Author(s):
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Jenab, M.; Bueno-De-Mesquita, H.B.; Ferrari, P.;
Duijnhoven, F.J.B. van
; Norat, T.; Pischon, T.; Jansen, E.H.; Slimani, N.; Byrnes, G.; Rinaldi, S.; Tjonneland, A.; Olsen, A.; Overvad, K.; Boutron-Ruault, M.C.; Clavel-Chapelon, F.; Morois, S.; Kaaks, R.; Linseisen, J.; Boeing, H.; Bergmann, M.M.; Trichopoulou, A.; Misirli, G.; Trichopoulos, D.; Berrino, F.; Vineis, P.; Panico, S.; Palli, D.; Tumino, R.;
Ros, M.M.
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Gils, C.H. van
; Peeters, P.H.M.; Brustad, M.; Lund, E.; Tormo, M.J.; Ardanaz, E.; Rodriguez, L.; Sanchez, M.J.; Dorronsoro, M.; Gonzalez, C.A.; Hallmans, G.; Palmqvist, R.; Roddam, A.; Key, T.J.; Khaw, K.T.; Autier, P.; Hainaut, P.; Riboli, E.
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Subject:
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NCEBP 1: Molecular epidemiology |
Former Organization:
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Epidemiology, Biostatistics & HTA
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Journal title:
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Bmj. British Medical Journal (Compact Ed.)
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Abstract:
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OBJECTIVE: To examine the association between pre-diagnostic circulating vitamin D concentration, dietary intake of vitamin D and calcium, and the risk of colorectal cancer in European populations. DESIGN: Nested case-control study. Setting The study was conducted within the EPIC study, a cohort of more than 520 000 participants from 10 western European countries. PARTICIPANTS: 1248 cases of incident colorectal cancer, which developed after enrolment into the cohort, were matched to 1248 controls MAIN OUTCOME MEASURES: Circulating vitamin D concentration (25-hydroxy-vitamin-D, 25-(OH)D) was measured by enzyme immunoassay. Dietary and lifestyle data were obtained from questionnaires. Incidence rate ratios and 95% confidence intervals for the risk of colorectal cancer by 25-(OH)D concentration and levels of dietary calcium and vitamin D intake were estimated from multivariate conditional logistic regression models, with adjustment for potential dietary and other confounders. RESULTS: 25-(OH)D concentration showed a strong inverse linear dose-response association with risk of colorectal cancer (P for trend <0.001). Compared with a pre-defined mid-level concentration of 25-(OH)D (50.0-75.0 nmol/l), lower levels were associated with higher colorectal cancer risk (<25.0 nmol/l: incidence rate ratio 1.32 (95% confidence interval 0.87 to 2.01); 25.0-49.9 nmol/l: 1.28 (1.05 to 1.56), and higher concentrations associated with lower risk (75.0-99.9 nmol/l: 0.88 (0.68 to 1.13); >or=100.0 nmol/l: 0.77 (0.56 to 1.06)). In analyses by quintile of 25-(OH)D concentration, patients in the highest quintile had a 40% lower risk of colorectal cancer than did those in the lowest quintile (P<0.001). Subgroup analyses showed a strong association for colon but not rectal cancer (P for heterogeneity=0.048). Greater dietary intake of calcium was associated with a lower colorectal cancer risk. Dietary vitamin D was not associated with disease risk. Findings did not vary by sex and were not altered by corrections for season or month of blood donation. CONCLUSIONS: The results of this large observational study indicate a strong inverse association between levels of pre-diagnostic 25-(OH)D concentration and risk of colorectal cancer in western European populations. Further randomised trials are needed to assess whether increases in circulating 25-(OH)D concentration can effectively decrease the risk of colorectal cancer.
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