title: The association of calcium and vitamin D with risk of colorectal adenomas.
abstract: The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial designed to determine the effects of a high-fiber, high-fruit and vegetable, low-fat diet on the recurrence of adenomatous polyps in the large bowel. Detailed dietary intake and supplement use data were collected at baseline and at each of 4 annual study visits. Adenoma recurrence was ascertained by complete colonoscopy at baseline and after 1 and 4 y. Recurrence was found in 754 of the 1905 trial participants. We evaluated the association between calcium and vitamin D intake and adenomatous polyp recurrence after adjusting for intervention group, age, gender, nonsteroidal anti-inflammatory drug use, total energy intake, and the interaction of gender and intervention group. Vitamin D models were also adjusted for the location of the clinic site. Dietary variables were adjusted for total energy intake via the residual method. There were no overall significant associations between adenoma recurrence and dietary calcium intake [odds ratio (OR) for the 5th compared with the lowest quintile = 0.91; 95% CI = 0.67-1.23; P-trend = 0.68], total calcium intake (OR = 0.86; 95% CI = 0.62-1.18; P-trend = 0.20), or dietary vitamin D intake (OR = 0.93; 95% CI = 0.69-1.25; P-trend = 0.43) averaged over follow-up. Total vitamin D intake was weakly inversely associated with adenoma recurrence (OR = 0.84; 95% CI = 0.62-1.13; P-trend = 0.03). Supplemental calcium and vitamin D use during follow-up also were inversely associated with adenoma recurrence (OR for any compared with no use = 0.82; 95% CI = 0.68-0.99; and OR = 0.82; 95% CI = 0.68-0.99; for calcium and vitamin D, respectively). Slightly stronger associations were noted for the prevention of multiple recurrences. Our analyses did not suggest a significant effect modification between total calcium and total vitamin D intake (P = 0.14) on risk for adenoma recurrence. This trial cohort provides some evidence that calcium and vitamin D may be inversely associated with adenoma recurrence.
authors.affiliation: Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA. tjh9@psu.edu
authors.forename: Terryl J
authors.initials: TJ
authors.lastname: Hartman
authors.forename: Paul S
authors.initials: PS
authors.lastname: Albert
authors.forename: Kirk
authors.initials: K
authors.lastname: Snyder
authors.forename: Martha L
authors.initials: ML
authors.lastname: Slattery
authors.forename: Bette
authors.initials: B
authors.lastname: Caan
authors.forename: Electra
authors.initials: E
authors.lastname: Paskett
authors.forename: Frank
authors.initials: F
authors.lastname: Iber
authors.forename: James Walter
authors.initials: JW
authors.lastname: Kikendall
authors.forename: James
authors.initials: J
authors.lastname: Marshall
authors.forename: Moshe
authors.initials: M
authors.lastname: Shike
authors.forename: Joel
authors.initials: J
authors.lastname: Weissfeld
authors.forename: Brenda
authors.initials: B
authors.lastname: Brewer
authors.forename: Arthur
authors.initials: A
authors.lastname: Schatzkin
authors.forename: Elaine
authors.initials: E
authors.lastname: Lanza
mesh_terms: D000236:Adenoma / Q000453:epidemiology*; D015992:Body Mass Index; D002118:Calcium; D003110:Colonic Neoplasms / Q000453:epidemiology*; D003111:Colonic Polyps / Q000517:prevention & control; D004032:Diet; D015930:Diet Records; D019587:Dietary Supplements; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000453:epidemiology*; D012008:Recurrence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014807:Vitamin D
chemical_list: D014807:Vitamin D; D002118:Calcium