Multivitamin, calcium and folic acid supplements and the risk of colorectal cancer in Lynch syndrome

Chau, Rowena, Dashti, Seyedeh Ghazaleh, Ouakrim, Driss Ait, Buchanan, Daniel D., Clendenning, Mark, Rosty, Christophe, Winship, Ingrid M., Young, Joanne P., Giles, Graham G., Macrae, Finlay A., Boussioutas, Alex, Parry, Susan, Figueiredo, Jane C., Levine, A. Joan, Ahnen, Dennis J., Casey, Graham, Haile, Robert W., Gallinger, Steven, Le Marchand, Loic, Thibodeau, Stephen N., Lindor, Noralane M., Newcomb, Polly A., Potter, John D., Baron, John A., Hopper, John L., Jenkins, Mark A. and Win, Aung Ko (2016) Multivitamin, calcium and folic acid supplements and the risk of colorectal cancer in Lynch syndrome. International Journal of Epidemiology, 45 3: 940-953. doi:10.1093/ije/dyw036


Author Chau, Rowena
Dashti, Seyedeh Ghazaleh
Ouakrim, Driss Ait
Buchanan, Daniel D.
Clendenning, Mark
Rosty, Christophe
Winship, Ingrid M.
Young, Joanne P.
Giles, Graham G.
Macrae, Finlay A.
Boussioutas, Alex
Parry, Susan
Figueiredo, Jane C.
Levine, A. Joan
Ahnen, Dennis J.
Casey, Graham
Haile, Robert W.
Gallinger, Steven
Le Marchand, Loic
Thibodeau, Stephen N.
Lindor, Noralane M.
Newcomb, Polly A.
Potter, John D.
Baron, John A.
Hopper, John L.
Jenkins, Mark A.
Win, Aung Ko
Title Multivitamin, calcium and folic acid supplements and the risk of colorectal cancer in Lynch syndrome
Journal name International Journal of Epidemiology   Check publisher's open access policy
ISSN 0300-5771
1464-3685
Publication date 2016-06-01
Year available 2016
Sub-type Article (original research)
DOI 10.1093/ije/dyw036
Open Access Status Not yet assessed
Volume 45
Issue 3
Start page 940
End page 953
Total pages 14
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Abstract People with a DNA mismatch repair (MMR) gene mutation have a substantially elevated risk of colorectal cancer (CRC) but the modifiers of this risk are not well established. We investigated the association between dietary supplement intake and CRC risk for carriers.

This study included 1966 (56% female) carriers of an MMR gene mutation (719 MLH1, 931 MSH2, 211 MSH6 and 105 PMS2) who were recruited from the USA, Canada, Australia and New Zealand into the Colon Cancer Family Registry between 1997 and 2012. Information on lifestyle factors including supplement intake was collected at the time of recruitment. Using Cox proportional hazards regression weighted to correct for ascertainment bias, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between self-reported multivitamin, calcium and folic acid supplement intake and CRC risk.

Of 744 carriers with CRC, 18%, 6% and 5% reported intake of multivitamin, calcium and folic acid supplements for at least 1 month, respectively, compared with 27%, 11% and 10% of 1222 carriers without CRC. After adjusting for identified confounding variables, a decreased CRC risk was associated with multivitam inintake for at least 3 years (HR 0.47, 95% CI 0.32-0.69) and calcium intake for at least 3 years(HR 0.42, 95% CI 0.23-0.74), compared with never users. There was no evidence of an association between folic acid supplement intake and CRC risk (P = 0.82).

Intake of multivitamin and calcium supplements might be associated with a decreased risk of CRC for MMR gene mutation carriers.
Formatted abstract
Background: People with a DNA mismatch repair (MMR) gene mutation have a substantially elevated risk of colorectal cancer (CRC) but the modifiers of this risk are not well established. We investigated the association between dietary supplement intake and CRC risk for carriers.

Methods: This study included 1966 (56% female) carriers of an MMR gene mutation (719 MLH1, 931 MSH2, 211 MSH6 and 105 PMS2) who were recruited from the USA, Canada, Australia and New Zealand into the Colon Cancer Family Registry between 1997 and 2012. Information on lifestyle factors including supplement intake was collected at the time of recruitment. Using Cox proportional hazards regression weighted to correct for ascertainment bias, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between self-reported multivitamin, calcium and folic acid supplement intake and CRC risk.

Results: Of 744 carriers with CRC, 18%, 6% and 5% reported intake of multivitamin, calcium and folic acid supplements for at least 1 month, respectively, compared with 27%, 11% and 10% of 1222 carriers without CRC. After adjusting for identified confounding variables, a decreased CRC risk was associated with multivitam inintake for at least 3 years (HR 0.47, 95% CI 0.32–0.69) and calcium intake for at least 3 years(HR 0.42, 95% CI 0.23–0.74), compared with never users. There was no evidence of an association between folic acid supplement intake and CRC risk (P = 0.82).

Conclusion: Intake of multivitamin and calcium supplements might be associated with a decreased risk of CRC for MMR gene mutation carriers.
Keyword Colorectal cancer
DNA mismatch repair
Lynch syndrome
Multivitamin
Calcium
Folic acid
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID U01 CA074799
U24 CA074783
U24 CA074794
U24 CA074806
U24 CA097735
U01 CA074794
U01 CA097735
UM1 CA167551
U01 CA074783
U24 CA074799
U01 CA074806
U24 CA074800
P30 CA071789
U01 CA074800
Institutional Status UQ

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Sub-type: Article (original research)
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