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Vrieling A, Bueno‐De‐Mesquita HB, Ros MM, Kampman E, Aben KK, Büchner FL, Jansen EH, Roswall N, Tjønneland A, Boutron‐Ruault M, Cadeau C, Chang‐Claude J, Kaaks R, Weikert S, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Sieri S, Palli D, Panico S, Peeters PH, Weiderpass E, Skeie G, Jakszyn P, Chirlaque M, Ardanaz E, Sánchez M, Ehrnström R, Malm J, Ljungberg B, Khaw K, Wareham NJ, Brennan P, Johansson M, Riboli E, Kiemeney LA. One-carbon metabolism biomarkers and risk of urothelial cell carcinoma in the European prospective investigation into cancer and nutrition. Int J Cancer 2019; 145:2349-2359. [PMID: 30694528 PMCID: PMC6899898 DOI: 10.1002/ijc.32165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 12/24/2018] [Accepted: 01/04/2019] [Indexed: 01/10/2023]
Abstract
Published associations between dietary folate and bladder cancer risk are inconsistent. Biomarkers may provide more accurate measures of nutrient status. This nested case-control analysis within the European Prospective Investigation into Cancer and Nutrition (EPIC) investigated associations between pre-diagnostic serum folate, homocysteine, vitamins B6 and B12 and the risk of urothelial cell carcinomas of the bladder (UCC). A total of 824 patients with newly diagnosed UCC were matched with 824 cohort members. Serum folate, homocysteine, and vitamins B6 and B12 were measured. Odds ratios (OR) and 95% confidence intervals (CI) for total, aggressive, and non-aggressive UCC were estimated using conditional logistic regression with adjustment for smoking status, smoking duration and intensity, and other potential confounders. Additionally, statistical interaction with smoking status was assessed. A halving in serum folate concentrations was moderately associated with risk of UCC (OR: 1.18; 95% CI: 0.98-1.43), in particular aggressive UCC (OR: 1.34; 95% CI: 1.02-1.75; p-heterogeneity = 0.19). Compared to never smokers in the highest quartile of folate concentrations, this association seemed only apparent among current smokers in the lowest quartile of folate concentrations (OR: 6.26; 95% CI: 3.62-10.81, p-interaction = 0.07). Dietary folate was not associated with aggressive UCC (OR: 1.26; 95% CI: 0.81-1.95; p-heterogeneity = 0.14). No association was observed between serum homocysteine, vitamins B6 and B12 and risk of UCC. This study suggests that lower serum folate concentrations are associated with increased UCC risk, in particular aggressive UCC. Residual confounding by smoking cannot be ruled out and these findings require confirmation in future studies with multiple measurements.
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Affiliation(s)
- Alina Vrieling
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - H. Bas Bueno‐De‐Mesquita
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of MedicineImperial College LondonLondonUnited Kingdom
- Department of Gastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of Social & Preventive Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Martine M. Ros
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Ellen Kampman
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | - Katja K. Aben
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
- Netherlands Comprehensive Cancer OrganisationUtrechtThe Netherlands
| | - Frederike L. Büchner
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Eugène H. Jansen
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Nina Roswall
- Danish Cancer Society Research CenterCopenhagenDenmark
| | | | - Marie‐Christine Boutron‐Ruault
- Inserm, Center for Research in Epidemiology and Population Health (CESP), U1018, NutritionHormones and Women's Health teamVillejuifFrance
- Université of Paris‐SudVillejuifFrance
- IGRVillejufFrance
| | - Claire Cadeau
- Inserm, Center for Research in Epidemiology and Population Health (CESP), U1018, NutritionHormones and Women's Health teamVillejuifFrance
- Université of Paris‐SudVillejuifFrance
- IGRVillejufFrance
| | - Jenny Chang‐Claude
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)Germany
- Cancer Epidemiology GroupUniversity Medical Centre Hamburg‐Eppendorf, University Cancer Centre Hamburg (UCCH)HamburgGermany
| | - Rudolf Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)Germany
| | - Steffen Weikert
- Department of EpidemiologyGerman Institute of Human NutritionNuthetalGermany
- Department of UrologyVivantes Humboldt HospitalBerlinGermany
| | - Heiner Boeing
- Department of EpidemiologyGerman Institute of Human NutritionNuthetalGermany
| | - Antonia Trichopoulou
- WHO Collaborating Center for Food and Nutrition Policies, Department of HygieneEpidemiology and Medical Statistics University of Athens Medical SchoolAthensGreece
- Hellenic Health FoundationAthensGreece
| | - Pagona Lagiou
- WHO Collaborating Center for Food and Nutrition Policies, Department of HygieneEpidemiology and Medical Statistics University of Athens Medical SchoolAthensGreece
- Department of EpidemiologyHarvard School of Public HealthBostonMA
- Bureau of Epidemiologic ResearchAcademy of AthensAthensGreece
| | - Dimitrios Trichopoulos
- Hellenic Health FoundationAthensGreece
- Department of EpidemiologyHarvard School of Public HealthBostonMA
- Bureau of Epidemiologic ResearchAcademy of AthensAthensGreece
| | - Sabina Sieri
- Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Domenico Palli
- Molecular and Nutritional Epidemiology UnitCancer and Prevention Institute (ISPO)FlorenceItaly
| | - Salvatore Panico
- Department of Clinical and Experimental MedicineFederico II University, Medical SchoolNaplesItaly
| | - Petra H. Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of MedicineImperial College LondonLondonUnited Kingdom
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health SciencesUniversity of Tromsø, The Artic University of NorwayTromsøNorway
- Department of ResearchCancer Registry of Norway – Institute of Population‐based Cancer ResearchOsloNorway
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health SciencesUniversity of Tromsø, The Artic University of NorwayTromsøNorway
| | - Paula Jakszyn
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research ProgrammeCatalan Institute of Oncology (ICO)BarcelonaSpain
| | - María‐Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER de Epidemiologia y Salud Pública)MadridSpain
- Department of Epidemiology, Murcia Health AuthorityIMIB‐Arrixaca. Murcia UniversitySpain
| | - Eva Ardanaz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER de Epidemiologia y Salud Pública)MadridSpain
- Instituto de Salud Pública de Navarra, IdiSNAPamplonaSpain
| | - María‐José Sánchez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER de Epidemiologia y Salud Pública)MadridSpain
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADAHospitales Universitarios de Granada/Universidad de GranadaGranadaSpain
| | - Roy Ehrnström
- Laboratory Medicine, Department of PathologySkåne University Hospital MalmöMalmöSweden
| | - Johan Malm
- Department of Translational Medicine, Division of Clinical ChemistryLund UniversityMalmöSweden
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and AndrologyUmeå UniversityUmeåSweden
| | - Kay‐Tee Khaw
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUnited Kingdom
| | - Nick J. Wareham
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUnited Kingdom
| | - Paul Brennan
- Genetic Epidemiology GroupInternational Agency for Research on Cancer (IARC)LyonFrance
| | - Mattias Johansson
- Genetic Epidemiology GroupInternational Agency for Research on Cancer (IARC)LyonFrance
- Department of Biobank ResearchUmeå UniversityUmeåSweden
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of MedicineImperial College LondonLondonUnited Kingdom
| | - Lambertus A. Kiemeney
- Radboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
- Department of UrologyRadboud University Medical CenterNijmegenThe Netherlands
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