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Lv S, Ding Y, Huang J, He Y, Xie R, Shi X, Ye W. Genetic prediction of micronutrient levels and the risk of colorectal polyps: A mendelian randomization study. Clin Nutr 2024; 43:1405-1413. [PMID: 38691983 DOI: 10.1016/j.clnu.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Previous epidemiological and experimental studies have yielded conflicting results regarding the influence of human micronutrient levels on the risk of colorectal polyps (CP). In our study, we conducted a two-sample Mendelian randomization (MR) investigation to probe the link between 13 human micronutrients (calcium, selenium, magnesium, phosphorus, folate, vitamins B-6, B-12, C, D, beta-carotene, iron, zinc, and copper) and the genetic susceptibility to CP. METHODS Summary statistics for CP (n = 463,010) were obtained from pan-European genome-wide association studies, and instrumental variables for 13 micronutrients were screened from published genome-wide association studies (GWAS). After selecting suitable instrumental variables, we performed a two-sample MR study, deploying sensitivity analyses to judge heterogeneity and pleiotropy, using inverse variance weighted methods as our primary estimation tool. RESULTS Our study identified that a genetic predisposition to elevated toenail and circulating selenium or serum β-carotene concentrations lowers the risk of CP occurrence. However, no statistically significant association was observed between the other 11 micronutrients and the risk of CP. CONCLUSION The study findings provide evidence that the micronutrient selenium and β-carotene may confer protective effects against the development of CP.
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Affiliation(s)
- Siyao Lv
- Department of Gastroenterology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310053, China.
| | - Yunyi Ding
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310053, China.
| | - Junli Huang
- Department of Geriatrics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310053, China.
| | - Yixin He
- Gynaecologic Department of Traditional Chinese Medicine, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310053, China.
| | - Ruijie Xie
- Division of Clinical Epidemiology and Aging Research, University of Heidelberg, Heidelberg, 69117, Germany.
| | - Xiaohong Shi
- Department of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China.
| | - Wei Ye
- Department of Gastroenterology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310053, China.
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O'Sullivan DE, Ruan Y, Forbes N, Heitman SJ, Hilsden RJ, Pader J, Brenner DR. Long-term Use of Hormone Replacement Therapy is Associated With a Lower Risk of Developing High-risk Serrated Polyps in Women. J Clin Gastroenterol 2022; 56:697-704. [PMID: 34406174 DOI: 10.1097/mcg.0000000000001606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/20/2021] [Indexed: 01/25/2023]
Abstract
GOALS/BACKGROUND Hormone replacement therapy (HRT) and parity have been suggested protective factors against the development of colorectal polyps. However, there are a limited number of studies that have examined the relationship of these factors with high-risk adenomatous polyps (HRAP) or high-risk serrated polyps (HRSP), which may have different causes and therefore implications for screening programs. STUDY Data from a cross-sectional study of 1384 women undergoing screening-related colonoscopy between 2008 and 2016 were analyzed. Modified Poisson regression models with robust error variance were used to determine the relative risk of developing adenomatous polyps, serrated polyps, HRAPs, and HRSPs associated with pregnancy, menopausal status, and the use of HRT (duration and type). RESULTS Women that used HRT for ≥6 years were at a significantly lower risk of developing a HRSP [risk ratios (RR): 0.53; 95% confidence interval (CI): 0.29-0.97]. Irrespective of the duration of use, the use of HRT that included progesterone alone or with estrogen was associated with a significantly lower risk of developing a HRSP (RR: 0.54; 95% CI: 0.30-0.95). The use HRT with progesterone for ≥6 years was associated with a nonsignificant lower risk of developing a HRSP (RR: 0.42; 95% CI: 0.17-1.04). None of the reproductive factors assessed or HRT were associated with the development of adenomatous polyps or HRAPs. CONCLUSIONS The results of this study suggests that the long-term use of HRT, and therapies that include progesterone are associated with a lower risk of developing HRSPs. These results could have implications for targeted screening for serrated polyps among women.
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Affiliation(s)
- Dylan E O'Sullivan
- Departments of Community Health Sciences
- Oncology
- Forzani and MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB, Canada
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services
| | - Nauzer Forbes
- Departments of Community Health Sciences
- Medicine, Cumming School of Medicine, University of Calgary
- Forzani and MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB, Canada
| | - Steven J Heitman
- Departments of Community Health Sciences
- Medicine, Cumming School of Medicine, University of Calgary
- Forzani and MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB, Canada
| | - Robert J Hilsden
- Departments of Community Health Sciences
- Medicine, Cumming School of Medicine, University of Calgary
- Forzani and MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB, Canada
| | - Joy Pader
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services
| | - Darren R Brenner
- Departments of Community Health Sciences
- Oncology
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services
- Forzani and MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB, Canada
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Peixoto RD, Oliveira LJDC, Passarini TDM, Andrade AC, Diniz PH, Prolla G, Amorim LC, Gil M, Lino F, Garicochea B, Jácome A, Ng K. Vitamin D and colorectal cancer - A practical review of the literature. Cancer Treat Res Commun 2022; 32:100616. [PMID: 35940119 DOI: 10.1016/j.ctarc.2022.100616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related mortality in the United States and the second cause worldwide. Its incidence rates have been decreasing in the overall population in the US in the past few decades, but with increasing rates in the population younger than 50 years old. Environmental factors are supposed to be involved in the development of the disease, with strong evidence favoring an influence of the diet and lifestyle. A diet high in red meat and calories, and low in fiber, fruits and vegetables increases the risk of CRC, as well as physical inactivity. The influence of low calcium intake and low levels of vitamin D on the risk of the disease and on the clinical outcomes of CRC patients has also been investigated. Hypovitaminosis D has been highly prevalent worldwide and associated with several chronic diseases, including malignancies. Vitamin D is a steroid hormone with the main function of regulating bone metabolism, but with many other physiological functions, such as anti-inflammatory, immunomodulatory, and antiangiogenic effects, potentially acting as a carcinogenesis inhibitor. In this review, we aim to describe the relation of vitamin D with malignant diseases, mainly CRC, as well as to highlight the results of the studies which addressed the potential role of vitamin D in the development and progression of the disease. In addition, we will present the results of the pivotal randomized clinical trials that evaluated the impact of vitamin D supplementation on the clinical outcomes of patients with CRC.
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Affiliation(s)
- Renata D'Alpino Peixoto
- Department of Gastrointestinal Medical Oncology, Centro Paulista de Oncologia, Oncoclinicas, Av. Brigadeiro Faria Lima 4300, São Paulo, SP 04538-132, Brazil.
| | - Leandro Jonata de Carvalho Oliveira
- Department of Gastrointestinal Medical Oncology, Centro Paulista de Oncologia, Oncoclinicas, Av. Brigadeiro Faria Lima 4300, São Paulo, SP 04538-132, Brazil
| | | | - Aline Chaves Andrade
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Belo Horizonte, Brazil
| | - Paulo Henrique Diniz
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Belo Horizonte, Brazil
| | - Gabriel Prolla
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Porto Alegre, Brazil
| | - Larissa Costa Amorim
- Department of Gastrointestinal Medical Oncology, Centro Paulista de Oncologia, Oncoclinicas, Av. Brigadeiro Faria Lima 4300, São Paulo, SP 04538-132, Brazil
| | - Mariana Gil
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Rio de Janeiro, Brazil
| | - Flora Lino
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Rio de Janeiro, Brazil
| | - Bernardo Garicochea
- Department of Gastrointestinal Medical Oncology, Centro Paulista de Oncologia, Oncoclinicas, Av. Brigadeiro Faria Lima 4300, São Paulo, SP 04538-132, Brazil
| | - Alexandre Jácome
- Department of Gastrointestinal Medical Oncology, Oncoclinicas, Belo Horizonte, Brazil
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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Sutherland RL, Boyne DJ, Jarada TN, Lix LM, Tinmouth J, Rabeneck L, Heitman SJ, Forbes N, Hilsden RJ, Brenner DR. Development and validation of a risk prediction model for high-risk adenomas at the time of first screening colonoscopy among screening aged Canadians. Prev Med 2021; 148:106563. [PMID: 33878349 DOI: 10.1016/j.ypmed.2021.106563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to develop a risk prediction model for high risk adenomas (HRAs) detected at screening colonoscopy based on readily available participant information. The cohort consisted of 3035 participants aged 50 to 74 years with no history of cancer who underwent a primary screening colonoscopy at a centralized colon cancer screening centre between 2008 and 2016. A multivariable logistic regression model was created using CRC risk factors identified from prior research. Model covariates were collected from a baseline questionnaire and included participant demographics (age and sex), lifestyle parameters (body mass index, alcohol, smoking, and vitamin D supplement use) and medical history (family history of CRC and diabetes). Mean participant age was 58.8 years, and 54.7% were male. 249 participants with HRAs were identified (8.2%). An adjusted c-statistic of 0.67 was calculated, and a specificity and negative predictive value of 97.2% (95% CI: 96.5-97.8) and 92.5% (95% CI: 92.2-92.8) for the detection of HRAs, respectively, were achieved using 20% predicted probability as a high-risk threshold. However, only a sensitivity of 12.1% (95% CI: 8.3-16.8) was achieved. Our model has moderate predictive ability, with strengths in being able to rule out those with an absence of HRAs on screening colonoscopy. Maximizing screening efficiency through improved risk prediction can enhance resource allocation. Ultimately, this model has the potential to improve patient care by reducing unnecessary colonoscopies, limiting this invasive procedure to those most likely to have significant findings.
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Affiliation(s)
- R Liam Sutherland
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Alberta, Canada
| | - Devon J Boyne
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Alberta, Canada
| | - Tamer N Jarada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Jill Tinmouth
- Department of Medicine, Sunnybrook Health Sciences Centre Research Institute and University of Toronto, Prevention and Cancer Control, Cancer Care, Ontario, Canada
| | - Linda Rabeneck
- Department of Medicine, University of Toronto, and Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Steven J Heitman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Nauzer Forbes
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Robert J Hilsden
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Canada.
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Hellwege JN, Zhu X, Huang X, Shrubsole MJ, Fan L, Li B, Ness R, Seidner DL, Giovannucci EL, Edwards TL, Dai Q. Blunted PTH response to vitamin D insufficiency/deficiency and colorectal neoplasia risk. Clin Nutr 2021; 40:3305-3313. [PMID: 33190990 PMCID: PMC8099932 DOI: 10.1016/j.clnu.2020.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND & AIMS In contrast to many observational studies, large-scale randomized trials do not support the protective role of vitamin D for the prevention of colorectal neoplasia. However, in previous studies, individuals with blunted parathyroid hormone (PTH) response to vitamin D insufficiency/deficiency (BPRVID), were not differentiated from those with high PTH response to vitamin D insufficiency/deficiency (HPRVID). Individuals with BPRVID are responsive to magnesium treatment, particularly treatment of magnesium plus vitamin D while those with HPRVID are responsive to vitamin D treatment. We prospectively compared these two distinct groups (i.e. BPRVID and HPRVID) for risk of incident adenoma, metachronous adenoma, and incident colorectal cancer (CRC) METHODS: Three nested case-control studies in the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial. RESULTS We found optimal 25(OH)D levels were associated with a significantly reduced risk of CRC, primarily among women. The associations between 25(OH)D and CRC risk significantly differed by PTH levels, particularly among women. Compared to individuals with optimal levels for both 25(OH)D and PTH, all others were at an elevated risk of incident CRC, primarily in women. We found those with BPRVID had 2.56-fold significantly increased risk of CRC compared to 1.65-fold non-significantly increased risk for those with HPRVID. Among women, we observed those with BPRVID had 4.79-6.25-fold significantly increased risks of incident CRC and adenoma whereas those with HPRVID had 3.65-fold significantly increased risk of CRC. CONCLUSIONS Individuals with BPRVID are at higher risks of incident adenoma and CRC compared to those with HPRVID, particularly among women.
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Affiliation(s)
- Jacklyn N Hellwege
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Xiangzhu Zhu
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Xiang Huang
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Martha J Shrubsole
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Lei Fan
- Master of Public Health Program, School of Medicine, Vanderbilt University, Nashville, TN, 37232, USA
| | - Bingshan Li
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA
| | - Reid Ness
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Douglas L Seidner
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Edward L Giovannucci
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, 02115, USA
| | - Todd L Edwards
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Qi Dai
- Division of Epidemiology, Vanderbilt Ingram Cancer Center, Department of Medicine, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37203, USA.
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