title: Folate intake and the risk of colorectal cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  Folic acid fortification and supplementation to prevent neural tube defects has led to concerns regarding increased risk of colorectal cancer. The results of existing studies have been inconclusive. The purpose was to examine the relationship between level of folate intake and the incidence of colorectal cancer.
  
  
  METHODS
  A systematic review and meta analysis were conducted. MEDLINE, Embase, and SCOPUS were searched from inception to October 2009 with the following search terms "folic acid," "folate", "colorectal cancer," "colon neoplasms," rectal neoplasms." Observational studies in adult populations were included that defined levels of folate intake and incidence of colorectal cancer.
  
  
  RESULTS
  Out of 6427 references, 27 studies met our inclusion criteria. The summary risk estimate for case control studies comparing high versus low total folate intake was 0.85 (CI 95% 0.74-0.99) with no significant heterogeneity among studies. Similarly, for cohort studies, the resulting summary risk estimate for high versus low dietary folate intake was 0.92 (CI 95% 0.81-1.05) with no significant heterogeneity. However, defining what represents a higher intake of folic acid is difficult as there is variability in the upper limit of folic acid intake used in the studies.
  
  
  CONCLUSIONS
  These results suggest that higher folate intake levels offer a reduction in one of the perceived risks associated with developing colorectal cancer. These data can serve to help reassure women planning a pregnancy to increase folic intake during the preconception period to levels sufficient to prevent neural tube defects.
authors.affiliation: The Motherisk Program, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8 Canada. dkennedy@ccnm.edu
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kennedy
authors.forename: Seth J
authors.initials: SJ
authors.lastname: Stern
authors.forename: Myla
authors.initials: M
authors.lastname: Moretti
authors.forename: Ilan
authors.initials: I
authors.lastname: Matok
authors.forename: Moumita
authors.initials: M
authors.lastname: Sarkar
authors.forename: Cheri
authors.initials: C
authors.lastname: Nickel
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
mesh_terms: D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D019587:Dietary Supplements; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D014803:Vitamin B Complex / Q000008:administration & dosage*
chemical_list: D014803:Vitamin B Complex; D005492:Folic Acid