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Intakes of vitamins A, C, and E and use of multiple vitamin supplements and risk of colon cancer: a pooled analysis of prospective cohort studies

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Abstract

Objective

To evaluate the associations between intakes of vitamins A, C, and E and risk of colon cancer.

Methods

Using the primary data from 13 cohort studies, we estimated study- and sex-specific relative risks (RR) with Cox proportional hazards models and subsequently pooled RRs using a random effects model.

Results

Among 676,141 men and women, 5,454 colon cancer cases were identified (7–20 years of follow-up across studies). Vitamin A, C, and E intakes from food only were not associated with colon cancer risk. For intakes from food and supplements (total), the pooled multivariate RRs (95% CI) were 0.88 (0.76–1.02, >4,000 vs. ≤1,000 μg/day) for vitamin A, 0.81 (0.71–0.92, >600 vs. ≤100 mg/day) for vitamin C, and 0.78 (0.66–0.92, >200 vs. ≤6 mg/day) for vitamin E. Adjustment for total folate intake attenuated these associations, but the inverse associations with vitamins C and E remained significant. Multivitamin use was significantly inversely associated with colon cancer risk (RR = 0.88, 95% CI: 0.81–0.96).

Conclusions

Modest inverse associations with vitamin C and E intakes may be due to high correlations with folate intake, which had a similar inverse association with colon cancer. An inverse association with multivitamin use, a major source of folate and other vitamins, deserves further study.

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Financial support

The study was funded by research grants CA55075 from the National Institutes of Health and the National Colorectal Cancer Research Alliance of the Entertainment Industry Foundation.

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Author notes

  1. Yikyung Park

    Present address: Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA

Authors and Affiliations

  1. Department of Nutrition, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA

    Yikyung Park, David J. Hunter, Edward Giovannucci, Meir J. Stampfer, Walter C. Willett & Stephanie A. Smith-Warner

  2. Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA

    Demetrius Albanes & Arthur Schatzkin

  3. Department of Epidemiology, Harvard School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA

    Donna Spiegelman, David J. Hunter, Julie E. Buring, Edward Giovannucci, Meir J. Stampfer, Walter C. Willett, Shumin M. Zhang & Stephanie A. Smith-Warner

  4. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    Donna Spiegelman

  5. Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    David J. Hunter, Edward Giovannucci, Meir J. Stampfer & Walter C. Willett

  6. Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Julie E. Buring & Shumin M. Zhang

  7. Department of Surgery and Centre for Clinical Research, Central Hospital, Västerås, Sweden

    Leif Bergkvist

  8. Department of Social and Preventive Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA

    Jo L. Freudenheim

  9. Department of Prevention and Health, TNO Quality of Life, Leiden, The Netherlands

    R. Alexandra Goldbohm

  10. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Lisa Harnack

  11. Department of Pathology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA

    Ikuko Kato

  12. Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy

    Vittorio Krogh & Sabina Sieri

  13. Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany

    Michael F. Leitzmann

  14. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Paul J. Limburg

  15. Department of Cancer Prevention and Population Science, Roswell Park Cancer Institute, Buffalo, NY, USA

    James R. Marshall

  16. Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA

    Marjorie L. McCullough

  17. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Anthony B. Miller

  18. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Thomas E. Rohan

  19. Department of Environmental Medicine, New York University, New York, NY, USA

    Roy Shore

  20. Radiation Effects Research Foundation, Hiroshima, Japan

    Roy Shore

  21. Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland

    Jarmo Virtamo

  22. Department of Epidemiology, School of Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands

    Matty Weijenberg

  23. Division of Nutritional Epidemiology, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

    Alicja Wolk

Authors
  1. Yikyung Park
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  2. Donna Spiegelman
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  3. David J. Hunter
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  4. Demetrius Albanes
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  6. Julie E. Buring
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  7. Jo L. Freudenheim
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  8. Edward Giovannucci
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  9. R. Alexandra Goldbohm
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  10. Lisa Harnack
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  11. Ikuko Kato
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  15. James R. Marshall
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  16. Marjorie L. McCullough
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  17. Anthony B. Miller
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  20. Roy Shore
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  25. Walter C. Willett
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  26. Alicja Wolk
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  27. Shumin M. Zhang
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  28. Stephanie A. Smith-Warner
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Corresponding author

Correspondence to Stephanie A. Smith-Warner.

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Park, Y., Spiegelman, D., Hunter, D.J. et al. Intakes of vitamins A, C, and E and use of multiple vitamin supplements and risk of colon cancer: a pooled analysis of prospective cohort studies. Cancer Causes Control 21, 1745–1757 (2010). https://doi.org/10.1007/s10552-010-9549-y

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