Background: Despite extensive study, the role of folate in colorectal cancer remains unclear. research has therefore begun to address the role of other elements of the folate-methionine metabolic cycles. this study investigated factors other than folate involved in one-carbon metabolism, i.e., choline, betaine, dimethylglycine, sarcosine, and methionine and relevant polymorphisms, in relation to the risk of colorectal cancer in a population with low intakes and circulating levels of folate. Methods: this was a prospective case-control study of 613 case subjects and 1,190 matched control subjects nested within the population-based northern Sweden Health and Disease Study. We estimated odds ratios (Or) by conditional logistic regression, and marginal risk differences with weighted maximum likelihood estimation using incidence data from the study cohort. Results: Higher plasma concentrations of methionine and betaine were associated with modest colorectal cancer risk reductions (Or [95% confidence interval {ci}] for highest versus lowest tertile: 0.76 [0.57, 0.99] and 0.72 [0.55, 0.94], respectively). estimated marginal risk differences corresponded to approximately 200 fewer colorectal cancer cases per 100,000 individuals on average. We observed no clear associations between choline, dimethylglycine, or sarcosine and colorectal cancer risk. the inverse association of methionine was modified by plasma folate concentrations (Or [95% ci] for highest/ lowest versus lowest/lowest tertile of plasma methionine/folate concentrations 0.39 [0.24, 0.64], P interaction = 0.06). Conclusions: in this population-based, nested case-control study with a long follow-up time from baseline to diagnosis (median: 8.2 years), higher plasma concentrations of methionine and betaine were associated with lower colorectal cancer risk.See Video abstract at http://links.lww.com/eDe/B83. (Epidemiology 2016;27: 787-796) O ne-carbon metabolism is an intracellular network involving the folate and methionine cycles, in which methyl groups and other one-carbon units are transferred to acceptor molecules ( Figure 1). a central role for one-carbon metabolism in cancer development is biologically plausible, as related nucleotide synthesis and methylation reactions including Dna methylation are vital for genome stability and function.the potential role of one-carbon metabolism in colorectal cancer development has been extensively studied, with most research to date focusing on folate. Diets rich in natural folates are associated with reduced risk of colorectal cancer. 1 However, a dual role of folate has been proposed, both preventing and promoting cancer, depending on the dose and timing of exposure. 2,3 Folate is not a one-carbon unit donor per se, but an enzymatic co-factor important for maintenance of the substrate flux in one-carbon metabolism. it might therefore be expected to stabilize the genome of normal mucosa, protecting against cancer, while accelerating the progression of precancerous or malignant lesions. 2 although evidence from animal...