title: Multivitamin, calcium and folic acid supplements and the risk of colorectal cancer in Lynch syndrome.
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.
authors.affiliation: Centre for Molecular, Environmental, Genetic and Analytic Epidemiology.
authors.forename: Rowena
authors.initials: R
authors.lastname: Chau
authors.affiliation: Centre for Molecular, Environmental, Genetic and Analytic Epidemiology.
authors.forename: Seyedeh Ghazaleh
authors.initials: SG
authors.lastname: Dashti
authors.affiliation: Centre for Molecular, Environmental, Genetic and Analytic Epidemiology.
authors.forename: Driss
authors.initials: D
authors.lastname: Ait Ouakrim
authors.affiliation: Centre for Molecular, Environmental, Genetic and Analytic Epidemiology Colorectal Oncogenomics Group, Department of Pathology, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Buchanan
authors.affiliation: Colorectal Oncogenomics Group, Department of Pathology, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Clendenning
authors.affiliation: Colorectal Oncogenomics Group, Department of Pathology, University of Melbourne, Parkville, VIC, Australia School of Medicine, University of Queensland, Herston, QLD, Australia.
authors.forename: Christophe
authors.initials: C
authors.lastname: Rosty
authors.affiliation: Department of Medicine Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia.
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: Winship
authors.affiliation: Departments of Haematology and Oncology, Queen Elizabeth Hospital SAHMRI Colorectal Node, Basil Hetzel Institute for Translational Research, Woodville, SA, Australia School of Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Young
authors.affiliation: Centre for Molecular, Environmental, Genetic and Analytic Epidemiology Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia.
authors.forename: Graham G
authors.initials: GG
authors.lastname: Giles
authors.affiliation: Department of Medicine Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia Colorectal Medicine and Genetics, Royal Melbourne Hospital, Parkville, VIC, Australia.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: Macrae
authors.affiliation: Department of Medicine Cancer Genomics and Predictive Medicine, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Boussioutas
authors.affiliation: New Zealand Familial Gastrointestinal Cancer Service, Auckland, New Zealand.
authors.forename: Susan
authors.initials: S
authors.lastname: Parry
authors.affiliation: Norris Comprehensive Cancer Centre, University of Southern California, Los Angeles, CA, USA.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Figueiredo
authors.affiliation: Department of Medicine, Stanford Cancer Institute, Stanford University, CA, USA.
authors.forename: A Joan
authors.initials: AJ
authors.lastname: Levine
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Ahnen
authors.affiliation: Norris Comprehensive Cancer Centre, University of Southern California, Los Angeles, CA, USA.
authors.forename: Graham
authors.initials: G
authors.lastname: Casey
authors.affiliation: Department of Medicine, Stanford Cancer Institute, Stanford University, CA, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Haile
authors.affiliation: Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.affiliation: University of Hawaii Cancer Centre, Honolulu, Hawaii, USA.
authors.forename: Loïc
authors.initials: L
authors.lastname: Le Marchand
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Stephen N
authors.initials: SN
authors.lastname: Thibodeau
authors.affiliation: Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, AZ, USA.
authors.forename: Noralane M
authors.initials: NM
authors.lastname: Lindor
authors.affiliation: Public Health Sciences Division, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Polly A
authors.initials: PA
authors.lastname: Newcomb
authors.affiliation: Public Health Sciences Division, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA School of Public Health, University of Washington, Seattle, WA, USA Centre for Public Health Research, Massey University, Wellington, New Zealand.
authors.forename: John D
authors.initials: JD
authors.lastname: Potter
authors.affiliation: Department of Medicine, University of North Carolina, Chapel Hill, Nc, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Baron
authors.affiliation: Centre for Molecular, Environmental, Genetic and Analytic Epidemiology Department of Epidemiology and Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Korea.
authors.forename: John L
authors.initials: JL
authors.lastname: Hopper
authors.affiliation: Centre for Molecular, Environmental, Genetic and Analytic Epidemiology.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Jenkins
authors.affiliation: Centre for Molecular, Environmental, Genetic and Analytic Epidemiology awin@unimelb.edu.au.
authors.forename: Aung Ko
authors.initials: AK
authors.lastname: Win
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002118:Calcium / Q000008:administration & dosage*; D002170:Canada / Q000453:epidemiology; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000453:epidemiology* / Q000235:genetics; D053843:DNA Mismatch Repair / Q000235:genetics; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006579:Heterozygote; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014815:Vitamins / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D014815:Vitamins; D005492:Folic Acid; D002118:Calcium
keywords: Colorectal cancer; DNA mismatch repair; Lynch syndrome; calcium; folic acid; multivitamin