Calcium Intake and Risk of Colon Cancer in Women and Men

Wu, Kana; Willett, Walter C.; Fuchs, Charles S.; Colditz, Graham A.; Giovannucci, Edward

doi:10.1093/jnci/94.6.437

Cited by 328 publications

(267 citation statements)

References 56 publications

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“…In the Cancer Prevention Study II Nutrition cohort, 9 the protective effect of total calcium was associated with intakes of over 1,255 mg/day compared to those of below 561 mg/day. The analysis of the NHS and HPFS data, 11 both of which had an interquintile range of the same magnitude (<500 mg to >1,250 mg/day), also found a protective effect of calcium on distal cancer risk. In contrast, no calcium effect was found in the Finnish study, where calcium intake was high (bottom quartile <1,178 mg).…”

Section: Discussionmentioning

confidence: 81%

“…9 A recent pooled analysis 12 of 10 cohort studies (not including the CPSN cohort) found a significant protective effect of calcium on colorectal cancer risk. Three case-control studies, 10,25,26 but not a fourth, 27 found similar results, but 2 cohort studies 11,28 failed to confirm them. Few studies have reported results on the association between calcium and risk of colorectal adenoma.…”

Section: Discussionmentioning

confidence: 82%

“…6 Although a meta-analysis 8 concluded that calcium had no protective effect on colorectal tumours, prospective studies and large case-control studies subsequently found a modestly beneficial effect. [9][10][11] Recently the Pooling Project, a pooled analysis of 10 prospective studies, 12 showed a significant protective effect of calcium and milk on colorectal cancer risk.Additional information has become available from recent intervention trials, 13-15 which suggested a protective effect of calcium supplementation on the risk of colorectal adenoma recurrence, but the level of calcium required for adenoma chemoprevention has yet to be defined. We prospectively studied the association between the intake of dietary calcium, phosphorus, vitamin D and/ or dairy products and the risk of adenomatous polyps and colorectal cancer among women participating in the E3N-EPIC study.…”

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Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study

et al. 2005

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A protective effect of calcium and/or dairy products on colorectal cancer has been reported in epidemiological studies but the findings are considered inconsistent. In particular, it is unclear whether they act at a particular step of the adenoma-carcinoma sequence. To investigate the effect of dairy product consumption and dietary calcium, vitamin D and phosphorus intake on the adenoma-carcinoma sequence in the French E3N-EPIC prospective study. The population for the study of risk factors for adenomas was composed of 516 adenoma cases, including 175 high-risk adenomas, and of 4,804 polyp-free subjects confirmed by colonoscopy. The population for the colorectal cancer study was composed of 172 cases and 67,312 cancer-free subjects. Diet was assessed using a self-administered questionnaire completed at baseline. There was a trend of decreasing risk of both adenoma (p trend 5 0.04) and cancer (p trend 50.08) with increasing calcium intake, with RRs for adenoma and cancer of 0.80 (IC 95%50.62-1.03) and 0.72 (95% CI50.47-1.10), respectively, in the fourth quartile compared to the first. A protective effect of dairy products on adenoma (RR Q4 vs. Q1 5 0.80, 95% CI50.62-1.05, p trend 5 0.04) was observed and of milk consumption on colorectal cancer (RR Q4vs. Q1 5 0.54, 95% CI50.33-0.89, p trend 5 0.09), although the latter did not reach significance. Phosphorus intake also decreased the risk of adenoma (RR Q4 vs. Q1 50.70, 95% CI50.54-0.90, p trend 5 0.005). No vitamin D effect was identified. Our data support the hypothesis that calcium, dairy products and phosphorus exert a protective effect at certain steps of the adenoma-carcinoma sequence. ' 2005 Wiley-Liss, Inc.Key words: colorectal cancer; colorectal adenoma; calcium; vitamin D; phosphorus; dairy productThe idea that an intake of calcium and vitamin D might protect against colorectal cancer was first suggested by Newmark et al. 1 In experimental studies, low calcium diets have consistently been associated with increased cell proliferation and low cell differentiation. 2 It has therefore been suggested that calcium acts directly on epithelial cell proliferation and differentiation, as well as indirectly by forming insoluble soaps with secondary bile acids, although this point has never been formally demonstrated. 2,3 Vitamin D plays a major role in the homeostasis of calcium and 2 studies have also suggested that it reduces epithelial cell proliferation and promotes differentiation. 2,4 It has been further suggested that polymorphisms of the vitamin D receptor (VDR) might modulate this effect. 5 However, findings from epidemiological studies on the relationship between calcium or dairy product intake and risk of colorectal adenoma or/and of cancer were judged inconsistent in 2 reviews, 6,7 except for a steady protective effect of dairy product reported in cohort studies. 6 Although a meta-analysis 8 concluded that calcium had no protective effect on colorectal tumours, prospective studies and large case-control studies subsequently found a modestly beneficial ...

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 82%

mentioning

confidence: 99%

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confidence: 99%

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Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study

et al. 2005

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“…[6][7][8][9] Ecological studies correlating sunlight exposure with cancer incidence provided the first evidence that vitamin D levels are inversely related to CRC development in humans. 10 Subsequent epidemiological studies have reported lower risks of CRA and CRC in individuals with high intakes and circulating levels of vitamin D. [11][12][13][14] Vitamin D plays a crucial role in calcium metabolism, and there is experimental, 15,16 epidemiologic [17][18][19] and clinical trial 20,21 data indicating that high calcium intake may also lower colorectal neoplasia risk. Furthermore, there is evidence that vitamin D and calcium may act together to reduce CRA recurrence.…”

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Dairy products, polymorphisms in the vitamin D receptor gene and colorectal adenoma recurrence

Muir

Liu

Logan

et al. 2008

Intl Journal of Cancer

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Vitamin D receptor (VDR) activation inhibits proliferation and angiogenesis in the colorectal epithelium, and inhibits metastasis of colorectal tumors. Polymorphisms in the VDR gene alter receptor cellular levels and functioning, and may confer altered susceptibility to colorectal neoplasia. We aimed to investigate the influence of VDR polymorphisms and dietary factors impacting on vitamin D metabolism on colorectal adenoma (CRA) recurrence. Data on dietary intakes of calcium, vitamin D and dairy products were collected from 853 participants in the United Kingdom Colorectal Adenoma Prevention trial, a randomized trial of aspirin and folate for CRA recurrence prevention. The VDR Cdx2, FokI, BsmI, ApaI and TaqI polymorphisms were genotyped in 546 participants with available DNA, and gene-diet interaction analyses performed in 480. Dairy product intake was inversely related to CRA recurrence risk independent of calcium and vitamin D [relative risk (RR) 5 0.64; 95% confidence intervals (CIs): 0.47-0.88, for subjects in the highest compared to lowest intake tertile, p trend 5 0.005]. Milk accounted for 60% of dairy product intake, and on analysis of milk and nonmilk dairy products separately recurrence risk in individuals in the highest tertile of milk intake was half that of lowest tertile individuals (RR 5 0.52; 95% CI: 0.38-0.72, p trend 5 3.2 3 10 25 ), whereas nonmilk dairy products did not influence recurrence. VDR polymorphism genotypes and haplotypes did not directly alter recurrence risk, but the reduction in risk associated with high dairy product intake was confined to individuals with ApaI aA/AA genotype (p interaction 5 0.02). These findings indicate dairy products, and in particular milk, have chemopreventive activity against CRA recurrence. ' 2008 Wiley-Liss, Inc.Key words: colorectal adenoma recurrence; dairy products; VDR; polymorphism Colorectal cancer (CRC) is the third commonest cancer worldwide after lung and breast cancer, and two-thirds of CRC occurs in developed countries. 1 Up to 90% of CRCs develop from colorectal adenomas (CRAs) and colonoscopic removal of CRA reduces the incidence of CRC. 2,3 In some individuals, the recurrence rate for CRA is as high as 40-50% after 3 years, 4 CRA recurrence is a surrogate marker for CRC risk and prevention of CRA recurrence is a useful endpoint for evaluating chemopreventive agents. 5 Activation of vitamin D receptors (VDRs) present in many cell types, including colorectal epithelial cells, can inhibit proliferation, angiogenesis and invasiveness, and studies in animal models indicate that vitamin D supplementation can lower the incidence and metastatic potential of intestinal tumors. 6-9 Ecological studies correlating sunlight exposure with cancer incidence provided the first evidence that vitamin D levels are inversely related to CRC development in humans. 10 Subsequent epidemiological studies have reported lower risks of CRA and CRC in individuals with high intakes and circulating levels of vitamin D. 11-14 Vitamin D plays a crucial role in calcium me...

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Association of Dietary Patterns With Cancer Recurrence and Survival in Patients With Stage III Colon Cancer

Meyerhardt¹,

Niedzwiecki²,

Hollis³

et al. 2007

JAMA

384

247

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tific research indicates that diet and other lifestyle factors have a significant influence on the risk of developing colon cancer. 1,2 However, the influence of diet and other lifestyle factors on the outcome of patients with established colon cancer is largely unknown. Patients diagnosed with cancer are highly motivated to seek information about diet, physical activity, dietary supplement use, and nutritional complementary therapies. 3-6 Two randomized controlled trials of patients with early stage breast cancer have provided mixed results on the impact of dietary changes after diagnosis and breast cancer outcomes. 7,8 In contrast, few studies have assessed the influence of diet on colon cancer recurrence and survival. Factor analysis has been used to examine overall dietary patterns beyond individual foods and nutrients and the risk of several cancers. 9-12 Specific dietary patterns have been associ

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Calcium Intake and Risk of Colon Cancer in Women and Men

Cited by 328 publications

References 56 publications

Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study

Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study

Dairy products, polymorphisms in the vitamin D receptor gene and colorectal adenoma recurrence

Association of Dietary Patterns With Cancer Recurrence and Survival in Patients With Stage III Colon Cancer

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