Table 4.
Multivariable* relative risk of distal colon cancer according to total calcium intake (every 300 mg/day increase) and other lifestyle and nutritional factors in the Nurses’ Health Study (1980–2012) and Health Professionals Follow-up Study (1986–2012)
| NHS | HPFS | Pooled results | |||||
|---|---|---|---|---|---|---|---|
|
|
|||||||
| Factors | No. cases | RR | No. cases | RR | No. cases | RR | P-interaction |
| BMI (kg/m2) | 0.15 | ||||||
| <25 | 264 | 0.80 (0.70, 0.92) | 117 | 1.01 (0.86, 1.20) | 381 | 0.90 (0.71, 1.13) | |
| 25–<30 | 166 | 0.98 (0.83, 1.15) | 201 | 1.00 (0.89, 1.14) | 367 | 1.00 (0.90, 1.10) | |
| 30+ | 98 | 0.66 (0.52, 0.85) | 46 | 0.72 (0.49, 1.05) | 144 | 0.68 (0.55, 0.83) | |
| Family history of colorectal cancer | 0.54 | ||||||
| No | 433 | 0.81 (0.73, 0.90) | 306 | 0.98 (0.89, 1.09) | 739 | 0.89 (0.74, 1.08) | |
| Yes | 95 | 0.91 (0.72, 1.14) | 58 | 0.98 (0.76, 1.27) | 153 | 0.94 (0.79, 1.12) | |
| Aspirin use | |||||||
| No | 339 | 0.86 (0.76, 0.97) | 228 | 1.00 (0.89, 1.12) | 567 | 0.93 (0.80, 1.08) | |
| Yes | 189 | 0.77 (0.66, 0.90) | 136 | 0.94 (0.79, 1.11) | 325 | 0.85 (0.70, 1.03) | |
| Smoking | 0.92 | ||||||
| Never | 243 | 0.89 (0.78, 1.02) | 157 | 1.03 (0.90, 1.17) | 400 | 0.96 (0.84, 1.10) | |
| >–<10 pack year | 73 | 0.85 (0.65, 1.10) | 28 | 1.16 (0.85, 1.58) | 101 | 0.98 (0.72, 1.32) | |
| 10+ pack year | 212 | 0.75 (0.64, 0.87) | 179 | 0.88 (0.76, 1.02) | 391 | 0.81 (0.69, 0.95) | |
| Physical activity (METs/wk) | 0.49 | ||||||
| <3 | 183 | 0.81 (0.68, 0.96) | 30 | 0.93 (0.62, 1.38) | 213 | 0.82 (0.70, 0.96) | |
| 3–17 | 289 | 0.83 (0.73, 0.94) | 208 | 0.95 (0.84, 1.08) | 497 | 0.89 (0.78, 1.02) | |
| 27+ | 56 | 0.94 (0.70, 1.26) | 126 | 1.07 (0.92, 1.25) | 182 | 1.04 (0.91, 1.19) | |
| Alcohol intake (g/day) | 0.94 | ||||||
| 0–<5 | 348 | 0.83 (0.74, 0.93) | 148 | 1.04 (0.91, 1.19) | 496 | 0.93 (0.74, 1.16) | |
| 5–<15 | 109 | 0.64 (0.51, 0.80) | 94 | 1.05 (0.87, 1.27) | 203 | 0.82 (0.50, 1.34) | |
| 15+ | 71 | 1.04 (0.79, 1.35) | 122 | 0.77 (0.62, 0.96) | 193 | 0.89 (0.67, 1.18) | |
| Total fat intake | 0.64 | ||||||
| Tertile 1 | 154 | 0.87 (0.75, 1.02) | 133 | 0.82 (0.68, 0.99) | 287 | 0.85 (0.76, 0.96) | |
| Tertile 2 | 191 | 0.72 (0.60, 0.85) | 108 | 1.08 (0.91, 1.29) | 299 | 0.88 (0.59, 1.32) | |
| Tertile 3 | 183 | 0.84 (0.71, 1.01) | 123 | 1.07 (0.93, 1.23) | 306 | 0.95 (0.76, 1.20) | |
| Total vitamin D intake | 0.76 | ||||||
| Tertile 1 | 187 | 0.74 (0.59, 0.93) | 126 | 0.81 (0.60, 1.09) | 313 | 0.76 (0.64, 0.92) | |
| Tertile 2 | 184 | 0.82 (0.68, 0.98) | 127 | 0.96 (0.79, 1.17) | 311 | 0.88 (0.75, 1.03) | |
| Tertile 3 | 157 | 0.88 (0.77, 1.02) | 111 | 1.04 (0.91, 1.18) | 268 | 0.96 (0.82, 1.12) | |
| Vitamin D predicted score | 0.57 | ||||||
| Tertile 1 | 247 | 0.82 (0.71, 0.95) | 151 | 0.92 (0.78, 1.09) | 398 | 0.86 (0.77, 0.96) | |
| Tertile 2 | 156 | 0.83 (0.69, 0.99) | 121 | 0.90 (0.76, 1.07) | 277 | 0.87 (0.77, 0.98) | |
| Tertile 3 | 125 | 0.78 (0.64, 0.94) | 92 | 1.08 (0.93, 1.26) | 217 | 0.92 (0.67, 1.27) | |
| Total phosphorous intake | 0.96 | ||||||
| Tertile 1 | 197 | 0.78 (0.63, 0.97) | 109 | 0.99 (0.85, 1.15) | 306 | 0.89 (0.71, 1.12) | |
| Tertile 2 | 169 | 0.80 (0.65, 1.00) | 121 | 0.96 (0.80, 1.16) | 290 | 0.89 (0.74, 1.06) | |
| Tertile 3 | 165 | 0.80 (0.67, 0.95) | 134 | 0.98 (0.83, 1.16) | 299 | 0.89 (0.72, 1.09) | |
| Total processed meat intake | 0.16 | ||||||
| Tertile 1 | 153 | 0.86 (0.74, 1.01) | 104 | 1.07 (0.93, 1.23) | 257 | 0.96 (0.78, 1.19) | |
| Tertile 2 | 177 | 0.78 (0.66, 0.93) | 116 | 0.94 (0.78, 1.13) | 293 | 0.86 (0.71, 1.02) | |
| Tertile 3 | 198 | 0.84 (0.71, 1.00) | 144 | 0.91 (0.76, 1.09) | 342 | 0.87 (0.77, 0.99) | |
| Total fiber intake | 0.61 | ||||||
| Tertile 1 | 158 | 0.88 (0.74, 1.05) | 144 | 0.87 (0.69, 1.10) | 302 | 0.88 (0.76, 1.01) | |
| Tertile 2 | 190 | 0.71 (0.59, 0.85) | 116 | 1.19 (0.99, 1.43) | 306 | 0.92 (0.55, 1.52) | |
| Tertile 3 | 180 | 0.87 (0.74, 1.02) | 104 | 0.94 (0.80, 1.10) | 284 | 0.90 (0.81, 1.01) | |
Multivariable relative risks were adjusted for age (in month), race (Caucasian vs. non-Caucasian), adult BMI (< 25, 25 –< 27.5, 27.5 –< 30, or ≥ 30 kg/m2), smoking (0, 1–10, or > 10 pack-years), history of colorectal cancer in a parent or sibling (yes or no), history of sigmoidoscopy/colonoscopy (yes or no), physical activity (< 3, 3–< 27, ≥ 27 MET-hrs/wk), regular aspirin use (yes, no), alcohol consumption (0 –< 5, 5 –<15, or ≥ 15 g/d), 25-hydroxyvitamin D (25(OH)D) scores (tertiles), current energy-adjusted total intake of folate, red meat, processed meat (all in tertiles), and postmenopausal hormone use (premenopausal, never, past, or current user; women only). Of note, variables examined in this table were not adjusted for.
In the NHS, the median values were 51.9 for tertile 1, 60.8 for tertile 2, and 71.0 for tertile 3 for total fat intake (g/d), the corresponding values were 962.0, 1134.7, and 1345.0 for total phosphorous intake (mg/d), 158.9, 306.3, and 543.7 for total vitamin D (IU/d), 0, 0.1, and 0.2 for processed meat (servings/d), and 9, 13.6, and 17.4 for total fiber intake (g/d).
In the HPFS, the median values were 57.7 for tertile 1, 69.8 for tertile 2, and 81.4 for tertile 3 for total fat intake (g/d), the corresponding values were 1212.5, 1406.0, and 1636.0 for total phosphorous intake (mg/d), 194.9, 371.3, and 661.6 for total vitamin D (IU/d), 0, 0.1, and 0.3 for processed meat (servings/d), and 16.0, 21.2, and 27.6 for total fiber intake (g/d).