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

Ann Intern Med. 1998 Oct 1;129(7):517-24. doi: 10.7326/0003-4819-129-7-199810010-00002.

Abstract

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 microg/d compared with intake < or = 200 microg/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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Colonic Neoplasms / epidemiology*
  • Colonic Neoplasms / prevention & control
  • Confounding Factors, Epidemiologic
  • Dietary Supplements*
  • Dose-Response Relationship, Drug
  • Female
  • Folic Acid / administration & dosage*
  • Humans
  • Incidence
  • Methionine / administration & dosage
  • Middle Aged
  • Multivariate Analysis
  • Prospective Studies
  • Risk Factors
  • Surveys and Questionnaires
  • Time Factors
  • Vitamins / administration & dosage*

Substances

  • Vitamins
  • Folic Acid
  • Methionine