Cancer Res Treat.  2021 Jan;53(1):140-147. 10.4143/crt.2020.480.

Adherence to the Recommended Intake of Calcium and Colorectal Cancer Risk in the HEXA Study

Affiliations
  • 1Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 2Cancer Research Institute, Seoul National University, Seoul, Korea
  • 3Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
  • 4JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 5Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 6Seoul Center for Infectious Disease Control, Seoul, Korea

Abstract

Purpose
Dietary calcium intake has been suggested to be protective against the development of colorectal cancer. The mean dietary calcium intake of Koreans is 490 mg/day, which is far below the recommended calcium intake of 700-800 mg/day. In this study, we explored the relationship between dietary calcium intake and colorectal cancer development in Koreans with relatively low calcium intake compared with individuals in Western countries.
Materials and Methods
The Health Examinees Study, a large-scale genomic community-based prospective cohort study, was designed to identify the general characteristics of major chronic diseases in Koreans. A total of 119,501 participants aged 40-69 years recruited between 2004 and 2013 were included in this analysis. The calcium intake level was categorized using the Dietary Reference Intakes for Koreans (KDRIs). The Cox proportional hazards regression model was used to estimate the hazard ratio (HR) and the corresponding 95% confidence intervals (CIs) for colorectal cancer risk, adjusting for potential confounders.
Results
In the multivariable-adjusted model, compared with the group that consumed less than the recommended amount of calcium, the group that consumed more than the recommended intake of calcium showed a significant reduction in the risk of colorectal cancer in women. (HR, 0.54; 95% CI, 0.31 to 0.95). Among men, however, no significant association was observed between dietary calcium intake and colorectal cancer risk (HR, 0.89; 95% CI, 0.54 to 1.45).
Conclusion
Korean women who adhere to the recommended intake of calcium showed a reduced risk of colorectal cancer.

Keyword

Colorectal neoplasms; Korea; Calcium intake; Recommended intake of calcium

Reference

References

1. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017; 66:683–91.
Article
2. Jung KW, Won YJ, Kong HJ, Lee ES. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2016. Cancer Res Treat. 2019; 51:417–30.
Article
3. World Cancer Research Fund; American Institute for Cancer Research. Continuous update project: keeping the science current. Colorectal cancer 2011 report: food, nutrition, physical activity and the prevention of colorectal cancer. London: World Cancer Research Fund;2011.
4. World Cancer Research Fund; American Institute for Cancer Research. Diet, nutrition, physical activity and colorectal cancer. London: World Cancer Research Fund;2017.
5. Cho E, Smith-Warner SA, Spiegelman D, Beeson WL, van den Brandt PA, Colditz GA, et al. Dairy foods, calcium, and colorectal cancer: a pooled analysis of 10 cohort studies. J Natl Cancer Inst. 2004; 96:1015–22.
Article
6. Han C, Shin A, Lee J, Lee J, Park JW, Oh JH, et al. Dietary calcium intake and the risk of colorectal cancer: a case control study. BMC Cancer. 2015; 15:966.
Article
7. Keum N, Aune D, Greenwood DC, Ju W, Giovannucci EL. Calcium intake and colorectal cancer risk: dose-response meta-analysis of prospective observational studies. Int J Cancer. 2014; 135:1940–8.
Article
8. Korea Centers for Disease Control and Prevention. National health statistics. Cheongju: Korea Centers for Disease Control and Prevention;2018.
9. Balk EM, Adam GP, Langberg VN, Earley A, Clark P, Ebeling PR, et al. Global dietary calcium intake among adults: a systematic review. Osteoporos Int. 2017; 28:3315–24.
Article
10. Health Examinees Study Group. The Health Examinees (HEXA) study: rationale, study design and baseline characteristics. Asian Pac J Cancer Prev. 2015; 16:1591–7.
11. Shin S, Lee HW, Kim CE, Lim J, Lee JK, Kang D. Association between milk consumption and metabolic syndrome among Korean adults: results from the health examinees study. Nutrients. 2017; 9:1102.
Article
12. Ahn Y, Kwon E, Shim JE, Park MK, Joo Y, Kimm K, et al. Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study. Eur J Clin Nutr. 2007; 61:1435–41.
Article
13. Newmark HL, Wargovich MJ, Bruce WR. Colon cancer and dietary fat, phosphate, and calcium: a hypothesis. J Natl Cancer Inst. 1984; 72:1323–5.
14. Jung KW, Won YJ, Oh CM, Kong HJ, Lee DH, Lee KH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2014. Cancer Res Treat. 2017; 49:292–305.
Article
15. Meng Y, Sun J, Yu J, Wang C, Su J. Dietary intakes of calcium, iron, magnesium, and potassium elements and the risk of colorectal cancer: a meta-analysis. Biol Trace Elem Res. 2019; 189:325–35.
Article
16. Mizoue T, Kimura Y, Toyomura K, Nagano J, Kono S, Mibu R, et al. Calcium, dairy foods, vitamin D, and colorectal cancer risk: the Fukuoka Colorectal Cancer Study. Cancer Epidemiol Biomarkers Prev. 2008; 17:2800–7.
Article
17. Zhang X, Fang YJ, Feng XL, Abulimiti A, Huang CY, Luo H, et al. Higher intakes of dietary vitamin D, calcium and dairy products are inversely associated with the risk of colorectal cancer: a case-control study in China. Br J Nutr. 2020; 123:699–711.
Article
18. Murphy N, Norat T, Ferrari P, Jenab M, Bueno-de-Mesquita B, Skeie G, et al. Consumption of dairy products and colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). PLoS One. 2013; 8:e72715.
19. Butler LM, Wang R, Koh WP, Yu MC. Prospective study of dietary patterns and colorectal cancer among Singapore Chinese. Br J Cancer. 2008; 99:1511–6.
Article
20. Kesse E, Boutron-Ruault MC, Norat T, Riboli E, Clavel-Chapelon F, Group EN. Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study. Int J Cancer. 2005; 117:137–44.
Article
21. Tantamango-Bartley Y, Knutsen SF, Jaceldo-Siegl K, Fan J, Mashchak A, Fraser GE. Independent associations of dairy and calcium intakes with colorectal cancers in the Adventist Health Study-2 cohort. Public Health Nutr. 2017; 20:2577–86.
Article
22. Valles X, Alonso MH, Lopez-Caleya JF, Diez-Obrero V, Dierssen-Sotos T, Lope V, et al. Colorectal cancer, sun exposure and dietary vitamin D and calcium intake in the MCC-Spain study. Environ Int. 2018; 121:428–34.
23. Korea Centers for Disease Control and Prevention. Korea National Health and Nutrition Examination Survey. Major food sources of Na and Ca in Korea. Cheongju: Korea Centers for Disease Control and Prevention;2010.
24. Braun M, Palacios C, Wigertz K, Jackman LA, Bryant RJ, McCabe LD, et al. Racial differences in skeletal calcium retention in adolescent girls with varied controlled calcium intakes. Am J Clin Nutr. 2007; 85:1657–63.
Article
25. Chakrabarty S, Radjendirane V, Appelman H, Varani J. Extracellular calcium and calcium sensing receptor function in human colon carcinomas: promotion of E-cadherin expression and suppression of beta-catenin/TCF activation. Cancer Res. 2003; 63:67–71.
26. Ye CP, Yano S, Tfelt-Hansen J, MacLeod RJ, Ren X, Terwilliger E, et al. Regulation of a Ca2+-activated K+ channel by calcium-sensing receptor involves p38 MAP kinase. J Neurosci Res. 2004; 75:491–8.
Article
27. Allen LH. Calcium bioavailability and absorption: a review. Am J Clin Nutr. 1982; 35:783–808.
Article
28. Franceschi S, Gallus S, Talamini R, Tavani A, Negri E, La Vecchia C. Menopause and colorectal cancer. Br J Cancer. 2000; 82:1860–2.
Article
29. Fernandez E, La Vecchia C, Balducci A, Chatenoud L, Franceschi S, Negri E. Oral contraceptives and colorectal cancer risk: a meta-analysis. Br J Cancer. 2001; 84:722–7.
Article
30. Grodstein F, Newcomb PA, Stampfer MJ. Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta-analysis. Am J Med. 1999; 106:574–82.
Article
31. Baker AH, Wardle J. Sex differences in fruit and vegetable intake in older adults. Appetite. 2003; 40:269–75.
Article
Full Text Links
  • CRT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr