roll or flat bread (40 g)
  • ½ cup cooked rice, pasta, noodles, barley, polenta or quinoa (75–120 g)
  • ½ cup cooked porridge (120 g), two thirds of a cup wheat cereal flakes (30 g) or ¼ cup muesli (30 g)
  • 3 crispbreads (35 g)
  • 1 crumpet (60 g) or 1 small English muffin or scone (35 g)
  • ¼ cup flour (30 g)

One serve of fruit equals[8]:

  • One medium piece (150 g) of fruit e.g. apple, banana, orange, pear
  • Two small pieces (150 g) of fruit, e.g. apricot, kiwi fruit, plum
  • One cup (150 g) diced, cooked or canned fruit
  • Half a cup (125 ml) 100% fruit juice
  • 30 g dried fruit e.g. 4 dried apricot halves, 1½ tablespoons of sultanas

One serve of vegetables equals[8]:

  • ½ cup (75 g) cooked green vegetables or orange vegetables, e.g. spinach, carrot
  • ½ cup (75 g) cooked dried or canned beans, chickpeas or lentils
  • ½ cup (75 g) raw vegetables e.g. green leafy vegetables, tomatoes
  • ½ cup (75 g) starchy vegetables e.g. potato, corn

A serve of nuts or seeds** equals[8]:

  • 30 g nuts or seeds
  • 30 g nut/seed paste

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Consumption levels in Australian adults

Dietary survey data shows that Australians are consuming less than the current recommended level of dietary fibre. The National Nutrition Survey showed that in 1995 (the most recent available data), women were eating approximately 20 g of fibre per day and men about 26 g per day, with around 40-45% of this dietary fibre coming from cereal foods[53][54].

Studies have shown that people consuming higher quantities of wholegrain cereals tend to be older, have a higher socio-economic background, are less likely to smoke and more likely to exercise[24][29][55].

Therefore, many Australians need to increase their intake of dietary fibre, and health promotion programs should continue to encourage the consumption of wholegrain foods.

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Future research

Additional studies on fibre, wholegrain cereals and cancer risk are needed. In the future, there is a need for more:

  • Well designed observational studies on diet and cancer.
  • Studies that explore the mechanisms of action of food bio-actives (i.e. investigate different components in wholegrain cereal foods such as lignans, oligosaccharides, amylase and protease inhibitors) to help establish mechanisms of action and thereby supportive evidence of observational effects.
  • Research that helps link knowledge of causal pathways with pathology of cancer at various sites, in particular paying greater attention to the influence of wholegrain cereal intake on cancers at sites other than the colorectum.
  • Investigations into the effect of specific foods in the context of the whole diet (such as the effect of co-consumption of fat and fibre and the impact on cancer risk, whether high wholegrain intake can counteract other negative dietary factors, or if there are specific grains in particular that are more beneficial) and lifestyle factors such as physical activity and the environment.

In addition, food databases need to be updated regularly with regard to the dietary fibre content of foods, and to accurately reflect the wide variety of cereal foods now available. Consumers also need greater assistance to identify wholegrain foods in the market place. Improvements in food labelling to identify wholegrain foods could be one possibility.

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* ↑ People intolerant to gluten may need to consider alternative sources of fibre and should discuss this with their dietitian.

** ↑ Nuts and seeds contain more energy than other high fibre foods.

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Position statement details

This position statement was reviewed and approved by the Public Health Committee November 2008 and updated October 2013.


Narelle McPhee, Nutrition Project Officer at the Cancer Council NSW, assisted in the development of this position statement.

This position statement was reviewed by:

  • Ian Olver
  • Andrew Penman
  • Craig Sinclair
  • Manny Noakes
  • Trevor Lockett
  • David Topping
  • Peter Clifton
  • Linda Tapsell
  • Trish Griffiths
  • Lucy Smith
  • Loren Muhlmann
  • Jenny Atkins
  • Steve Pratt
  • Hayley Erickson
  • Susan Edwards

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