Folate may be inversely related to colorectal cancer risk, possibly in combination with low methionine and high alcohol consumption. We considered, therefore, the relation between folate and colorectal cancer in a multicentric casecontrol study of 1,953 cases and 4,154 controls from Italy, i.e., a population with frequent regular alcohol drinking. In the overall data set, the odds ratio (OR) was 0.72 for the highest quintile of folate, and the continuous OR per 100 g was 0.86. The inverse relation was similar in men and women and somewhat stronger for the rectum (OR ؍ 0.59 for the highest quintile) compared to the colon (OR ؍ 0.81). It was also somewhat stronger in the highest tertile of alcohol drinking (OR ؍ 0.65), though trends were not heterogeneous across strata of alcohol, whereas no appreciable difference was observed across strata of methionine intake. Compared to subjects reporting low alcohol, high methionine and high folate intake, the OR was 1.83 for those reporting high alcohol, low methionine and low folate intake. Folate is important for DNA methylation and repair, and abnormalities in DNA methylation may contribute to loss of normal control of proto-oncogene expression. Folate and methionine are involved in the production of S-adenosylmethionine, the primary methyl donor in the body. Alcohol consumption may increase folate requirements and cause relative folate deficiency, 1,2 which has been related to increased breast cancer risk. [3][4][5] Folate deficiency, or simply low levels of folate intake, may be related to the risk of colorectal cancer, possibly together with elevated alcohol drinking. 2,6 -8 Thus, in the American Health Professionals cohort study, based on 205 cases of colon cancer, the relative risk (RR) was 3.3 for the combination of low folate, low methionine and high alcohol intake compared to low alcohol, high methionine, high folate intake among nonusers of aspirin. 2 In a cohort study based on the Canadian National Breast Screening Study, the RR was 0.6 for the highest level of folate intake. 9 A large, multicentric U.S. case-control study 10 found no consistent support for an association between folate, other factors involved in DNA methylation and colon cancer risk; in the NHANES I epidemiologic follow-up study, the RR was 1.6 for subjects reporting low-folate, low-methionine and high-alcohol diets compared to those reporting low-alcohol, high-folate and high-methionine diets. The association was stronger in men. 11 A multicentric Italian case-control study found RRs of 0.7-0.8 in the highest quintile of folic acid compared to the lowest. 12 Regular alcohol drinking is frequent in the Italian population. 13 We decided, therefore, to further consider the effect of folate consumption in the Italian multicentric study, 12 using a comprehensive food-composition database including more than 60 natural sources of folate. 14 We also considered the interaction of folate with alcohol and methionine on the risk of colorectal cancer in Italy.The data were derived from a case-contro...