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Dietary vitamin D intake and colorectal cancer risk: a longitudinal approach within the PREDIMED study

  • Original Contribution
  • Published:
European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

We evaluated whether the intake of dietary vitamin D is associated with the incidence of both colorectal cancer (CRC) and colon cancer in the framework of the PREDIMED cohort of older adults at high cardiovascular risk.

Methods

We analyzed data from 7216 men and women (55–80 years) without CRC at baseline from the PREvención con DIeta MEDiterránea study. Baseline consumption of vitamin D was assessed using a validated 137-item food frequency questionnaire. Cox proportional hazards ratios (HRs) of CRC and colon cancer incidence were estimated for quartiles and per 1-SD of baseline vitamin D intake.

Results

During a median follow-up of 6 years, we documented 97 incident CRC cases after the exclusion of subjects with no baseline dietary data and/or outliers of energy intake. A non-significant HRs and 95% confidence intervals (CIs) of CRC for the comparison of extreme quartiles (4th vs 1st) of vitamin D intake were observed [0.55 (0.30–1.00), P for trend = 0.072], whereas it was significant for colon cancer incidence alone [0.44 (0.22–0.90), P for trend = 0.032]. However, this association became significant in CRC and colon cancer incidence, after excluding 391 subjects consuming baseline vitamin D and/or calcium medication or prescribed supplements [0.52 (0.28–0.96) and 0.41 (0.12–0.85), respectively].

Conclusion

A higher dietary intake of vitamin D was significantly associated with a reduced CRC risk in individuals at high cardiovascular risk.

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Availability of data and materials

The datasets generated and analyzed during the current study are not publicly available due to data regulations and for ethical reasons, considering that this information might compromise research participants’ consent because our participants only gave their consent for the use of their data by the original team of investigators. However, collaboration for data analyses can be requested by sending a letter to the PREDIMED steering Committee (www.predimed-steering-committe@googlegroups.com). The request will then be passed to all the members of the PREDIMED Steering Committee for deliberation.

Code availability

Please, refer to the “Availability of data and material”.

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Acknowledgements

Adjudication Committee: F. Arós (chair), M. Aldamiz-Echevarría, A.M. Alonso-Gómez, J. Berjón, L. Forga, J. Gállego, A. García-Layana, A. Larrauri, J. Portu-Zapirain, and J. Timiraos. Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain: M.Serra-Mir, A. Pérez-Heras, C. Viñas, R. Casas, A. Medina-Remón, S. Romero, J.M. Baena, M. García, M. Oller, J. Amat, I. Duaso, Y. García, C. Iglesias, C. Simón, L. Quinzavos, L. Parra, M. Liroz, J. Benavent, J. Clos, I. Pla, M. Amorós, M.T. Bonet, M.T. Martín, M.S. Sánchez, J. Altirriba, E. Manzano, A. Altés, M. Cofán, M. Doménech TM. Freitas-Simoes, I. Roth, AJ Amor, E. Ortega, J.C. Laguna, M. Alegret, R. Gilabert, and N. Bargalló. University Rovira i Virgili, Reus, Spain: J. García Roselló, A. Diaz-López, F. Martin, R. Tort, A. Isach, N. Becerra, J.J. Cabré, J. Fernández-Ballart, J.L. Piñol, T. Basora, A. Salas-Huetos, G Mena-Sanchez, J.M. Hernández, V. Ruíz, C. Mestres, Palau, and I. Abellán. University of Navarra, Primary Care Centres, Pamplona, Spain: P. Buil-Cosiales, M. Ruiz-Canela, C. Razquin, A. Sánchez-Tainta, B. Sanjulián, J. Díez-Espino, A. García-Arellano, I. Zazpe, F.J. Basterra-Gortari, S. Eguaras, E. Goñi, Z. Vazquez, M. Bes-Rastrollo, A. Gea, A. Marti, J. Alfredo Martínez, E.H. Martínez-Lapiscina, J.M. Nuñez-Córdoba, S. Cervantes, A. Sola Larraza, F. Barcena Amigo, C. Oreja Arrayago, M.J. Lasanta Saez, L. Quintana Pedraza, P. Cia Lecumberri, T. Elcarte Lopez, T. Forcen Alonso. University of Valencia, Valencia, Spain: P. Carrasco, C. Ortega-Azorín, E.M. Asensio, R. Osma, R. Barragán, F. Francés, M. Guillén, J.I. González, C. Sáiz, O. Portolés, F.J. Giménez, O. Coltell, R. Fernández-Carrión, P. Guillem-Sáiz, I. González-Monje, L. Quiles, V. Pascual, C. Riera, M.A. Pages, D. Godoy, A. Carratalá-Calvo, S. Sánchez-Navarro, and C. Valero- Barceló. Hospital del Mar Research Institute, Barcelona, Spain: S. Tello, R. de la Torre, D. Muñoz-Aguayo, R. Elosua, J. Marrugat, H. Schröder, N. Molina, E. Maestre, A. Rovira, O. Castañer, and M. Farré. University Hospital of Alava, Vitoria, Spain: I. Salaverría, J. Rekondo, M.C. Belló, T. del Hierro, J. Algorta, S. Francisco, A. Alonso, J. San Vicente, E. Sanz, I. Felipe, A. Alonso Gómez, and A. Loma-Osorio. University of Málaga, Málaga, Spain: J. Fernández-Crehuet, R. Benítez Pont, M. Bianchi Alba, J. Wärnberg, R. Gómez-Huelgas, J. Martínez-González, V. Velasco García, J. de Diego Salas, A. Baca Osorio, J. Gil Zarzosa, J.J. Sánchez Luque, and E. Vargas López. Palma Institute of Health Research (IdISPa), Palma de Mallorca, Spain: D Romaguera, M. García-Valdueza, M. Moñino, A. Yáñez, A. Proenza, R. Prieto, S. Munuera, M. Vivó, F. Bestard, J.A. Munar, L. Coll, F. Fiol, M. Ginard, A. Jover, J. García. Department of Family Medicine, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain: M. Leal, E. Martínez, J.M. Santos-Lozano, M. Ortega-Calvo, P. Román, F. José García, P. Iglesias, Y. Corchado, L. Mellado, L. Miró-Moriano, J.M. Lozano-Rodríguez, C. Domínguez-Espinaco, and S. Vaquero-Díaz. School of Pharmacy, University of Barcelona, Barcelona, Spain: M.C. López- Sabater, A.I. Castellote-Bargalló, P. Quifer-Rada, and A. Tresserra-Rimbau. Instituto Universitario de Investigaciones Biomédicas y Sanitarias (I.U.I.B.S.) de la Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain: J. Álvarez-Pérez, E.M. Díaz-Benítez, A. Sánchez-Villegas, L.T. Casañas-Quintana, J. Pérez-Cabrera, C. Ruano-Rodríguez, I. Bautista-Castaño, F. Sarmiento de la Fe, J.A. García Pastor, B.V.Díaz-González, J.M. Castillo Anzalas, R.E. Sosa-Also, J. Medina-Ponce. Hospital Universitari de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain: E. de la Cruz, M. Fanlo-Maresma, A. Galera, F. Trias, I. Sarasa, E. Corbella, and X. Corbella. Primary Care Division, Catalan Institute of Health, Barcelona, Spain: C.Cabezas, E. Vinyoles, M.A. Rovira, L. García, G. Flores, J.M. Verdú, P. Baby, A. Ramos, L. Mengual, P. Roura, M.C. Yuste, A. Guarner, A. Rovira, M.I. Santamaría, M. Mata, C. de Juan, and A. Brau. Instituto de la Grasa, Consejo Superior de Investigaciones Científicas, Sevilla, Spain: V. Ruiz-Gutiérrez, J. Sánchez Perona, E. Montero Romero, M. García-García, and E. Jurado-Ruiz.

Funding

The Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN) is an initiative of the Spanish Instituto de Salud Carlos III (ISCIII) which is funded by FEDER “A way to make Europe”/” Investing in your future” (CB06/03). It is supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through grants provided to research networks specifically developed for the trial (RTIC G03/140 and RD 06/0045) through CIBEROBN, and by Grants from the Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigación Sanitaria–Fondo Europeo de Desarrollo Regional (PI04–2239, PI05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI07/0473, PI10/01407, PI10/02658, PI11/01647, and PI11/02505; PI13/00462 and PI18/01399), Ministerio de Ciencia e Innovación (AGL-2009–13906-C02 and AGL2010–22319-C03), Fundación Mapfre 2010, Consejería de Salud de la Junta de Andalucía (PI0105/2007), Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (PROMETEO17/2017), and the Navarra Regional Government (27/2011). The Fundación Patrimonio Comunal Olivarero and Hojiblanca SA (Málaga, Spain), California Walnut Commission (Sacramento, CA), Borges SA (Reus, Spain), and Morella Nuts SA (Reus, Spain) donated the olive oil, walnuts, almonds, and hazelnuts, respectively, used in the study. JS-S, the senior author/gratefully acknowledges the financial support by ICREA under the ICREA Academia program. Dr. PH-A was supported by a postdoctoral fellowship (Juan de la Cierva-Formación, FJCI-2017-32205). None of the funding sources played a role in the design, collection, analysis or interpretation of the data or in the decision to submit the manuscript for publication. MM-G was the recipient of the Nicolas Monardes Programme from the “Servicio Andaluz de Salud, Junta de Andalucia”, Spain (RC-0001-2018 and C-0029-2023). This work is partially supported by ICREA under the ICREA Academia programme.

Author information

Authors and Affiliations

  1. Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, C/Sant Llorenç 21, 43201, Reus, Spain

    Pablo Hernández-Alonso, Silvia Canudas, Nancy Babio & Jordi Salas-Salvadó

  2. Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari San Joan de Reus, 43204, Reus, Spain

    Pablo Hernández-Alonso, Silvia Canudas, Nancy Babio & Jordi Salas-Salvadó

  3. Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Malaga (IBIMA), University of Malaga, 29016, Málaga, Spain

    Pablo Hernández-Alonso, Hatim Boughanem & Manuel Macias-González

  4. Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain

    Pablo Hernández-Alonso, Silvia Canudas, Estefanía Toledo, Jose V. Sorlí, Ramón Estruch, Olga Castañer, José Lapetra, Angel M. Alonso-Gómez, Miquel Fiol, Lluis Serra-Majem, Xavier Pintó, Emilio Ros, Montse Fitó, Manuel Macias-González, Nancy Babio & Jordi Salas-Salvadó

  5. Department of Preventive Medicine and Public Health, Universidad de Navarra, 31008, Pamplona, Spain

    Estefanía Toledo & Cesar I. Fernandez-Lazaro

  6. IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain

    Estefanía Toledo

  7. Department of Preventive Medicine, Universidad de Valencia, 46010, Valencia, Spain

    Jose V. Sorlí

  8. Cardiovascular Risk, Nutrition and Aging Research Unit, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08003, Barcelona, Spain

    Ramón Estruch

  9. Internal Medicine Service, Hospital Clínic, 08036, Barcelona, Spain

    Ramón Estruch

  10. Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), 08003, Barcelona, Spain

    Olga Castañer & Montse Fitó

  11. Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013, Sevilla, Spain

    José Lapetra

  12. Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 01002, Vitoria-Gasteiz, Spain

    Angel M. Alonso-Gómez

  13. Department of Preventive Medicine and Public Health, School of Medicine, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, 29010, Málaga, Spain

    Mario Gutiérrez-Bedmar

  14. Health Research Institute of the Balearic Islands (IdISBa), Hospital Son Espases, 07120, Palma de Mallorca, Spain

    Miquel Fiol

  15. Institute for Biomedical and Health Research, Universidad de Las Palmas de Gran Canaria, 35016, Las Palmas, Spain

    Lluis Serra-Majem

  16. Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge-Idibell, 08907, L’Hospitalet de Llobregat, Spain

    Xavier Pintó

  17. Lipid Clinic, Department of Endocrinology and Nutrition Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain

    Emilio Ros

  18. Servicio de Oncología, Hospital de Sagunto, 46520, Valencia, Spain

    Judith B. Ramirez-Sabio

  19. Bioaraba, Infectious Diseases Research Group, Vitoria-Gasteiz, Spain

    Joseba Portu-Zapirain

  20. Internal Medicine Department, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain

    Joseba Portu-Zapirain

Authors
  1. Pablo Hernández-Alonso
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Contributions

Conceptualization: PH-A, SC, JS-S, MM-G, NB, and HB; methodology: PH-A, SC, JS-S, MM-G, and NB; acquisition of data: NB and JS-S; formal analysis: PH-A and JS-S; writing-review and editing: All the authors; supervision: JS-S, PH-A, MM-G, and NB; All authors have read and approved the final version to be published.

Corresponding authors

Correspondence to Manuel Macias-González or Nancy Babio.

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Conflict of interest

JS-S is a nonpaid member of the Scientific Committee of the International Nut and Dried Fruit Foundation. He has received grants/research support from the American Pistachio Growers and International Nut and Dried Fruit Foundation through his institution. He has received honoraria from Nuts for Life, Danone, and Eroski. He reports personal fees from Danone. He is a member of the executive committee of Instituto Danone Spain. The other authors declare that they have no conflicts of interest.

Ethical approval

All participants provided written informed consent, and the study protocol and procedures were approved according to the ethical standards of the Declaration of Helsinki.

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Hernández-Alonso, P., Canudas, S., Boughanem, H. et al. Dietary vitamin D intake and colorectal cancer risk: a longitudinal approach within the PREDIMED study. Eur J Nutr 60, 4367–4378 (2021). https://doi.org/10.1007/s00394-021-02585-1

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  • DOI: https://doi.org/10.1007/s00394-021-02585-1

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