title: Association between carotenoids and outcome of cervical intraepithelial neoplasia: a prospective cohort study.
abstract: BACKGROUND
  It has been suggested that micronutrients such as alpha-tocopherol, retinol, lutein, cryptoxanthin, lycopene, and alpha- and beta-carotene may help in the prevention of cervical cancer. Our aim was to investigate whether serum concentrations and/or dietary intake of micronutrients influence the regression or progression of low-grade cervical abnormalities.
  
  
  METHODS
  In a prospective cohort study of 391 patients with cervical intraepithelial neoplasia (CIN) grade 1-2 lesions, we measured serum micronutrient concentrations in addition to a self-administered questionnaire about dietary intake. We evaluated the hazard ratio (HR) adjusted for CIN grade, human papillomavirus genotype, total energy intake and smoking status.
  
  
  RESULTS
  In non-smoking regression subjects, regression was significantly associated with serum levels of zeaxanthin/lutein (HR 1.25, 0.78-2.01, p = 0.024). This benefit was abolished in current smokers. Regression was inhibited by high serum levels of alpha-tocopherol in smokers (p = 0.042). In progression subjects, a significant protective effect against progression to CIN3 was observed in individuals with a medium level of serum beta-carotene [HR 0.28, 95 % confidence interval (CI) 0.11-0.71, p = 0.007), although any protective effect from a higher level of serum beta-carotene was weaker or abolished (HR 0.52, 95 % CI 0.24-1.13, p = 0.098). Increasing beta-carotene intake did not show a protective effect (HR 2.30, 95 % CI 0.97-5.42, p = 0.058).
  
  
  CONCLUSIONS
  Measurements of serum levels of carotenoids suggest that regression is modulated by smoking status. Maintaining a medium serum level of beta-carotene has a protective effect for progression; however, carotene intake is not correlated with serum levels of carotenoids.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan, fujiit@a5.keio.jp.
authors.forename: Takuma
authors.initials: T
authors.lastname: Fujii
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Takatsuka
authors.forename: Chisato
authors.initials: C
authors.lastname: Nagata
authors.forename: Koji
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Akinori
authors.initials: A
authors.lastname: Oki
authors.forename: Reiko
authors.initials: R
authors.lastname: Furuta
authors.forename: Hiroo
authors.initials: H
authors.lastname: Maeda
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yasugi
authors.forename: Kei
authors.initials: K
authors.lastname: Kawana
authors.forename: Akira
authors.initials: A
authors.lastname: Mitsuhashi
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hirai
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Iwasaka
authors.forename: Nobuo
authors.initials: N
authors.lastname: Yaegashi
authors.forename: Yoh
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nagai
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kitagawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D000368:Aged; D002338:Carotenoids / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D027383:Papillomaviridae / Q000472:pathogenicity; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D002578:Uterine Cervical Dysplasia / Q000097:blood* / Q000473:pathology* / Q000821:virology
chemical_list: D002338:Carotenoids