补充钙加维生素D与结直肠癌风险

Calcium plus vitamin D supplementation and the risk of colorectal cancer.

作者信息

Wactawski-Wende Jean, Kotchen Jane Morley, Anderson Garnet L, Assaf Annlouise R, Brunner Robert L, O'Sullivan Mary Jo, Margolis Karen L, Ockene Judith K, Phillips Lawrence, Pottern Linda, Prentice Ross L, Robbins John, Rohan Thomas E, Sarto Gloria E, Sharma Santosh, Stefanick Marcia L, Van Horn Linda, Wallace Robert B, Whitlock Evelyn, Bassford Tamsen, Beresford Shirley A A, Black Henry R, Bonds Denise E, Brzyski Robert G, Caan Bette, Chlebowski Rowan T, Cochrane Barbara, Garland Cedric, Gass Margery, Hays Jennifer, Heiss Gerardo, Hendrix Susan L, Howard Barbara V, Hsia Judith, Hubbell F Allan, Jackson Rebecca D, Johnson Karen C, Judd Howard, Kooperberg Charles L, Kuller Lewis H, LaCroix Andrea Z, Lane Dorothy S, Langer Robert D, Lasser Norman L, Lewis Cora E, Limacher Marian C, Manson JoAnn E

机构信息

Department of Social and Preventive Medicine, University at Buffalo, 270 Farber Hall, Buffalo, NY 14214, USA.

出版信息

N Engl J Med. 2006 Feb 16;354(7):684-96. doi: 10.1056/NEJMoa055222.

DOI:10.1056/NEJMoa055222

PMID:16481636

Abstract

BACKGROUND

Higher intake of calcium and vitamin D has been associated with a reduced risk of colorectal cancer in epidemiologic studies and polyp recurrence in polyp-prevention trials. However, randomized-trial evidence that calcium with vitamin D supplementation is beneficial in the primary prevention of colorectal cancer is lacking.

METHODS

We conducted a randomized, double-blind, placebo-controlled trial involving 36,282 postmenopausal women from 40 Women's Health Initiative centers: 18,176 women received 500 mg of elemental calcium as calcium carbonate with 200 IU of vitamin D3 [corrected] twice daily (1000 mg of elemental calcium and 400 IU of vitamin D3) and 18,106 received a matching placebo for an average of 7.0 years. The incidence of pathologically confirmed colorectal cancer was the designated secondary outcome. Baseline levels of serum 25-hydroxyvitamin D were assessed in a nested case-control study.

RESULTS

The incidence of invasive colorectal cancer did not differ significantly between women assigned to calcium plus vitamin D supplementation and those assigned to placebo (168 and 154 cases; hazard ratio, 1.08; 95 percent confidence interval, 0.86 to 1.34; P=0.51), and the tumor characteristics were similar in the two groups. The frequency of colorectal-cancer screening and abdominal symptoms was similar in the two groups. There were no significant treatment interactions with baseline characteristics.

CONCLUSIONS

Daily supplementation of calcium with vitamin D for seven years had no effect on the incidence of colorectal cancer among postmenopausal women. The long latency associated with the development of colorectal cancer, along with the seven-year duration of the trial, may have contributed to this null finding. Ongoing follow-up will assess the longer-term effect of this intervention. (ClinicalTrials.gov number, NCT00000611.).

摘要

背景

在流行病学研究中，较高的钙和维生素D摄入量与结直肠癌风险降低以及息肉预防试验中的息肉复发有关。然而，缺乏随机试验证据表明补充钙和维生素D对结直肠癌的一级预防有益。

方法

我们进行了一项随机、双盲、安慰剂对照试验，涉及来自40个妇女健康倡议中心的36282名绝经后妇女：18176名妇女每天两次服用500毫克碳酸钙形式的元素钙和200国际单位维生素D3（1000毫克元素钙和400国际单位维生素D3），18106名妇女服用匹配的安慰剂，平均持续7.0年。病理确诊的结直肠癌发病率是指定的次要结局。在一项巢式病例对照研究中评估血清25-羟维生素D的基线水平。