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Nutritional Epidemiology

Tobacco Use and Associations of ß-Carotene and Vitamin Intakes with Colorectal Adenoma Risk^1,2

Pierre Senesse^*,**, Mathilde Touvier, Emmanuelle Kesse, Jean Faivre^* and Marie-Christine Boutron-Ruault^*,,3

^* Registre Bourguignon des Cancers Digestifs, Faculté de Médecine, Dijon Cedex, France; Nutrition, Hormones and Cancer Unit, Institut Gustave Roussy, Villejuif, France; and ^** CRLC Val d’Aurelle, Montpellier, Cedex 5, France

³To whom correspondence should be addressed. E-mail: boutron{at}igr.fr.

The effects of vitamins and ß-carotene on the risk of colorectal adenomas have not been fully investigated. Recent data suggest that smoking could modulate the effect of ß-carotene supplements on adenoma recurrence. We investigated the effect of dietary vitamins and ß-carotene on the risk of adenomas, and a potential interaction with smoking status as part of a case-control study of environmental factors associated with the risk of colorectal adenomas and cancers. We compared nutrient intakes in polyp-free controls (n = 427) and adenoma cases (n = 362) globally and using models stratified by smoking status, adjusted for age, sex, BMI, and energy and alcohol intakes. Folate and vitamins C and B-6 were inversely related to adenoma risk (P for trend = 0.005, 0.03, and 0.02, respectively), whereas vitamin D tended to be inversely associated with risk (P for trend = 0.05). There was a significant interaction between ß-carotene and smoking (P interaction = 0.04). In nonsmokers, ß-carotene was inversely associated with adenoma risk, especially that of colon adenomas [odds ratios (ORs) in low vs. high consumers and 95% CI 0.4 (0.2–0.9)], whereas in past or current smokers, ß-carotene was associated with a nonsignificant (P for trend = 0.19) increase in the risk of colon adenomas [corresponding OR = 1.9 (95% CI = 0.9–4.1)]. Our findings support a protective effect of folate and vitamins C and B-6 irrespective of smoking habits, and a protective effect of ß-carotene in nonsmokers only. They suggest an adverse effect of ß-carotene in smokers, who should be cautious about taking high doses of this micronutrient.

KEY WORDS: • colorectal neoplasms • adenomas • ß-carotene • folate • tobacco