Influence of Methodologic Factors in a Pooled Analysis of 13 Case-Control Studies of Colorectal Cancer and Dietary Fiber

We examined the study design features and data collection methods from 13 case-control studies of colorectal cancer and diet, which had been previously combined and analyzed, to determine whether they influenced the results obtained from a pooled analysis. We assessed the methods used in each study, estimated a quality score, and used random effects models to re-estimate the pooled odds ratio for the association between dietary fiber and colorectal cancer for these data. Key features of the methods used in each study and the quality score were examined in random effects models to determine whether the heterogeneity found between study-specific risk estimates could be explained by these variables. The odds ratio for dietary fiber and colorectal cancer was 0.46 (95% confidence interval = 0.34-0.64) for the 13 case-control studies as estimated with a random effects model. Two factors, whether the diet questionnaire had been validated before use in the case-control study and whether qualitative data on dietary habits and cooking methods had been incorporated into the nutrient estimation, explained some of the heterogeneity found between studies. Risk estimates for dietary fiber and colorectal cancer were closer to the null for the studies that had these two characteristics. Quality score did not explain any between-study heterogeneity. Random effects models, which included fixed effects covariates, explained some between-study heterogeneity in these data and would be useful for future pooled analyses.