{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:58:56Z","timestamp":1790963936324,"version":"4.1.0"},"reference-count":61,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Colorectal cancer (CRC) survivors frequently report bowel-related symptoms, but longitudinal data are scarce and diet has not been extensively investigated in relation to bowel-related symptoms.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the prevalence of bowel-related symptoms as well as their association with dietary fiber intake until 5 years after CRC diagnosis.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This prospective cohort study using data from the Colorectal Cancer: Longitudinal, Observational Study on Nutritional and Lifestyle Factors (COLON) study included CRC survivors with stage I-IV disease recruited at diagnosis from 11 hospitals in the Netherlands between August 2010 and February 2020. CRC survivors were followed up until 5 years after diagnosis. Data were analyzed between April 2024 and March 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Clinical data including CRC treatment strategy, retrieved from hospital records and national registries, and habitual dietary fiber intake, assessed by a food frequency questionnaire, at 6 months, 2 years, and 5 years after CRC diagnosis.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Prevalence of self-reported diarrhea, constipation, flatulence or bloating, frequent stools, mucus in stools, or false urgency at 6 months, 2 years, and 5 years after diagnosis, obtained via a questionnaire. The validated European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) was also used to evaluate prevalence of moderate-to-severe diarrhea or constipation and health-related quality of life (HRQOL) at these time points. Odds ratios (ORs) for associations between fiber intake and bowel-related symptoms (yes or no) were calculated using multivariable logistic regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 1751 CRC survivors who underwent surgery and were included in the analysis, median age at diagnosis was 66 years (IQR, 61-71 years), and 1115 (63.7%) were men. Bowel-related symptoms were reported by 817 of 1751 survivors (46.7%) at 6 months, 614 of 1511 (40.6%) at 2 years, and 290 of 812 (35.7%) at 5 years after diagnosis. At 6 months after diagnosis, symptoms were predominantly reported by survivors who had received chemotherapy (260 of 446 [58.3%]), whereas symptoms at 2 and 5 years occurred mostly in those who received radiotherapy (86 of 160 [53.8%] at 2 years and 47 of 92 [51.1%] at 5 years). Of the studied bowel-related symptoms, diarrhea was associated with the lowest HRQOL score (B, \u22129.6; 95% CI, \u221214.0 to \u22125.2) at 5 years after diagnosis. In multivariable logistic regression analyses, higher fiber intake (per 10-g\/d increment) was associated with a significantly lower prevalence of moderate-to-severe diarrhea at 6 months (OR, 0.44; 95% CI, 0.28-0.70) and 2 years (OR, 0.53; 95% CI, 0.30-0.94) after diagnosis, but the association was not statistically significant at 5 years (OR, 0.43; 95% CI, 0.16-1.13).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of CRC survivors, the prevalence of bowel-related symptoms was considerably high during the 5 years after diagnosis, highlighting a need for effective symptom management. Higher dietary fiber intake was associated with a lower prevalence of diarrhea, suggesting a potential role of diet in management of bowel-related symptoms in CRC survivors.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.42147","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T16:30:51Z","timestamp":1762792251000},"page":"e2542147","source":"Crossref","is-referenced-by-count":5,"title":["Bowel-Related Symptoms and Dietary Fiber Intake in Colorectal Cancer Survivors"],"prefix":"10.1001","volume":"8","author":[{"given":"Niels","family":"Klaassen-Dekker","sequence":"first","affiliation":[{"name":"Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben J. 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Tjarda","family":"van Heek","sequence":"additional","affiliation":[{"name":"Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands"},{"name":"Department of Surgery, Gelderse Vallei Hospital, Ede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flip M.","family":"Kruyt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gelderse Vallei Hospital, Ede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Valgaeren","sequence":"additional","affiliation":[{"name":"Department of Dietetics, Gelderse Vallei Hospital, Ede, the Netherlands"},{"name":"Nutrition and Healthcare Alliance, Gelderse Vallei Hospital, Ede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elske C.","family":"Gootjes","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"R\u00fctten","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"van \u2018t Veer","sequence":"additional","affiliation":[{"name":"Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate M.","family":"Winkels","sequence":"additional","affiliation":[{"name":"Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e4nzel J. 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