European Journal of Nutrition

, Volume 51, Issue 4, pp 407–413

Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg)

  • Kuanrong Li
  • Rudolf Kaaks
  • Jakob Linseisen
  • Sabine Rohrmann
Original Contribution

DOI: 10.1007/s00394-011-0224-1

Cite this article as:
Li, K., Kaaks, R., Linseisen, J. et al. Eur J Nutr (2012) 51: 407. doi:10.1007/s00394-011-0224-1

Abstract

Purpose

To prospectively evaluate the association of vitamin/mineral supplementation with cancer, cardiovascular, and all-cause mortality.

Methods

In the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg), which was recruited in 1994–1998, 23,943 participants without pre-existing cancer and myocardial infarction/stroke at baseline were included in the analyses. Vitamin/mineral supplementation was assessed at baseline and during follow-up. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

After an average follow-up time of 11 years, 1,101 deaths were documented (cancer deaths = 513 and cardiovascular deaths = 264). After adjustment for potential confounders, neither any vitamin/mineral supplementation nor multivitamin supplementation at baseline was statistically significantly associated with cancer, cardiovascular, or all-cause mortality. However, baseline users of antioxidant vitamin supplements had a significantly reduced risk of cancer mortality (HR: 0.52; 95% CI: 0.28, 0.97) and all-cause mortality (HR: 0.58; 95% CI: 0.38, 0.88). In comparison with never users, baseline non-users who started taking vitamin/mineral supplements during follow-up had significantly increased risks of cancer mortality (HR: 1.74; 95% CI: 1.09, 2.77) and all-cause mortality (HR: 1.58; 95% CI: 1.17, 2.14).

Conclusions

Based on limited numbers of users and cases, this cohort study suggests that supplementation of antioxidant vitamins might possibly reduce cancer and all-cause mortality. The significantly increased risks of cancer and all-cause mortality among baseline non-users who started taking supplements during follow-up may suggest a “sick-user effect,” which researchers should be cautious of in future observational studies.

Keywords

SupplementsCancerCardiovascular diseaseMortalityCohort study

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Kuanrong Li
    • 1
  • Rudolf Kaaks
    • 1
  • Jakob Linseisen
    • 1
    • 2
  • Sabine Rohrmann
    • 1
    • 3
  1. 1.Division of Cancer EpidemiologyGerman Cancer Research CentreHeidelbergGermany
  2. 2.Institute of Epidemiology IHelmholtz Centre MunichNeuherbergGermany
  3. 3.Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive MedicineUniversity of ZurichZurichSwitzerland