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Nutritional Epidemiology

The Association of Calcium and Vitamin D with Risk of Colorectal Adenomas

Terryl J. Hartman¹, Paul S. Albert^*, Kirk Snyder, Martha L. Slattery^**, Bette Caan, Electra Paskett^#, Frank Iber, James Walter Kikendall^##, James Marshall, Moshe Shike^***, Joel Weissfeld, Brenda Brewer, Arthur Schatzkin^###, Elaine Lanza and the Polyp Prevention Study Group²

Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA; ^* Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD; Information Management Services, Incorporated, Rockville, MD; ^** University of Utah, Salt Lake City, UT; Kaiser Foundation Research Institute, Oakland, CA; ^# Ohio State University, Columbus, OH; Edward Hines, Jr., Hospital, Veterans Affairs Medical Center, Hines, IL; ^## National Naval Medical Center, Bethesda, MD; Roswell Park Cancer Institute, Buffalo, NY; ^*** Memorial Sloan-Kettering Cancer Center, New York, NY; University of Pittsburgh, Pittsburgh, PA; Westat, Rockville, MD; ^### Nutritional Epidemiology Branch, Division of Epidemiology & Genetics, National Cancer Institute, Bethesda, MD; and Laboratory of Cancer Prevention, Center for Cancer Research, National Cancer Institute, Bethesda, MD

¹To whom correspondence should be addressed. E-mail: tjh9{at}psu.edu.

The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial designed to determine the effects of a high-fiber, high-fruit and vegetable, low-fat diet on the recurrence of adenomatous polyps in the large bowel. Detailed dietary intake and supplement use data were collected at baseline and at each of 4 annual study visits. Adenoma recurrence was ascertained by complete colonoscopy at baseline and after 1 and 4 y. Recurrence was found in 754 of the 1905 trial participants. We evaluated the association between calcium and vitamin D intake and adenomatous polyp recurrence after adjusting for intervention group, age, gender, nonsteroidal anti-inflammatory drug use, total energy intake, and the interaction of gender and intervention group. Vitamin D models were also adjusted for the location of the clinic site. Dietary variables were adjusted for total energy intake via the residual method. There were no overall significant associations between adenoma recurrence and dietary calcium intake [odds ratio (OR) for the 5th compared with the lowest quintile = 0.91; 95% CI = 0.67–1.23; P-trend = 0.68], total calcium intake (OR = 0.86; 95% CI = 0.62–1.18; P-trend = 0.20), or dietary vitamin D intake (OR = 0.93; 95% CI = 0.69–1.25; P-trend = 0.43) averaged over follow-up. Total vitamin D intake was weakly inversely associated with adenoma recurrence (OR = 0.84; 95% CI = 0.62–1.13; P-trend = 0.03). Supplemental calcium and vitamin D use during follow-up also were inversely associated with adenoma recurrence (OR for any compared with no use = 0.82; 95% CI = 0.68–0.99; and OR = 0.82; 95% CI = 0.68–0.99; for calcium and vitamin D, respectively). Slightly stronger associations were noted for the prevention of multiple recurrences. Our analyses did not suggest a significant effect modification between total calcium and total vitamin D intake (P = 0.14) on risk for adenoma recurrence. This trial cohort provides some evidence that calcium and vitamin D may be inversely associated with adenoma recurrence.

KEY WORDS: • calcium • vitamin D • Polyp Prevention Trial • colorectal adenomas

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