Observational Study

. 2021 Oct;161(4):1208-1217.e9.

doi: 10.1053/j.gastro.2021.07.002. Epub 2021 Jul 7.

Total Vitamin D Intake and Risks of Early-Onset Colorectal Cancer and Precursors

Hanseul Kim¹, Marla Lipsyc-Sharf², Xiaoyu Zong³, Xiaoyan Wang³, Jinhee Hur⁴, Mingyang Song⁵, Molin Wang⁶, Stephanie A Smith-Warner⁷, Charles Fuchs⁸, Shuji Ogino⁹, Kana Wu⁴, Andrew T Chan¹⁰, Yin Cao¹¹, Kimmie Ng¹², Edward L Giovannucci¹³

Affiliations

¹ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
² Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
³ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
⁴ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
⁵ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
⁷ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
⁸ Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut.
⁹ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Cancer Immunology Program and Cancer Epidemiology Program, Dana-Farber Harvard Cancer Center, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
¹⁰ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
¹¹ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri; Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
¹² Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.
¹³ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: egiovann@hsph.harvard.edu.

PMID: 34245763
PMCID: PMC8463427
DOI: 10.1053/j.gastro.2021.07.002

Observational Study

Total Vitamin D Intake and Risks of Early-Onset Colorectal Cancer and Precursors

Hanseul Kim et al. Gastroenterology. 2021 Oct.

. 2021 Oct;161(4):1208-1217.e9.

doi: 10.1053/j.gastro.2021.07.002. Epub 2021 Jul 7.

Authors

Affiliations

¹ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
² Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
³ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
⁴ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
⁵ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
⁷ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
⁸ Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut.
⁹ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Cancer Immunology Program and Cancer Epidemiology Program, Dana-Farber Harvard Cancer Center, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts.
¹⁰ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
¹¹ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri; Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
¹² Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.
¹³ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: egiovann@hsph.harvard.edu.

PMID: 34245763
PMCID: PMC8463427
DOI: 10.1053/j.gastro.2021.07.002

Abstract

Background & aims: Vitamin D has been implicated in colorectal cancer (CRC) pathogenesis, but it remains unknown whether total vitamin D intake is associated with early-onset CRC and precursors diagnosed before age 50.

Methods: We prospectively examined the association between total vitamin D intake and risks of early-onset CRC and precursors among women enrolled in the Nurses' Health Study II. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for early-onset CRC were estimated with Cox proportional hazards model. Multivariable-adjusted odds ratios (ORs) and 95% CIs for early-onset conventional adenoma and serrated polyp were estimated with logistic regression model.

Results: We documented 111 incident cases of early-onset CRC during 1,250,560 person-years of follow-up (1991 to 2015). Higher total vitamin D intake was significantly associated with a reduced risk of early-onset CRC (HR for ≥450 IU/day vs <300 IU/day, 0.49; 95% CI, 0.26-0.93; P for trend = .01). The HR per 400 IU/day increase was 0.46 (95% CI, 0.26-0.83). The inverse association was significant and appeared more evident for dietary sources of vitamin D (HR per 400 IU/day increase, 0.34; 95% CI, 0.15-0.79) than supplemental vitamin D (HR per 400 IU/day increase, 0.77; 95% CI, 0.37-1.62). For CRC precursors, the ORs per 400 IU/day increase were 0.76 (95% CI, 0.65-0.88) for conventional adenoma (n = 1,439) and 0.85 (95% CI, 0.75-0.97) for serrated polyp (n = 1,878).

Conclusions: In a cohort of younger women, higher total vitamin D intake was associated with decreased risks of early-onset CRC and precursors.

Keywords: Cancer Epidemiology; Colorectal Adenoma; Colorectal Cancer; Vitamin D.

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Conflict of interest statement

Conflict of interest statement: Andrew T. Chan reported receiving consulting fees from Boehringer Ingelheim, Pfizer Inc, and Bayer Pharma AG. Charles Fuchs has been a consultant and/or a scientific advisor for Eli Lilly, Entrinsic Health, Pfizer, Merck, Sanofi, Roche, Genentech, Merrimack Pharmaceuticals, Dicerna, Bayer, Celgene, Agios, Gilead Sciences, Five Prime Therapeutics, Taiho, and KEW. Kimmie Ng reported the following disclosures for the past 12 months: research funding from Pharmavite, Revolution Medicines, Janssen, and Evergrande Group; Advisory boards for Array Biopharma, Seattle Genetics, and BiomX; and consulting for X-Biotix Therapeurics. No other disclosures were reported.

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Total Vitamin D Intake and Risks of Early-Onset Colorectal Cancer and Precursors

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Total Vitamin D Intake and Risks of Early-Onset Colorectal Cancer and Precursors

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