# Improving dietary fiber intake is associated with a declining burden of early-onset colorectal cancer: a three-decade comparative analysis in China and globally

## TL;DR

Higher dietary fiber intake in China over three decades is linked to a significant decline in early-onset colorectal cancer risk compared to global trends.

## Contribution

This study demonstrates that improving dietary fiber intake can effectively reduce the burden of early-onset colorectal cancer in young adults.

## Key findings

- China's dietary fiber intake increased significantly from 5.0 to 23.3 g/day between 1990 and 2018.
- China's attributable EOCRC mortality rate dropped to converge with global levels by 2021.
- The decline in disability-adjusted life years was more pronounced in women in China.

## Abstract

The global incidence of early-onset colorectal cancer (EOCRC) is rising. We compared trends in dietary fiber intake, a key modifiable risk factor, and its attributable EOCRC burden among young adults in China versus globally from 1990 to 2021.

Using data from the GDD and GBD 2021 for adults aged 25–49, we analyzed age-standardized mean fiber intake, summary exposure value (SEV) for low intake, and attributable EOCRC mortality and disability-adjusted life years (DALYs). Trends were quantified using the estimated annual percentage change (EAPC).

Between 1990 and 2018, China’s mean dietary fiber intake increased dramatically from 5.0 to 23.3 g/day (EAPC 5.73%), substantially outpacing the global increase (EAPC 1.41%). This led to a profound reversal in risk exposure; China’s SEV for low fiber declined at nearly twice the global rate (EAPC −2.14% vs −1.15%), falling below the global benchmark after 2005. Consequently, the attributable age-standardized mortality rate in China dropped from 0.15 per 100,000 to converge with the global level of 0.05 by 2021 (EAPC −3.81% vs −2.17% globally). Similar rapid declines occurred for DALYs and were more pronounced in women. Favorable epidemiological changes were the primary driver of this reduction.

China’s success in reducing its EOCRC burden from low dietary fiber highlights nutritional improvement as a potent primary prevention strategy, reinforcing the urgent need to promote fiber-rich diets globally.

The online version contains supplementary material available at 10.1007/s00384-025-05076-5.