Calcium supplementation for the prevention of colorectal adenomas: A systematic review and meta-analysis of randomized controlled trials

Bonovas, Stefanos; Fiorino, Gionata; Lytras, Theodore; Malesci, Alberto; Danese, Silvio

doi:10.3748/wjg.v22.i18.4594

Cited by 42 publications

(29 citation statements)

References 67 publications

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“…In a 2016 meta-analysis of 4 randomized, controlled trials of the efficacy of supplemental calcium on reducing colorectal adenoma recurrence, the summary RR was 0.89 (95% CI, 0.82-0.96; ref. 42). In a 2014 meta-analysis of 4 prospective cohort studies of a magnesium-colorectal cancer association, the summary RR among those in the highest relative to the lowest category of magnesium intake was 0.78 (95% CI, 0.66-0.92; ref.…”

Section: Discussionmentioning

confidence: 99%

Combined Mineral Intakes and Risk of Colorectal Cancer in Postmenopausal Women

Swaminath

Prizment

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Despite considerable biological plausibility, other than for calcium, there are few reported epidemiologic studies on mineral intake-colorectal cancer associations, none of which investigated multiple minerals in aggregate.Methods: Accordingly, we incorporated 11 minerals into a mineral score and investigated its association with incident colorectal cancer in the Iowa Women's Health Study, a prospective cohort study of 55-to 69-year-old women who completed a food frequency questionnaire in 1986. In the analytic cohort (n ¼ 35, 221), 1,731 incident colorectal cancer cases were identified via the State Health Registry of Iowa. Participants' calcium, magnesium, manganese, zinc, selenium, potassium, and iodine intakes were ranked 1 to 5, with higher ranks indicating higher, potentially anticarcinogenic, intakes, whereas for iron, copper, phosphorus, and sodium intakes, the rankings were reversed to account for their possible procarci-nogenic properties. The rankings were summed to create each woman's mineral score. The mineral score-incident colorectal cancer association was estimated using multivariable Cox proportional hazards regression.Results: There was decreasing risk with an increasing score (P trend ¼ 0.001). The hazard ratios and 95% confidence intervals (CI) for those in mineral score quintiles 2 to 5 relative to those in the lowest were 0.91 (CI, 0.88-1.08), 0.85 (CI, 0.75-0.95), 0.86 (CI, 0.75-0.97), and 0.75 (CI, 0.71-0.95), respectively.Conclusions: Our findings suggest that a predominance of putative anti-relative to pro-colorectal carcinogenic mineral intakes may be inversely associated with colorectal cancer risk.Impact: These results support further investigation of colorectal cancer etiology using composite mineral intake scores.

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Section: Discussionmentioning

confidence: 99%

Combined Mineral Intakes and Risk of Colorectal Cancer in Postmenopausal Women

Swaminath

Prizment

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…[ 6 – 8 ] The results of previous meta-analyses regarding the association between calcium intake and colorectal adenoma risk have not always been consistent. [ 8 – 12 ] Four previous meta-analyses of RCTs [ 8 – 11 ] that have examined the effect of supplemental calcium compared with placebo on adenoma recurrence demonstrated moderate to larger protective effects (20–26% relative risk reduction). However, the latest one [ 12 ] does not demonstrate a greater protective effect (only 11–13% relative risk reduction) for calcium.…”

Section: Introductionmentioning

confidence: 99%

“…Meta-analyses including the latest one, merely considered some bias components, [ 10 ] included trials with high or unclear risk of bias in the meta-analyses [ 10 , 12 ] and did not GRADE the evidence. [ 9 – 11 ] It is recommended that review authors do not combine studies at different risk of bias in analyses.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the latest meta-analysis [ 12 ] used all subjects from a recent randomized controlled trial (RCT) [ 15 ] who received calcium and placebo with or without vitamin D, rather than the number of subjects who received calcium alone and placebo in the analysis. Since the data on the number of subjects who received calcium alone and placebo were available from the recent RCT, the use of these data in a meta-analysis which compares calcium against placebo appear to be more meaningful.…”

Section: Introductionmentioning

confidence: 99%

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Effects of calcium on the incidence of recurrent colorectal adenomas

et al. 2017

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“…Recent randomized controlled trials (RCTs)16,17 have demonstrated the moderate beneficial effect of low-dose aspirin on the incidence of adenomas. Similarly, evidence from good quality RCTs46–48 suggests a possible protective effect of calcium supplementation on the recurrence of adenomas, without important adverse effects 49. However, evidence of the comparative advantage of low-dose aspirin and calcium with other potential CPAs on adenoma recurrence is necessary to justify the continuous growth of these agents in this era of stagnant screening acceptance,9,50 limited endoscopic capacity51 and rising health care expenditures 52…”

Section: Introductionmentioning

confidence: 99%

Effects of chemopreventive agents on the incidence of recurrent colorectal adenomas: a systematic review with network meta-analysis of randomized controlled trials

Veettil

Teerawattanapong

Ching³

et al. 2017

OTT

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BackgroundProtective effects of several chemopreventive agents (CPAs) against colorectal adenomas have been well documented in randomized controlled trials (RCTs); however, there is uncertainty regarding which agents are the most effective.MethodsWe searched for RCTs published up until September 2016. Retrieved trials were evaluated using risk of bias. We performed both pairwise analysis and network meta-analysis (NMA) of RCTs to compare the effects of CPAs on the recurrence of colorectal adenomas (primary outcome). Using NMA, we ranked CPAs based on efficacy.ResultsWe identified 20 eligible RCTs enrolling 12,625 participants with a history of colorectal cancer or adenomas who were randomly assigned to receive either a placebo or one of 12 interventions. NMA using all trials demonstrated that celecoxib 800 mg/day (relative risk [RR] 0.61, 95% confidence interval [CI] 0.45–0.83), celecoxib 400 mg/day (RR 0.70, 95% CI 0.55–0.87), low-dose aspirin (RR 0.75, 95% CI 0.59–0.96) and calcium (RR 0.81, 95% CI 0.69–0.96) were significantly associated with a reduction in the recurrence of any adenomas. NMA results were consistent with those from pairwise meta-analysis. The evidence indicated a high (celecoxib), moderate (low-dose aspirin) and low (calcium) Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality. NMA ranking showed that celecoxib 800 mg/day and celecoxib 400 mg/day were the best CPAs, followed by low-dose aspirin and calcium. Considering advanced adenoma recurrence, only celecoxib 800 mg/day and celecoxib 400 mg/day were demonstrated to have a protective effect (RR 0.37, 95% CI 0.27–0.52 vs RR 0.48, 95% CI 0.38–0.60, respectively).ConclusionThe available evidence from NMA suggests that celecoxib is more effective in reducing the risk of recurrence of colorectal adenomas, followed by low-dose aspirin and calcium. Since cyclooxygenase-2 (COX-2) inhibitors (eg, celecoxib) are associated with important cardiovascular events and gastrointestinal harms, more attention is warranted toward CPAs with a favorable benefit-to-risk ratio, such as low-dose aspirin and calcium.

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Calcium supplementation for the prevention of colorectal adenomas: A systematic review and meta-analysis of randomized controlled trials

Abstract: Our results suggest a modest chemopreventive effect of calcium supplements against recurrent colorectal adenomas over a period of 36 to 60 mo. Further research is warranted.

Cited by 42 publications

References 67 publications

Combined Mineral Intakes and Risk of Colorectal Cancer in Postmenopausal Women

Combined Mineral Intakes and Risk of Colorectal Cancer in Postmenopausal Women

Effects of calcium on the incidence of recurrent colorectal adenomas

Effects of chemopreventive agents on the incidence of recurrent colorectal adenomas: a systematic review with network meta-analysis of randomized controlled trials

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