A large-scale epidemiologic study, published in The Journal of Nutrition, suggests that a group of fermentable dietary compounds, collectively known as FODMAPs, may promote inflammation and subsequent increased cancer risk.
Chronic intestinal inflammation is a known risk factor for irritable bowel syndrome, inflammatory bowel disease, and colorectal cancer. While various dietary factors are already well-known proinflammatory influences, less thoroughly investigated dietary components merit attention for their role in inflammation as well. Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, collectively referred to as FODMAPs, may contribute to localized inflammatory states that could then expand at a systemic level and lead to cancer development at various other sites, apart from the colon-rectum.
Low-FODMAP diets are increasingly recommended by health professionals and are gaining popularity among individuals with intestinal disorder symptoms. However, this practice remains controversial because eliminating major food groups from the diet can lead to lower intakes for some nutrients, in particular fiber.
To bridge this knowledge gap, Charlotte Debras, Mathilde Touvier and colleagues, at the French National Institute for Health and Medical Research (Inserm) and Sorbonne Paris Nord University investigated the associations between FODMAP intake (total and type) and cancer risk (overall, breast, prostate, and colorectal) in the large prospective NutriNet-Santé cohort study (launched in 2009) that included 104,909 adult participants without cancer at baseline. Baseline dietary intakes were obtained from repeated 24-hour dietary records at baseline and every 6 months during follow-up, which enabled researchers to capture dietary intakes at different times of the year. Total FODMAP intake and type-specific FODMAP content were assessed using the NutriNet-Santé food composition database containing total and type-specific FODMAP contents. Associations between FODMAP intake (expressed in quintiles) and cancer risks were assessed. Health status was reported at baseline and every 6 months. Cancer cases were verified by medical experts and all first primary cancers diagnosed between baseline and January 2020 were considered cases.
Dairy products, FODMAP-rich fruit, and sweet foods were the main contributors to FODMAPs, accounting for 47%, 22%, and 11% of the total intake, respectively. During follow-up, 3374 incident cancer cases were diagnosed, including 982 breast, 405 prostate, and 272 colorectal cancers. Total FODMAP intake was associated with higher overall cancer risk and oligosaccharides were associated with increased colorectal cancer risk for quintile 5 compared with quintile 1. Modifications in gut microbiota, after rapid fermentation of FODMAPs, and inflammation-related mechanisms may be involved in these associations.
Nutrition.org/June 18, 2022