Association of dietary intakes of vitamin B12, vitamin B6, folate, and methionine with the risk of esophageal cancer: the Japan Public Health Center-based (JPHC) prospective study

BMC Cancer. 2021 Sep 1;21(1):982. doi: 10.1186/s12885-021-08721-8.


Background: B vitamins and methionine are essential substrates in the one-carbon metabolism pathway involved in DNA synthesis and methylation. They may have essential roles in cancer development. We aimed to evaluate the associations of dietary intakes of vitamin B12, vitamin B6, folate, and methionine with the risk of esophageal cancer (EC) using data from the Japan Public Health Center-based Prospective Study.

Methods: We included 87,053 Japanese individuals who completed a food frequency questionnaire and were followed up from 1995-1998 to 2013 and 2015. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by Cox proportional-hazard regression across quintiles of dietary intakes of B vitamins and methionine.

Results: After 1,456,678 person-years of follow-up, 427 EC cases were documented. The multivariable HR (95% CI) of incident EC in the highest versus lowest quintile of dietary intake of vitamin B12 was 1.75 (1.13-2.71; p-trend=0.01). Stratification analysis based on alcohol consumption showed that higher dietary intakes of vitamin B12 and methionine were associated with an increased risk of EC among never-drinkers; HRs (95% CIs) were 2.82 (1.18-6.74; p-trend=0.009; p-interaction=0.18) and 3.45 (1.32-9.06; p-trend=0.003; p-interaction 0.02) for vitamin B12 and methionine, respectively. Meanwhile, there was no association between vitamin B12 and methionine intake with the risk of EC among drinkers. There were no associations between dietary intake of folate or vitamin B6 and the risk of EC.

Conclusion: Dietary intake of vitamin B12 was positively associated with the risk of EC in the Japanese population.

Keywords: Esophageal cancer; Folate intake; One-carbon metabolism; Prospective cohort study; Vitamin B12 intake.

MeSH terms

  • Aged
  • Alcohol Drinking / physiopathology*
  • Eating
  • Esophageal Neoplasms / epidemiology*
  • Esophageal Neoplasms / metabolism
  • Female
  • Folic Acid / administration & dosage*
  • Follow-Up Studies
  • Humans
  • Japan / epidemiology
  • Male
  • Methionine / administration & dosage*
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Public Health
  • Risk Factors
  • Vitamin B 12 / administration & dosage*
  • Vitamin B 6 / administration & dosage*
  • Vitamins / administration & dosage*


  • Vitamins
  • Vitamin B 6
  • Folic Acid
  • Methionine
  • Vitamin B 12