Cancer Causes & Control

, Volume 21, Issue 11, pp 1919–1930 | Cite as

Pooled analyses of 13 prospective cohort studies on folate intake and colon cancer

  • Dong-Hyun Kim
  • Stephanie A. Smith-WarnerEmail author
  • Donna Spiegelman
  • Shiaw-Shyuan Yaun
  • Graham A. Colditz
  • Jo L. Freudenheim
  • Edward Giovannucci
  • R. Alexandra Goldbohm
  • Saxon Graham
  • Lisa Harnack
  • Eric J. Jacobs
  • Michael Leitzmann
  • Satu Mannisto
  • Anthony B. Miller
  • John D. Potter
  • Thomas E. Rohan
  • Arthur Schatzkin
  • Frank E. Speizer
  • Victoria L. Stevens
  • Rachael Stolzenberg-Solomon
  • Paul Terry
  • Paolo Toniolo
  • Matty P. Weijenberg
  • Walter C. Willett
  • Alicja Wolk
  • Anne Zeleniuch-Jacquotte
  • David J. Hunter
Original paper



Studies of folate intake and colorectal cancer risk have been inconsistent. We examined the relation with colon cancer risk in a series of 13 prospective studies.


Study- and sex-specific relative risks (RRs) were estimated from the primary data using Cox proportional hazards models and then pooled using a random-effects model.


Among 725,134 participants, 5,720 incident colon cancers were diagnosed during follow-up. The pooled multivariate RRs (95% confidence interval [CI]) comparing the highest vs. lowest quintile of intake were 0.92 (95% CI 0.84–1.00, p-value, test for between-studies heterogeneity = 0.85) for dietary folate and 0.85 (95% CI 0.77–0.95, p-value, test for between-studies heterogeneity = 0.42) for total folate. Results for total folate intake were similar in analyses using absolute intake cutpoints (pooled multivariate RR = 0.87, 95% CI 0.78–0.98, comparing ≥560 mcg/days vs. <240 mcg/days, p-value, test for trend = 0.009). When analyzed as a continuous variable, a 2% risk reduction (95% CI 0–3%) was estimated for every 100 μg/day increase in total folate intake.


These data support the hypothesis that higher folate intake is modestly associated with reduced risk of colon cancer.


Colon cancer Folate Cohort studies Meta-analysis Pooled analysis 



Supported by research grant CA55075 from the National Institutes of Health and by the National Colorectal Cancer Research Alliance.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Dong-Hyun Kim
    • 1
  • Stephanie A. Smith-Warner
    • 2
    • 3
    Email author
  • Donna Spiegelman
    • 3
    • 4
  • Shiaw-Shyuan Yaun
    • 2
  • Graham A. Colditz
    • 6
  • Jo L. Freudenheim
    • 8
  • Edward Giovannucci
    • 2
    • 3
    • 7
  • R. Alexandra Goldbohm
    • 9
  • Saxon Graham
    • 8
  • Lisa Harnack
    • 10
  • Eric J. Jacobs
    • 11
  • Michael Leitzmann
    • 12
  • Satu Mannisto
    • 15
  • Anthony B. Miller
    • 16
  • John D. Potter
    • 17
  • Thomas E. Rohan
    • 18
  • Arthur Schatzkin
    • 13
  • Frank E. Speizer
    • 5
    • 7
  • Victoria L. Stevens
    • 11
  • Rachael Stolzenberg-Solomon
    • 14
  • Paul Terry
    • 19
  • Paolo Toniolo
    • 22
  • Matty P. Weijenberg
    • 20
  • Walter C. Willett
    • 2
    • 3
    • 7
  • Alicja Wolk
    • 21
  • Anne Zeleniuch-Jacquotte
    • 22
  • David J. Hunter
    • 2
    • 3
    • 7
  1. 1.Department of Social and Preventive Medicine, College of MedicineHallym UniversityChunchonKorea
  2. 2.Department of NutritionHarvard School of Public HealthBostonUSA
  3. 3.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  4. 4.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  5. 5.Department of Environmental HealthHarvard School of Public HealthBostonUSA
  6. 6.Institute for Public HealthWashington University School of MedicineSt. LouisUSA
  7. 7.Channing Laboratory, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  8. 8.Department of Social and Preventive MedicineUniversity at Buffalo, State University of New YorkBuffaloUSA
  9. 9.Department of Prevention and HealthTNO Quality of LifeLeidenThe Netherlands
  10. 10.Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  11. 11.Epidemiology and Surveillance ResearchAmerican Cancer SocietyAtlantaUSA
  12. 12.Institute of Epidemiology and Preventive MedicineUniversity of RegensburgRegensburgGermany
  13. 13.Nutritional Epidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer Institute, NIH, DHHSBethesdaUSA
  14. 14.Nutritional Epidemiology Branch, Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaUSA
  15. 15.Department of Health Promotion and Chronic Disease PreventionNational Public Health InstituteHelsinkiFinland
  16. 16.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  17. 17.Division of Public Health ServicesFred Hutchinson Cancer Research CenterSeattleUSA
  18. 18.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA
  19. 19.Department of EpidemiologyEmory University, Rollins School of Public HealthAtlantaUSA
  20. 20.Department of Epidemiology, School for Oncology and Developmental Biology (GROW)Maastricht UniversityMaastrichtThe Netherlands
  21. 21.Division of Nutritional Epidemiology, The National Institute of Environmental MedicineKarolinska InstituteStockholmSweden
  22. 22.Department of Environmental MedicineNew York UniversityNew YorkUSA

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