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Calcium and Vitamin D and Risk of Colorectal Cancer: Results From a Large Population-based Case-control Study in Newfoundland and Labrador and Ontario

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Abstract

Background: Previous epidemiological studies have been suggestive but inconclusive in demonstrating inverse associations of calcium, vitamin D, dairy product intakes with risk of colorectal cancer (CRC). We conducted a large population-based comparison of such associations in Newfoundland and Labrador (NL) and Ontario (ON).

Methods: A case control study design was used. Colorectal cancer cases were new CRC patients aged 20–74 years. Controls were a sex and age-group matched random sample of the population in each province. 1760 cases and 2481 controls from NL and ON were analyzed. Information on dietary intake and lifestyle was collected using self-administered food frequency and personal history questionnaires.

Results: Controls reported higher mean daily intakes of total calcium and total vitamin D than cases in both provinces. In ON, significant reduced CRC risk was associated with intakes of total calcium (OR of highest vs. lowest quintiles was 0.57, 95% CI 0.42–0.77, pbtrend=0.03), total vitamin D (OR=0.73, 95% CI 0.54–1.00), dietary calcium (OR=0.76, 95% CI 0.60–0.97), dietary vitamin D (OR=0.77, 95% CI 0.61–0.99), total dairy products and milk (OR=0.78, 95% CI 0.60–1.00), calcium-containing supplements use (OR=0.76). In NL, the inverse associations of calcium, vitamin D with CRC risk were most pronounced among calcium- or vitamin D-containing supplement users (OR=0.67, 0.68, respectively).

Conclusions: Results of this study add to the evidence that total calcium, dietary calcium, total vitamin D, dietary vitamin D, calcium- or vitamin D-containing supplement use may reduce the risk of CRC. The inverse associations of CRC risk with intakes of total dairy products and milk may be largely due to calcium and vitamin D.

Résumé

Contexte: Des études épidémiologiques antérieures, bien que peu concluantes, donnent à penser que les apports en calcium, en vitamine D et en produits laitiers sont inversement associés au risque de cancer colorectal (CCR). Nous avons mené une vaste comparaison populationnelle de telles associations à Terre-Neuve-et-Labrador (T.-N.-L.) et en Ontario.

Méthode: Nous avons utilisé un plan d’étude cas/témoins. Nos cas de cancer colorectal étaient des patients nouvellement atteints de CCR âgés de 20 à 74 ans. Nos témoins étaient un échantillon aléatoire de la population de chaque province, assortis selon le sexe et le groupe d’âge. Nous avons analysé 1 760 cas et 2 481 témoins de T.-N.-L. et de l’Ontario. Des renseignements sur leurs apports alimentaires et leurs modes de vie ont été recueillis au moyen de questionnaires autoadministrés sur la fréquence de consommation des produits alimentaires et les antécédents personnels.

Résultats: Dans les deux provinces, les témoins ont déclaré des apports moyens quotidiens plus élevés en calcium total et en vitamine D totale. En Ontario, un risque de CCR significativement réduit était associé aux apports en calcium total (RC des quintiles supérieur et inférieur = 0,57, IC de 95% = 0,42–0,77, P=0,03), en vitamine D totale (RC=0,73, IC de 95% = 0,54–1,00), en calcium alimentaire (RC=0,76, IC de 95 % = 0,60–0,97), en vitamine D alimentaire (RC=0,77, IC de 95% = 0,61–0,99), en lait et produits laitiers totaux (RC=0,78, IC de 95% = 0,60–1,00) et à la consommation de suppléments contenant du calcium (RC=0,76). À T.-N.-L., les associations inverses entre le calcium, la vitamine D et le risque de CCR étaient plus prononcées chez les consommateurs de suppléments contenant du calcium ou de la vitamine D (RC=0,67, 0,68, respectivement).

Conclusion: Les résultats de cette étude tendent à confirmer que le calcium total, le calcium alimentaire, la vitamine D totale, la vitamine D alimentaire et la consommation de suppléments contenant du calcium ou de la vitamine D peuvent réduire le risque de CCR. Les associations inverses entre le risque de CCR et les apports en lait et produits laitiers totaux pourraient s’expliquer dans une large mesure par le calcium et la vitamine D.

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Authors and Affiliations

  1. Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, A1B 3V6, Canada

    Zhuoyu Sun MSc,  Peizhong Peter Wang PhD, Barbara Roebothan PhD, Sharon Buehler PhD, Jinhui Zhao PhD, Josh Squires BSc, Jing Zhao BMed & Yun Zhu BMed

  2. School of Public Health, Tianjin Medical University, Tianjin, China

    Peizhong Peter Wang PhD

  3. Population Studies and Surveillance, Cancer Care Ontario, Toronto, ON, Canada

    Michelle Cotterchio PhD

  4. Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada

    Roger Green PhD, Elizabeth Dicks PhD & Patrick S. Parfrey MD

  5. Epidemiology Research Program, American Cancer Society, Atlanta, GA, Canada

    Peter T. Campbell PhD

  6. Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada

    John R. Mclaughlin PhD

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  1. Zhuoyu Sun MSc
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  2. Peizhong Peter Wang PhD
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Corresponding author

Correspondence to Peizhong Peter Wang PhD.

Additional information

Acknowledgements: This work was supported by the Canadian Institutes of Health Research Team Grant [CIHR-CPT79845] and Canadian Institutes of Health Research Team in Interdisciplinary Research on Colorectal Cancer Studentship [205835]. Zhuoyu Sun was awarded by the Newfoundland and Labrador Centre for Applied Health Research through a Master’s fellowship. Jing Zhao was supported by a trainee award from the Beatrice Hunter Cancer Research Institute with funds provided by The Terry Fox Foundation Strategic Health Research Training Program in Cancer Research at CIHR.

Conflict of Interest: None to declare.

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Sun, Z., Wang, P.P., Roebothan, B. et al. Calcium and Vitamin D and Risk of Colorectal Cancer: Results From a Large Population-based Case-control Study in Newfoundland and Labrador and Ontario. Can J Public Health 102, 382–389 (2011). https://doi.org/10.1007/BF03404181

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