The Influence of Folate and Multivitamin Use on the Familial Risk of Colon Cancer in Women

DOI: Published March 2002

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Fig. 1.
a, multivariate relative risk of colon cancer according to total folate intake in 1980 (dietary and supplemental sources) and family history of colorectal cancer. b, multivariate relative risk of colon cancer according to folate intake in 1980 from food sources only and family history of colorectal cancer. In b, women who used multivitamin supplements for >5 years were excluded. Numbers in parentheses, 95% CIs; N, number of cases for each category.
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Fig. 2.
a, multivariate relative risk of colon cancer according to duration of multivitamin use and family history of colorectal cancer. b, multivariate relative risk of colon cancer according to duration of high folate use (highest tertile) and family history of colorectal cancer. Only women in either the lowest or highest tertiles were included in b; women in the lower tertile of folate intake were considered the referents. Numbers in parentheses, 95% CIs; N, number of cases for each category.
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Fig. 3.
a, multivariate relative risk of colon cancer according to methionine intake in 1980 and family history of colorectal cancer. b, multivariate relative risk of colon cancer according to alcohol intake in 1980 and family history of colorectal cancer. Numbers in parentheses, 95% CIs; N, number of cases for each category.

Table 1

Characteristics of the study participants according to the presence or absence of a family history of colorectal cancer^a

	No family history n = 81,802	Family history n = 6,956
Age (yr)	46.7	46.8
Body mass index (kg/m²)	24.3	24.3
Alcohol intake (g/day)	6.6	6.8
Dietary intake^b
Folate (μg/day)^c	365	365
Methionine (g/day)	1.9	1.9
Animal fat (g/day)	52.2	51.9
Dietary fiber (g/day)	16.8	16.9
Beef, pork or lamb as a main dish (servings/week)	2.6	2.6
Calcium (mg/day)^c	732	732
Vitamin D (IU/day)^c	292	291
Regular aspirin use (%)^d	23.5	26.4
Multivitamin supplement use (%)	34.0	34.1
Mean duration of multivitamin use at baseline (yr)^e	4.4	4.3
Mean duration of multivitamin use in 1994 (yr)^f	8.0	8.1
Screening endoscopy use at baseline (%)	5.4	5.7
Screening endoscopy use through study follow-up (%)^g	20.3	43.1
Regular vigorous exercise (%)^b	44.7	46.0
Mean pack-years of smoking before age 30 yr	3.0	2.9

^a Based on reports of a family history of colorectal cancer in one or more first-degree relatives obtained at study initiation. Values are means directly standardized according to the age distribution of the cohort.
^b Dietary values represent the mean energy-adjusted intake.
^c Includes the use of supplements.
^d Defined as aspirin use on two or more days/week.
^e Mean duration of use among multivitamin users at baseline.
^f Mean duration of use among multivitamin users in 1994.
^g Includes screening endoscopy use during study follow-up and at baseline.
^hRegular vigorous exercise was defined as vigorous physical activity (enough to work up a sweat) on one or more days/week.

Table 2

RR of colon cancer according to multivitamin supplement use in 1980 and family history of colorectal cancer^a^,b

^a Multivariate RRs are adjusted for age (5-year categories), pack-years of smoking before age 30 years (0, 1–5, 6–10, 11–15, or >15 pack-years), body-mass index (in quintiles), regular vigorous exercise (≥1 day/week), regular aspirin use (≥2 times per week), screening endoscopy (yes or no), beef, pork, or lamb as a main dish (<1 per month, 1–3 per month, 1 per week, 2–4 per week, or ≥5 per week), alcohol consumption (abstinence, history of greatly reduced consumption, or <15, 15–30, or >30 g/day), and energy-adjusted levels of methionine (≤1.4, 1.5–1.8, 1.9–2.2, >2.3 g/day).
^b P for interaction for the cross-product term of multivitamin supplement use in 1980 and family history of colorectal cancer = 0.04.