Calcium Supplements for the Prevention of Colorectal Adenomas

Baron, J. H.; Beach, Michael; Js, Mandel; Ru, van Stolk; Rw, Haile; Rs, Sandler; Rothstein, Richard I.; Rw, Summers; Dc, Snover; Beck, GJ; Jh, Bond; Er, Greenberg

doi:10.1056/nejm199901143400204

Cited by 791 publications

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“…Two intervention trials conducted on adenoma recurrence found a beneficial effect 13,15 of calcium supplementation, although it was significant in only 1 trial. 13 A more recent analysis found that a stronger beneficial effect of calcium supplementation on the risk of recurrence with advanced neoplasms than with tubular adenomas.…”

Section: Discussionmentioning

confidence: 99%

“…13 A more recent analysis found that a stronger beneficial effect of calcium supplementation on the risk of recurrence with advanced neoplasms than with tubular adenomas. 14 The effect was greater for subjects with a high dietary calcium intake.…”

Section: Discussionmentioning

confidence: 99%

“…Additional information has become available from recent intervention trials, [13][14][15] which suggested a protective effect of calcium supplementation on the risk of colorectal adenoma recurrence, but the level of calcium required for adenoma chemoprevention has yet to be defined. We prospectively studied the association between the intake of dietary calcium, phosphorus, vitamin D and/ or dairy products and the risk of adenomatous polyps and colorectal cancer among women participating in the E3N-EPIC study.…”

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Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study

et al. 2005

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A protective effect of calcium and/or dairy products on colorectal cancer has been reported in epidemiological studies but the findings are considered inconsistent. In particular, it is unclear whether they act at a particular step of the adenoma-carcinoma sequence. To investigate the effect of dairy product consumption and dietary calcium, vitamin D and phosphorus intake on the adenoma-carcinoma sequence in the French E3N-EPIC prospective study. The population for the study of risk factors for adenomas was composed of 516 adenoma cases, including 175 high-risk adenomas, and of 4,804 polyp-free subjects confirmed by colonoscopy. The population for the colorectal cancer study was composed of 172 cases and 67,312 cancer-free subjects. Diet was assessed using a self-administered questionnaire completed at baseline. There was a trend of decreasing risk of both adenoma (p trend 5 0.04) and cancer (p trend 50.08) with increasing calcium intake, with RRs for adenoma and cancer of 0.80 (IC 95%50.62-1.03) and 0.72 (95% CI50.47-1.10), respectively, in the fourth quartile compared to the first. A protective effect of dairy products on adenoma (RR Q4 vs. Q1 5 0.80, 95% CI50.62-1.05, p trend 5 0.04) was observed and of milk consumption on colorectal cancer (RR Q4vs. Q1 5 0.54, 95% CI50.33-0.89, p trend 5 0.09), although the latter did not reach significance. Phosphorus intake also decreased the risk of adenoma (RR Q4 vs. Q1 50.70, 95% CI50.54-0.90, p trend 5 0.005). No vitamin D effect was identified. Our data support the hypothesis that calcium, dairy products and phosphorus exert a protective effect at certain steps of the adenoma-carcinoma sequence. ' 2005 Wiley-Liss, Inc.Key words: colorectal cancer; colorectal adenoma; calcium; vitamin D; phosphorus; dairy productThe idea that an intake of calcium and vitamin D might protect against colorectal cancer was first suggested by Newmark et al. 1 In experimental studies, low calcium diets have consistently been associated with increased cell proliferation and low cell differentiation. 2 It has therefore been suggested that calcium acts directly on epithelial cell proliferation and differentiation, as well as indirectly by forming insoluble soaps with secondary bile acids, although this point has never been formally demonstrated. 2,3 Vitamin D plays a major role in the homeostasis of calcium and 2 studies have also suggested that it reduces epithelial cell proliferation and promotes differentiation. 2,4 It has been further suggested that polymorphisms of the vitamin D receptor (VDR) might modulate this effect. 5 However, findings from epidemiological studies on the relationship between calcium or dairy product intake and risk of colorectal adenoma or/and of cancer were judged inconsistent in 2 reviews, 6,7 except for a steady protective effect of dairy product reported in cohort studies. 6 Although a meta-analysis 8 concluded that calcium had no protective effect on colorectal tumours, prospective studies and large case-control studies subsequently found a modestly beneficial ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study

et al. 2005

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“…Calcium is hypothesized to prevent carcinogenesis in the colon by either binding bile acids and or fatty acids in the lumen or by having a direct inhibitory effect of the proliferation of the epithelial cells in the colon. The randomized controlled trial which assessed the efficacy of calcium supplementation on the risk of new colon adenoma formation amongst individuals with history of adenomas has revealed reduced incidence of adenomas apparent after just 1 year of supplementation 24 .…”

Section: Obesity and Colorectal Cancermentioning

confidence: 99%

Obesity and Colorectal Cancer

Jochem

Leitzmann

2016

Recent Results in Cancer Research

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“…Progress has been slow, however, in defining specific dietary interventions to reduce the risk (Greenberg et al, 1994;MacLennan et al, 1995;Baron et al, 1999;Alberts et al, 2000;Bonithon-Kopp et al, 2000;Schatzkin et al, 2000). This may have been a consequence of the cumbersome method that has been used to test possible interventions.…”

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A pilot randomised controlled trial to reduce colorectal cancer risk markers associated with B-vitamin deficiency, insulin resistance and colonic inflammation

Cirocco

Giacca

et al. 2005

Br J Cancer

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Colorectal cancer risk is associated with biochemical markers for B-vitamin deficiency, insulin resistance and colonic inflammation, suggesting that these three conditions are each involved in colon carcinogenesis. We expected that dietary supplements of folic acid, n-3 fatty acids and calcium would reduce the markers and thus possibly cancer risk. We therefore randomised 98 participants, with previous colonic polyps or intramucosal carcinomas, to a combined treatment of supplementary folic acid, fish oil and calcium carbonate, or placebos for 28 days. Blood and faecal samples were obtained prior to and at the conclusion of the intervention and analysed for plasma folate, homocysteine, insulin, free fatty acids, triglycerides and faecal calprotectin. In addition, plasma vitamin B 12 , thiamin, glucose and C-reactive protein were assessed. Our supplemental strategy modestly affected some of the biomarkers associated with folate metabolism and insulin resistance, but had no effect on those associated with colonic inflammation. This pilot study demonstrates the feasibility and practicality of clinical trials aimed at reducing diet-related biochemical risk markers for colon cancer. We suggest that long-term intervention studies with tumour-related end points should be undertaken when the intervention agents used are found effective in short-term biochemical risk marker trials.

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Calcium Supplements for the Prevention of Colorectal Adenomas

Abstract: Calcium supplementation is associated with a significant - though moderate - reduction in the risk of recurrent colorectal adenomas.

Cited by 791 publications

References 36 publications

Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study

Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study

Obesity and Colorectal Cancer

A pilot randomised controlled trial to reduce colorectal cancer risk markers associated with B-vitamin deficiency, insulin resistance and colonic inflammation

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