Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study.
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 (ptrend=0.04) and cancer (ptrend=0.08) with increasing calcium intake, with RRs for adenoma and cancer of 0.80 (IC 95%=0.62-1.03) and 0.72 (95% CI=0.47-1.10), respectively, in the fourth quartile compared to the first. A protective effect of dairy products on adenoma (RRQ4 vs. Q1=0.80, 95% CI=0.62-1.05, ptrend=0.04) was observed and of milk consumption on colorectal cancer (RRQ4vs. Q1=0.54, 95% CI=0.33-0.89, ptrend=0.09), although the latter did not reach significance. Phosphorus intake also decreased the risk of adenoma (RRQ4 vs. Q1=0.70, 95% CI=0.54-0.90, ptrend=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.
Kesse
Emmanuelle
E
INSERM, Equipe E3N-EPIC, Institut Gustave Roussy, Villejuif Cedex, France.
Boutron-Ruault
Marie-Christine
MC
Norat
Teresa
T
Riboli
Elio
E
Clavel-Chapelon
Françoise
F
D000236:Adenoma / Q000453:epidemiology* / Q000517:prevention & control; D000368:Aged; D002136:Calcium, Dietary / Q000008:administration & dosage*; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D003611:Dairy Products; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D016226:Phosphorus, Dietary / Q000008:administration & dosage*; D011446:Prospective Studies; D012307:Risk Factors; D014807:Vitamin D / Q000008:administration & dosage*
D002136:Calcium, Dietary; D016226:Phosphorus, Dietary; D014807:Vitamin D