Multivitamin use, folate, and colon cancer in women in the Nurses' Health Study.

Abstract:

BACKGROUND:High intake of folate may reduce risk for colon cancer, but the dosage and duration relations and the impact of dietary compared with supplementary sources are not well understood. OBJECTIVE:To evaluate the relation between folate intake and incidence of colon cancer. DESIGN:Prospective cohort study. SETTING:88,756 women from the Nurses' Health Study who were free of cancer in 1980 and provided updated assessments of diet, including multivitamin supplement use, from 1980 to 1994. PATIENTS:442 women with new cases of colon cancer. MEASUREMENTS:Multivariate relative risk (RR) and 95% CIs for colon cancer in relation to energy-adjusted folate intake. RESULTS:Higher energy-adjusted folate intake in 1980 was related to a lower risk for colon cancer (RR, 0.69 [95% CI, 0.52 to 0.93] for intake > 400 microg/d compared with intake < or = 200 microg/d) after controlling for age; family history of colorectal cancer; aspirin use; smoking; body mass; physical activity; and intakes of red meat, alcohol, methionine, and fiber. When intake of vitamins A, C, D, and E and intake of calcium were also controlled for, results were similar. Women who used multivitamins containing folic acid had no benefit with respect to colon cancer after 4 years of use (RR, 1.02) and had only nonsignificant risk reductions after 5 to 9 (RR, 0.83) or 10 to 14 years of use (RR, 0.80). After 15 years of use, however, risk was markedly lower (RR, 0.25 [CI, 0.13 to 0.51]), representing 15 instead of 68 new cases of colon cancer per 10,000 women 55 to 69 years of age. Folate from dietary sources alone was related to a modest reduction in risk for colon cancer, and the benefit of long-term multivitamin use was present across all levels of dietary intakes. CONCLUSIONS:Long-term use of multivitamins may substantially reduce risk for colon cancer. This effect may be related to the folic acid contained in multivitamins.

journal_name

Ann Intern Med

authors

Giovannucci E,Stampfer MJ,Colditz GA,Hunter DJ,Fuchs C,Rosner BA,Speizer FE,Willett WC

doi

10.7326/0003-4819-129-7-199810010-00002

subject

Has Abstract

pub_date

1998-10-01 00:00:00

pages

517-24

issue

7

eissn

0003-4819

issn

1539-3704

journal_volume

129

pub_type

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