Intake of Vitamins D and A and Calcium and Risk of Non-Hodgkin Lymphoma: San Francisco Bay Area Population-Based Case-Control Study
Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California 94118-1944, USA.Nutrition and Cancer (Impact Factor: 2.32). 06/2012; 64(5):674-84. DOI: 10.1080/01635581.2012.689916
Several nutrients identified as potentially cancer protective have been inconsistently associated with non-Hodgkin lymphoma (NHL) risk. Dietary history data, including use of vitamin supplements, were collected using a semiquantitative food frequency questionnaire administered during in-person interviews with 4,133 participants (2,052 cases, 2,081 controls) in a San Francisco Bay Area population-based case-control study. Data were used to determine the association of intake levels of vitamins D and A and calcium with risk of NHL and NHL subtypes. Odds ratios (OR) and 95% confidence intervals (CI) were computed as estimates of relative risk using adjusted unconditional logistic regression. Increasing vitamin D intake from food and supplements was positively associated with NHL risk in men (5th quintile: OR = 1.6, 95% CI = 1.0-2.4, P(trend) = 0.07) and with diffuse large B-cell lymphoma (DLBCL) in women and men (5th quintile: OR = 1.6, 95% CI = 1.0-2.5, P(trend) = 0.02); that was largely due to the effect in men (P(trend) = 0.03). These results do not support a strong role for vitamin D intake with NHL risk, with the exception of a potential association for DLBCL risk in men. Our results should be interpreted conservatively until further investigation in larger pooled studies can be conducted to better assess the role of vitamin D intake in lymphomagenesis.
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ABSTRACT: The relation between vitamin D status and lymphoma risk is inconclusive. We examined the association between prediagnostic plasma 25-hydroxyvitamin D [25(OH)D] and lymphoid cancer risk. We conducted a study nested within the European Prospective Investigation into Cancer and Nutrition cohort of 1127 lymphoma cases and 1127 matched controls with a mean follow-up time of 7.1 y. Conditional logistic regression was used to estimate multivariable-adjusted incidence rate ratios of lymphoma risk in relation to plasma 25(OH)D. Season-standardized and season-specific 25(OH)D quartiles were used. We also analyzed 25(OH)D as a continuous variable and used predefined cutoffs. No statistically significant association between plasma 25(OH)D and overall lymphoid cancer risk was observed. A positive association for B-cell non-Hodgkin lymphoma was noted only in those with a diagnosis made during the first 2 y of follow-up (P-heterogeneity = 0.03), which suggests the possibility of reverse causality. Further analysis restricted to participants with ≥2 y of follow-up time showed a significant association between 25(OH)D and chronic lymphocytic leukemia (CLL) (n = 161): adjusted incidence rate ratios were 0.40 (95% CI: 0.18, 0.90; P-trend = 0.05) and 0.31 (95% CI: 0.13, 0.76; P-trend = 0.03) for the top compared with bottom season-standardized and season-specific quartiles, respectively. Data on dietary vitamin D intake provided further support for the observed association (incidence rate ratio: 0.33; 95% CI = 0.12, 0.89; P-trend = 0.006). Our findings do not support a protective role of high 25(OH)D concentration in lymphoid cancers overall. However, they suggest that higher concentrations of 25(OH)D are associated with a reduced risk of CLL.
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ABSTRACT: Non-Hodgkin lymphoma (NHL) is among the ten most frequent malignancies in Europe and USA. Results for vitamin D status and risk of NHL have been inconsistent. The objective was to perform a meta-analysis to summarize the available evidence from case-control studies and cohort studies on the association of vitamin D status and the risk of NHL. We searched PubMed, ISI Web of Science, the Cochrane Library, EMBASE, and reference lists for relevant articles. Study-specific odds ratios (ORs) or relative risks and 95 % confidence intervals (CIs) were pooled using fixed-effects, random-effects, or linear regression dose-response models. Nine studies (eight case-control and one cohort studies) were included in the meta-analysis. The estimated summary OR for highest compared with lowest categories of vitamin D status was 1.03 (95 % CI 0.84, 1.26; heterogeneity I (2) = 57.5 %). The subgroup analysis showed the similar results for dietary vitamin D intake group (1.07; 95 % CI 0.82, 1.40) and serum 25-hydroxyvitamin D concentration values group (1.03; 95 % CI 0.84, 1.26). The pooling ORs of NHL most common subtypes were 1.05 (0.73, 1.52), 1.00 (0.63, 1.58), 1.10 (0.56, 2.14), and 1.69 (0.68, 4.20) for diffuse large B cell lymphoma, follicular lymphoma, small lymphocytic lymphomas/chronic lymphocytic leukemia, and T cell lymphoma. The result from the linear regression dose-response model was similar (p = 0.205). Higher vitamin D status does not play a protective role in risk of NHL or common NHL subtypes.
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