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Multivitamin Use, Folate, and Colon Cancer in Women in the Nurses' Health Study

Edward Giovannucci, MD, ScD; Meir J. Stampfer, MD, DrPH; Graham A. Colditz, MD, DrPH; David J. Hunter, MBBS, ScD; Charles Fuchs, MD, MPH; Bernard A. Rosner, PhD; Frank E. Speizer, MD; and Walter C. Willett, MD, DrPH
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Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(7):517-524. doi:10.7326/0003-4819-129-7-199810010-00002
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Background: High intake of folate may reduce risk for colon cancer, but the dosage and duration relations and the impact of dietary compared with supplementary sources are not well understood.

Objective: To evaluate the relation between folate intake and incidence of colon cancer.

Design: Prospective cohort study.

Setting: 88 756 women from the Nurses' Health Study who were free of cancer in 1980 and provided updated assessments of diet, including multivitamin supplement use, from 1980 to 1994.

Patients: 442 women with new cases of colon cancer.

Measurements: Multivariate relative risk (RR) and 95% CIs for colon cancer in relation to energy-adjusted folate intake.

Results: Higher energy-adjusted folate intake in 1980 was related to a lower risk for colon cancer (RR, 0.69 [95% CI, 0.52 to 0.93] for intake >400 µg/d compared with intake ≤ 200 µg/d) after controlling for age; family history of colorectal cancer; aspirin use; smoking; body mass; physical activity; and intakes of red meat, alcohol, methionine, and fiber. When intake of vitamins A, C, D, and E and intake of calcium were also controlled for, results were similar. Women who used multivitamins containing folic acid had no benefit with respect to colon cancer after 4 years of use (RR, 1.02) and had only nonsignificant risk reductions after 5 to 9 (RR, 0.83) or 10 to 14 years of use (RR, 0.80). After 15 years of use, however, risk was markedly lower (RR, 0.25 [CI, 0.13 to 0.51]), representing 15 instead of 68 new cases of colon cancer per 10 000 women 55 to 69 years of age. Folate from dietary sources alone was related to a modest reduction in risk for colon cancer, and the benefit of long-term multivitamin use was present across all levels of dietary intakes.

Conclusions: Long-term use of multivitamins may substantially reduce risk for colon cancer. This effect may be related to the folic acid contained in multivitamins.

Figures

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Figure 1.
Relative risk for colon cancer according to years since the start of use of multivitamins containing folic acid in the Nurses' Health Study (1980 to 1994).

Age; aspirin use; physical activity; body mass index; pack-years of smoking before age 30 years; family history of colorectal cancer; intake of beef, pork, or lamb as a main dish; and intake of alcohol, fiber, and methionine were controlled for. Vertical bars represent 95% CIs.

Grahic Jump Location

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