Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg)
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To prospectively evaluate the association of vitamin/mineral supplementation with cancer, cardiovascular, and all-cause mortality.
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).
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).
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.
KeywordsSupplements Cancer Cardiovascular disease Mortality Cohort study
This study was supported by the Deutsche Krebshilfe [Grant-No.: 70-488-Ha I] and the German Research Foundation, Graduiertenkolleg 793: Epidemiology of communicable and chronic noncommunicable diseases and their interrelationships.
Conflict of interest
The authors declare that they have no conflict of interest.
- 5.Neuhouser ML, Wassertheil-Smoller S, Thomson C, Aragaki A, Anderson GL, Manson JE, Patterson RE, Rohan TE, van HL, Shikany JM, Thomas A, LaCroix A, Prentice RL (2009) Multivitamin use and risk of cancer and cardiovascular disease in the women’s health initiative cohorts. Arch Intern Med 169(3):294–304CrossRefGoogle Scholar
- 8.Bohlscheid-Thomas S, Hoting I, Boeing H, Wahrendorf J (1997) Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the German part of the EPIC project. European prospective investigation into cancer and nutrition. Int J Epidemiol 26(Suppl 1):S59–S70CrossRefGoogle Scholar
- 9.Bohlscheid-Thomas S, Hoting I, Boeing H, Wahrendorf J (1997) Reproducibility and relative validity of energy and macronutrient intake of a food frequency questionnaire developed for the German part of the EPIC project. European prospective investigation into cancer and nutrition. Int J Epidemiol 26(Suppl 1):S71–S81CrossRefGoogle Scholar
- 10.Wareham NJ, Jakes RW, Rennie KL, Schuit J, Mitchell J, Hennings S, Day NE (2003) Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European prospective investigation into cancer and nutrition (EPIC) study. Public Health Nutr 6(4):407–413CrossRefGoogle Scholar
- 11.Li JY, Taylor PR, Li B, Dawsey S, Wang GQ, Ershow AG, Guo W, Liu SF, Yang CS, Shen Q (1993) Nutrition intervention trials in Linxian, China: multiple vitamin/mineral supplementation, cancer incidence, and disease-specific mortality among adults with esophageal dysplasia. J Natl Cancer Inst 85(18):1492–1498CrossRefGoogle Scholar
- 13.Hertog MG, Bueno-de-Mesquita HB, Fehily AM, Sweetnam PM, Elwood PC, Kromhout D (1996) Fruit and vegetable consumption and cancer mortality in the caerphilly study. Cancer Epidemiol Biomarkers Prev 5(9):673–677Google Scholar
- 15.Colditz GA, Branch LG, Lipnick RJ, Willett WC, Rosner B, Posner BM, Hennekens CH (1985) Increased green and yellow vegetable intake and lowered cancer deaths in an elderly population. Am J Clin Nutr 41(1):32–36Google Scholar
- 22.Heart protection study collaborative group (2002) MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 360(9326):23–33Google Scholar
- 23.The alpha-tocopherol, beta-carotene cancer prevention study group (1994) The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 330(15):1029–1035Google Scholar