Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations:a nested case-control study.

Abstract

OBJECTIVE:

To examine the association between pre-diagnostic circulating vitamin D concentration, dietary intake of vitamin D and calcium, and the risk of colorectal cancer in European populations.

DESIGN:

Nested case-control study. Setting The study was conducted within the EPIC study, a cohort of more than 520 000 participants from 10 western European countries.

PARTICIPANTS:

1248 cases of incident colorectal cancer, which developed after enrolment into the cohort, were matched to 1248 controls

MAIN OUTCOME MEASURES:

Circulating vitamin D concentration (25-hydroxy-vitamin-D, 25-(OH)D) was measured by enzyme immunoassay. Dietary and lifestyle data were obtained from questionnaires. Incidence rate ratios and 95% confidence intervals for the risk of colorectal cancer by 25-(OH)D concentration and levels of dietary calcium and vitamin D intake were estimated from multivariate conditional logistic regression models, with adjustment for potential dietary and other confounders.

RESULTS:

25-(OH)D concentration showed a strong inverse linear dose-response association with risk of colorectal cancer (P for trend <0.001). Compared with a pre-defined mid-level concentration of 25-(OH)D (50.0-75.0 nmol/l), lower levels were associated with higher colorectal cancer risk (<25.0 nmol/l: incidence rate ratio 1.32 (95% confidence interval 0.87 to 2.01); 25.0-49.9 nmol/l: 1.28 (1.05 to 1.56), and higher concentrations associated with lower risk (75.0-99.9 nmol/l: 0.88 (0.68 to 1.13); >or=100.0 nmol/l: 0.77 (0.56 to 1.06)). In analyses by quintile of 25-(OH)D concentration, patients in the highest quintile had a 40% lower risk of colorectal cancer than did those in the lowest quintile (P<0.001). Subgroup analyses showed a strong association for colon but not rectal cancer (P for heterogeneity=0.048). Greater dietary intake of calcium was associated with a lower colorectal cancer risk. Dietary vitamin D was not associated with disease risk. Findings did not vary by sex and were not altered by corrections for season or month of blood donation.

CONCLUSIONS:

The results of this large observational study indicate a strong inverse association between levels of pre-diagnostic 25-(OH)D concentration and risk of colorectal cancer in western European populations. Further randomised trials are needed to assess whether increases in circulating 25-(OH)D concentration can effectively decrease the risk of colorectal cancer.

• Authors: Mazda Jenab, H Bas Bueno-de-Mesquita, Pietro Ferrari, Franzel J B van Duijnhoven, Teresa Norat, Tobias Pischon, Eugène H J M Jansen, Nadia Slimani, Graham Byrnes, Sabina Rinaldi, Anne Tjønneland, Anja Olsen, Kim Overvad, Marie-Christine Boutron-Ruault, Françoise Clavel-Chapelon, Sophie Morois, Rudolf Kaaks, Jakob Linseisen, Heiner Boeing, Manuela M Bergmann, Antonia Trichopoulou, Gesthimani Misirli, Dimitrios Trichopoulos, Franco Berrino, Paolo Vineis, Salvatore Panico, Domenico Palli, Rosario Tumino, Martine M Ros, Carla H van Gils, Petra H Peeters, Magritt Brustad, Eiliv Lund, María-José Tormo, Eva Ardanaz, Laudina Rodríguez, Maria-José Sánchez, Miren Dorronsoro, Carlos A Gonzalez, Göran Hallmans, Richard Palmqvist, Andrew Roddam, Timothy J Key, Kay-Tee Khaw, Philippe Autier, Pierre Hainaut, Elio Riboli
• Journal: BMJ (Clinical research ed.) (BMJ) Vol. 340 Pg. b5500 (Jan 21 2010) ISSN: 1756-1833 [Electronic] England
• PMID: 20093284 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Vitamin D
• Calcium

Topics

• Calcium (administration & dosage)
• Case-Control Studies
• Colorectal Neoplasms (blood, epidemiology)
• Diet
• Dose-Response Relationship, Drug
• Enzyme-Linked Immunosorbent Assay
• Europe (epidemiology)
• Female
• Humans
• Life Style
• Male
• Middle Aged
• Risk Factors
• Vitamin D (administration & dosage, blood)