11 september 2025: Bron: 2022 Sep 1;15(9):623-634

Uit de 20-jarige placebo gecontroleerde en gerandomiseerde CAPP2 studie met totaal bijna 1.000 deelnemers blijkt dat resistent zetmeel - gefermenteerd zetmeel, dat voorkomt in een breed scala aan voedingsmiddelen zoals haver, ontbijtgranen, gekookte en afgekoelde pasta of rijst, erwten en bonen en lichtgroene bananen een sterk preventieve werking vanuit gaat voor vormen van erfelijke kanker met het Lynch-syndroom. Vooral de bovenste darmen vanaf de maag waaronder slokdarmkanker, maagkanker, galwegkanker, alvleesklierkanker en twaalfvingerige darmkankers blijken heel goed te reageren op dagelijks gebruik van resistent zetmeel in een voedingspatroon. Eerder onderzoek, gepubliceerd als onderdeel van hetzelfde onderzoek, toonde aan dat aspirine het ontstaan van kanker van de dikke darm met 50% verminderde.

"We ontdekten dat resistent zetmeel een reeks vormen van kanker met meer dan 60% vermindert. Het effect was het duidelijkst in het bovenste deel van de darm", aldus professor John Mathers, hoogleraar Humane Voeding aan de Universiteit van Newcastle. "Dit is belangrijk omdat kanker in het bovenste deel van het maag-darmkanaal moeilijk te diagnosticeren is en vaak niet in een vroeg stadium wordt ontdekt. 

Resistent zetmeel is een koolhydraat dat niet in je dunne darm wordt verteerd, maar in je dikke darm fermenteert en zo nuttige darmbacteriën voedt. Het werkt in je spijsverteringsstelsel als voedingsvezels. Dit type zetmeel heeft verschillende gezondheidsvoordelen en minder calorieën dan gewoon zetmeel. We denken dat resistent zetmeel de ontwikkeling van kanker kan verminderen door het bacteriële metabolisme van galzuren te veranderen en de galzuren te verminderen die ons DNA kunnen beschadigen en uiteindelijk kanker kunnen veroorzaken. Dit vereist echter verder onderzoek. Aldus professor John Mathers.  

De CAPP2 studie  is tussen 1999 en 2005 begonnen met bijna 1000 deelnemers die twee jaar lang dagelijks 30 gram resistent zetmeel in poedervorm gebruikten, of aspirine of een placebo. Aan het einde van de behandelfase was er geen algemeen verschil tussen degenen die resistent zetmeel of aspirine hadden gebruikt en degenen die dat niet hadden gedaan. Het onderzoeksteam verwachtte echter een effect op de langere termijn en ontwierp de 10-jarige studie voor verdere follow-up. 

Tijdens de follow-up periode van 10 jaar waren er slechts 5 nieuwe gevallen van kanker van het bovenste deel van het maag-darmkanaal onder de 463 deelnemers die het resistent zetmeel hadden gebruikt, vergeleken met 21 nieuwe gevallen van kanker onder de 455 deelnemers die een placebo kregen.

Het onderzoeksteam leidt nu de internationale studie CaPP3, waaraan meer dan 1800 mensen met het Lynch-syndroom deelnemen. Het team onderzoekt of kleinere, veiligere doses aspirine kunnen worden gebruikt om het risico op kanker te verminderen. Ook het LUMC Leiden doet mee aan deze CAPP3 studie. 

Het volledige studierapport van de CAPP2 studie is gratis te lezen of te downloaden. Klik daarvoor op de titel van het abstract:

Abstract

Abstract: The CAPP2 trial investigated the long-term effects of aspirin and resistant starch on cancer incidence in patients with Lynch syndrome (LS). Participants with LS were randomized double-blind to 30 g resistant starch (RS) daily or placebo for up to 4 years. We present long-term cancer outcomes based on the planned 10-year follow-up from recruitment, supplemented by National Cancer Registry data to 20 years in England, Wales, and Finland. Overall, 463 participants received RS and 455 participants received placebo. After up to 20 years follow-up, there was no difference in colorectal cancer incidence (n = 52 diagnosed with colorectal cancer among those randomized to RS against n = 53 on placebo) but fewer participants had non-colorectal LS cancers in those randomized to RS (n = 27) compared with placebo (n = 48); intention-to-treat (ITT) analysis [HR, 0.54; 95% confidence interval (CI), 0.33-0.86; P = 0.010]. In ITT analysis, allowing for multiple primary cancer diagnoses among participants by calculating incidence rate ratios (IRR) confirmed the protective effect of RS against non-colorectal cancer LS cancers (IRR, 0.52; 95% CI, 0.32-0.84; P = 0.0075). These effects are particularly pronounced for cancers of the upper GI tract; 5 diagnoses in those on RS versus 21 diagnoses on placebo. The reduction in non-colorectal cancer LS cancers was detectable in the first 10 years and continued in the next decade. For colorectal cancer, ITT analysis showed no effect of RS on colorectal cancer risk (HR, 0.92; 95% CI, 0.62-1.34; P = 0.63). There was no interaction between aspirin and RS treatments. In conclusion, 30 g daily RS appears to have a substantial protective effect against non-colorectal cancer cancers for patients with LS.

Prevention relevance: Regular bowel screening and aspirin reduce colorectal cancer among patients with LS but extracolonic cancers are difficult to detect and manage. This study suggests that RS reduces morbidity associated with extracolonic cancers. See related Spotlight, p. 557.

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Figures

Figure 1. Trial profile showing distribution of participants by randomisation group and length of follow-up together with counted outcomes of cancer diagnoses among participants; colorectal cancer = colorectal cancer, LS Ca = Lynch syndrome associated cancers (other than colorectal cancer). colorectal cancer = colorectal cancer; LS Ca = Lynch syndrome associated cancers.
 
Figure 2. Time to first colorectal cancer and time to first non-colorectal cancer Lynch syndrome cancer in all CAPP2 study participants followed up for 10 years and for 20 years in England, Finland, and Wales. Cox proportional hazards (HRs and 95% CIs) comparing those on Resistant Starch vs. those on placebo and depicted by Cumulative incidence curves (n = 918). A, Intention-to-treat analysis (n = 463 Resistant Starch, 455 placebo) by randomisation group. B, Per-protocol analysis of all those achieving 2 years Resistant Starch or placebo (n = 521). C, Intention-to-treat analysis for Non-colorectal cancer Lynch syndrome cancers. D, Per-protocol analysis for non-colorectal cancer Lynch syndrome cancers.

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preventie, CAPP2 studie, placebo, geradomiseerde studie, resistent zetmeel, voedingsmiddelen, haver, ontbijtgranen, gekookte en afgekoelde pasta, rijst, erwten en bonen, lichtgroene bananen, maagkanker, Lynch Syndroom, slokdarmkanker


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