Nutr Res Pract.  2017 Oct;11(5):419-429. 10.4162/nrp.2017.11.5.419.

Circulating folate levels and colorectal adenoma: a case-control study and a meta-analysis

• Park YM
• Youn J
• Cho CH
• Kim SH
• Lee JE

• KMID: 2390135
• DOI: http://doi.org/10.4162/nrp.2017.11.5.419

Abstract

BACKGROUND/OBJECTIVES
The relationship between folate and colorectal neoplasia remains controversial. We examined the association between serum folate concentrations and colorectal adenomas in a case-control study of Korean adults and conducted a meta-analysis.
SUBJECTS/METHODS
Our case-control study included 113 pairs of case and control who underwent colonoscopy and provided blood samples. We used multivariable conditional logistic regression models to obtain the odds ratios and 95% confidence interval (CIs). For meta-analysis, we identified the relevant studies by searching the PubMed database up to February 2017, included our case-control study and combined the study-specific relative risks (RRs) using a random-effects model.
RESULTS
In this case-control study, we included 58 men and 55 women with colorectal adenomas and sex and fasting status matched the controls. We did not find any significant association between the serum folate levels and colorectal adenomas in either men or women. For meta-analysis, a total of eleven studies were included in our analysis and classified into two groups; polyp clearance group (PC) for the studies that included participants who underwent endoscopies and had their polyps removed at baseline; and no polyp clearance group (NPC) for the studies that included participants whose histories of endoscopies were unknown or who underwent their first endoscopies. Four PC (1,311 cases and 1,672 non-cases) and eight NPC studies (3,501 cases and 11,347 non-cases) were included. The combined RRs (95% CIs) comparing the bottom with the top categories of circulating folate levels were 1.07 (0.97-1.18) for the NPC group but 1.45 (1.16-1.74) for the PC group.
CONCLUSIONS
Low circulating folate levels were associated with new adenoma formation.

Keyword

Folate; colorectal adenoma; meta-analysis

MeSH Terms

Adenoma*
Adult
Case-Control Studies*
Colonoscopy
Fasting
Female
Folic Acid*
Humans
Logistic Models
Male
Odds Ratio
Polyps
Folic Acid

Figure

• 

  Fig. 1 Flow chart of publication selection for the meta-analysis of the association between circulating folate levels and colorectal adenoma

• 

  Fig. 2 Forest plot for bottom versus top categories of circulating folate levels in relation to colorectal adenoma by PC or NPC groups. NPC indicated no polyp clearance group and PC indicated polyp clearance group. M, W, and C represented men, women, and combined sex, respectively. The black circles indicate the study specific relative risks; the horizontal lines indicate the 95% confidence intervals. The gray squares represent the study specific weights, which are inverse of the variance. The dash line indicates the overall combined RR and the diamonds indicate the 95% CIs for the combined RRs. P for difference between NPC and PC groups was 0.06.

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