Cancer Causes & Control

, 22:1375 | Cite as

Dietary calcium and magnesium intake in relation to cancer incidence and mortality in a German prospective cohort (EPIC-Heidelberg)

  • Kuanrong Li
  • Rudolf Kaaks
  • Jakob Linseisen
  • Sabine RohrmannEmail author
Original paper


To prospectively evaluate the associations of dietary calcium and magnesium intake with cancer incidence and mortality, data of 24,323 participants of the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg), who were aged 35–64 years and cancer-free at recruitment (1994–1998), were analyzed using multivariate Cox regression models. After an average follow-up time of 11 years, 2,050 incident cancers were diagnosed and 513 cancer deaths occurred. Dietary calcium intake was inversely but not statistically significantly associated with colorectal cancer risk (hazard ratio [HR] for per 100 mg increase in intake: 0.95; 95% confidence interval [CI]: 0.88, 1.02) and lung cancer risk (HR for per 100 mg increase in intake: 0.94; 95% CI: 0.87, 1.02). No statistically significant associations were observed between dietary calcium intake and site-specific or overall cancer incidence or mortality. Dietary magnesium intake was not statistically significantly associated with any of the investigated outcomes. This prospective cohort study provides no strong evidence to support that high dietary calcium and magnesium intake in the intake range observed in a German population may reduce cancer incidence or mortality.


Calcium Magnesium Diet Cancer Incidence Mortality 



This study was funded by the Deutsche Krebshilfe [Grant-No.: 70-488-Ha I] and the Graduiertenkolleg 793: Epidemiology of communicable and chronic non-communicable diseases and their interrelationships.

Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    Whitfield JF (1992) Calcium signals and cancer. Crit Rev Oncog 3:55–90PubMedGoogle Scholar
  2. 2.
    Lamprecht SA, Lipkin M (2001) Cellular mechanisms of calcium and vitamin D in the inhibition of colorectal carcinogenesis. Ann N Y Acad Sci 952:73–87PubMedCrossRefGoogle Scholar
  3. 3.
    Cho E, Smith-Warner SA, Spiegelman D et al (2004) Dairy foods, calcium, and colorectal cancer: a pooled analysis of 10 cohort studies. J Natl Cancer Inst 96:1015–1022PubMedCrossRefGoogle Scholar
  4. 4.
    Larsson SC, Bergkvist L, Rutegard J, Giovannucci E, Wolk A (2006) Calcium and dairy food intakes are inversely associated with colorectal cancer risk in the Cohort of Swedish Men. Am J Clin Nutr 83:667–673PubMedGoogle Scholar
  5. 5.
    Park SY, Murphy SP, Wilkens LR, Nomura AM, Henderson BE, Kolonel LN (2007) Calcium and vitamin D intake and risk of colorectal cancer: the Multiethnic Cohort Study. Am J Epidemiol 165:784–793PubMedCrossRefGoogle Scholar
  6. 6.
    Mizoue T, Kimura Y, Toyomura K et al (2008) Calcium, dairy foods, vitamin D, and colorectal cancer risk: the Fukuoka Colorectal Cancer Study. Cancer Epidemiol Biomarkers Prev 17:2800–2807PubMedCrossRefGoogle Scholar
  7. 7.
    Ishihara J, Inoue M, Iwasaki M, Sasazuki S, Tsugane S (2008) Dietary calcium, vitamin D, and the risk of colorectal cancer. Am J Clin Nutr 88:1576–1583PubMedCrossRefGoogle Scholar
  8. 8.
    Huncharek M, Muscat J, Kupelnick B (2009) Colorectal cancer risk and dietary intake of calcium, vitamin D, and dairy products: a meta-analysis of 26, 335 cases from 60 observational studies. Nutr Cancer 61:47–69PubMedCrossRefGoogle Scholar
  9. 9.
    Chen P, Hu P, Xie D, Qin Y, Wang F, Wang H (2010) Meta-analysis of vitamin D, calcium and the prevention of breast cancer. Breast Cancer Res Treat 121:469–477PubMedCrossRefGoogle Scholar
  10. 10.
    Kawase T, Matsuo K, Suzuki T et al (2010) Association between vitamin D and calcium intake and breast cancer risk according to menopausal status and receptor status in Japan. Cancer Sci 101:1234–1240PubMedCrossRefGoogle Scholar
  11. 11.
    Kesse-Guyot E, Bertrais S, Duperray B et al (2007) Dairy products, calcium and the risk of breast cancer: results of the French SU.VI.MAX prospective study. Ann Nutr Metab 51:139–145PubMedCrossRefGoogle Scholar
  12. 12.
    McCullough ML, Rodriguez C, Diver WR et al (2005) Dairy, calcium, and vitamin D intake and postmenopausal breast cancer risk in the Cancer Prevention Study II Nutrition Cohort. Cancer Epidemiol Biomarkers Prev 14:2898–2904PubMedCrossRefGoogle Scholar
  13. 13.
    Shin MH, Holmes MD, Hankinson SE, Wu K, Colditz GA, Willett WC (2002) Intake of dairy products, calcium, and vitamin d and risk of breast cancer. J Natl Cancer Inst 94:1301–1311PubMedGoogle Scholar
  14. 14.
    Lin J, Manson JE, Lee IM, Cook NR, Buring JE, Zhang SM (2007) Intakes of calcium and vitamin D and breast cancer risk in women. Arch Intern Med 167:1050–1059PubMedCrossRefGoogle Scholar
  15. 15.
    Allen NE, Key TJ, Appleby PN et al (2008) Animal foods, protein, calcium and prostate cancer risk: the European Prospective Investigation into Cancer and Nutrition. Br J Cancer 98:1574–1581PubMedCrossRefGoogle Scholar
  16. 16.
    Ahn J, Albanes D, Peters U et al (2007) Dairy products, calcium intake, and risk of prostate cancer in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Epidemiol Biomarkers Prev 16:2623–2630PubMedCrossRefGoogle Scholar
  17. 17.
    Tseng M, Breslow RA, Graubard BI, Ziegler RG (2005) Dairy, calcium, and vitamin D intakes and prostate cancer risk in the National Health and Nutrition Examination Epidemiologic Follow-up Study cohort. Am J Clin Nutr 81:1147–1154PubMedGoogle Scholar
  18. 18.
    Chan JM, Stampfer MJ, Ma J, Gann PH, Gaziano JM, Giovannucci EL (2001) Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study. Am J Clin Nutr 74:549–554PubMedGoogle Scholar
  19. 19.
    Mitrou PN, Albanes D, Weinstein SJ et al (2007) A prospective study of dietary calcium, dairy products and prostate cancer risk (Finland). Int J Cancer 120:2466–2473PubMedCrossRefGoogle Scholar
  20. 20.
    Giovannucci E, Liu Y, Stampfer MJ, Willett WC (2006) A prospective study of calcium intake and incident and fatal prostate cancer. Cancer Epidemiol Biomarkers Prev 15:203–210PubMedCrossRefGoogle Scholar
  21. 21.
    Gao X, LaValley MP, Tucker KL (2005) Prospective studies of dairy product and calcium intakes and prostate cancer risk: a meta-analysis. J Natl Cancer Inst 97:1768–1777PubMedCrossRefGoogle Scholar
  22. 22.
    Anghileri LJ (2009) Magnesium, calcium and cancer. Magnes Res 22:247–255PubMedGoogle Scholar
  23. 23.
    Wolf FI, Maier JA, Nasulewicz A et al (2007) Magnesium and neoplasia: from carcinogenesis to tumor growth and progression or treatment. Arch Biochem Biophys 458:24–32PubMedCrossRefGoogle Scholar
  24. 24.
    Anastassopoulou J, Theophanides T (2002) Magnesium-DNA interactions and the possible relation of magnesium to carcinogenesis. Irradiation and free radicals. Crit Rev Oncol Hematol 42:79–91PubMedCrossRefGoogle Scholar
  25. 25.
    Mori H, Morishita Y, Shinoda T, Tanaka T (1993) Preventive effect of magnesium hydroxide on carcinogen-induced large bowel carcinogenesis in rats. Basic Life Sci 61:111–118PubMedGoogle Scholar
  26. 26.
    Patiroglu T, Sahin G, Kontas O, Uzum K, Saraymen R (1997) Protective effect of magnesium supplementation on experimental 3-methyl cholanthrene-induced fibrosarcoma and changes in tissue magnesium distribution during carcinogenesis in rats. Biol Trace Elem Res 56:179–185PubMedCrossRefGoogle Scholar
  27. 27.
    Tanaka T, Shinoda T, Yoshimi N, Niwa K, Iwata H, Mori H (1989) Inhibitory effect of magnesium hydroxide on methylazoxymethanol acetate-induced large bowel carcinogenesis in male F344 rats. Carcinogenesis 10:613–616PubMedCrossRefGoogle Scholar
  28. 28.
    Wang A, Yoshimi N, Tanaka T, Mori H (1994) The inhibitory effect of magnesium hydroxide on the bile acid-induced cell proliferation of colon epithelium in rats with comparison to the action of calcium lactate. Carcinogenesis 15:2661–2663PubMedCrossRefGoogle Scholar
  29. 29.
    Mori H, Morishita Y, Mori Y, Yoshimi N, Sugie S, Tanaka T (1992) Effect of magnesium hydroxide on methylazoxymethanol acetate-induced epithelial proliferation in the large bowels of rats. Cancer Lett 62:43–48PubMedCrossRefGoogle Scholar
  30. 30.
    Folsom AR, Hong CP (2006) Magnesium intake and reduced risk of colon cancer in a prospective study of women. Am J Epidemiol 163:232–235PubMedCrossRefGoogle Scholar
  31. 31.
    Larsson SC, Bergkvist L, Wolk A (2005) Magnesium intake in relation to risk of colorectal cancer in women. JAMA 293:86–89PubMedCrossRefGoogle Scholar
  32. 32.
    Lin J, Cook NR, Lee IM, Manson JE, Buring JE, Zhang SM (2006) Total magnesium intake and colorectal cancer incidence in women. Cancer Epidemiol Biomarkers Prev 15:2006–2009PubMedCrossRefGoogle Scholar
  33. 33.
    van den Brandt PA, Smits KM, Goldbohm RA, Weijenberg MP (2007) Magnesium intake and colorectal cancer risk in the Netherlands Cohort Study. Br J Cancer 96:510–513PubMedCrossRefGoogle Scholar
  34. 34.
    Kaluza J, Orsini N, Levitan EB, Brzozowska A, Roszkowski W, Wolk A (2010) Dietary calcium and magnesium intake and mortality: a prospective study of men. Am J Epidemiol 171:801–807PubMedCrossRefGoogle Scholar
  35. 35.
    Boeing H, Korfmann A, Bergmann MM (1999) Recruitment procedures of EPIC-Germany. European Investigation into Cancer and Nutrition. Ann Nutr Metab 43:205–215PubMedCrossRefGoogle Scholar
  36. 36.
    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(1):S59–S70Google Scholar
  37. 37.
    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(1):S71–S81Google Scholar
  38. 38.
    Welch AA, Fransen H, Jenab M et al. (2009) Variation in intakes of calcium, phosphorus, magnesium, iron and potassium in 10 countries in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 63(4):S101–S121Google Scholar
  39. 39.
    Willett W, Stampfer MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124:17–27PubMedGoogle Scholar
  40. 40.
    Zhao D (2011) Logistic regression adjustment of proportion and its macro procedure.
  41. 41.
    Wareham NJ, Jakes RW, Rennie KL et al (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 6:407–413PubMedCrossRefGoogle Scholar
  42. 42.
    Nimptsch K, Rohrmann S, Kaaks R, Linseisen J (2010) Dietary vitamin K intake in relation to cancer incidence and mortality: results from the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg). Am J Clin Nutr 91:1348–1358PubMedCrossRefGoogle Scholar
  43. 43.
    Park Y, Leitzmann MF, Subar AF, Hollenbeck A, Schatzkin A (2009) Dairy food, calcium, and risk of cancer in the NIH-AARP Diet and Health Study. Arch Intern Med 169(4):391–401PubMedCrossRefGoogle Scholar
  44. 44.
    Shaukat A, Scouras N, Schunemann HJ (2005) Role of supplemental calcium in the recurrence of colorectal adenomas: a metaanalysis of randomized controlled trials. Am J Gastroenterol 100:390–394PubMedCrossRefGoogle Scholar
  45. 45.
    Bostick RM, Potter JD, Fosdick L et al (1993) Calcium and colorectal epithelial cell proliferation: a preliminary randomized, double-blinded, placebo-controlled clinical trial. J Natl Cancer Inst 85:132–141PubMedCrossRefGoogle Scholar
  46. 46.
    Rozen P, Fireman Z, Fine N, Wax Y, Ron E (1989) Oral calcium suppresses increased rectal epithelial proliferation of persons at risk of colorectal cancer. Gut 30:650–655PubMedCrossRefGoogle Scholar
  47. 47.
    Holt PR, Wolper C, Moss SF, Yang K, Lipkin M (2001) Comparison of calcium supplementation or low-fat dairy foods on epithelial cell proliferation and differentiation. Nutr Cancer 41:150–155PubMedGoogle Scholar
  48. 48.
    Lamprecht SA, Lipkin M (2003) Chemoprevention of colon cancer by calcium, vitamin D and folate: molecular mechanisms. Nat Rev Cancer 3:601–614PubMedCrossRefGoogle Scholar
  49. 49.
    Newmark HL, Wargovich MJ, Bruce WR (1984) Colon cancer and dietary fat, phosphate, and calcium: a hypothesis. J Natl Cancer Inst 72:1323–1325PubMedGoogle Scholar
  50. 50.
    Zhou W, Park S, Liu G et al (2005) Dietary iron, zinc, and calcium and the risk of lung cancer. Epidemiology 16:772–779PubMedCrossRefGoogle Scholar
  51. 51.
    Huncharek M, Muscat J, Kupelnick B (2008) Dairy products, dietary calcium and vitamin D intake as risk factors for prostate cancer: a meta-analysis of 26, 769 cases from 45 observational studies. Nutr Cancer 60:421–441PubMedCrossRefGoogle Scholar
  52. 52.
    Butler LM, Wong AS, Koh WP, Wang R, Yuan JM, Yu MC (2010) Calcium intake increases risk of prostate cancer among Singapore Chinese. Cancer Res 70:4941–4948PubMedCrossRefGoogle Scholar
  53. 53.
    Kurahashi N, Inoue M, Iwasaki M, Sasazuki S, Tsugane AS (2008) Dairy product, saturated fatty acid, and calcium intake and prostate cancer in a prospective cohort of Japanese men. Cancer Epidemiol Biomarkers Prev 17:930–937PubMedCrossRefGoogle Scholar
  54. 54.
    Qin LQ, Wang PY, Kaneko T, Hoshi K, Sato A (2004) Estrogen: one of the risk factors in milk for prostate cancer. Med Hypotheses 62:133–142PubMedCrossRefGoogle Scholar
  55. 55.
    Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC (2007) Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. Int J Cancer 121:1571–1578PubMedCrossRefGoogle Scholar
  56. 56.
    Park Y, Mitrou PN, Kipnis V, Hollenbeck A, Schatzkin A, Leitzmann MF (2007) Calcium, dairy foods, and risk of incident and fatal prostate cancer: the NIH-AARP Diet and Health Study. Am J Epidemiol 166:1270–1279PubMedCrossRefGoogle Scholar
  57. 57.
    Mahabir S, Wei Q, Barrera SL et al (2008) Dietary magnesium and DNA repair capacity as risk factors for lung cancer. Carcinogenesis 29:949–956PubMedCrossRefGoogle Scholar
  58. 58.
    Yang CY, Chiu HF, Tsai SS, Cheng MF, Lin MC, Sung FC (2000) Calcium and magnesium in drinking water and risk of death from prostate cancer. J Toxicol Environ Health A 60:17–26PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Kuanrong Li
    • 1
  • Rudolf Kaaks
    • 1
  • Jakob Linseisen
    • 1
    • 2
  • Sabine Rohrmann
    • 1
    • 3
    Email author
  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

Personalised recommendations