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01-03-2020 | Lung Cancer | Original Contribution

Food intake of folate, folic acid and other B vitamins with lung cancer risk in a low-income population in the Southeastern United States

Authors: Yumie Takata, Xiao-Ou Shu, Maciej S. Buchowski, Heather M. Munro, Wanqing Wen, Mark D. Steinwandel, Margaret K. Hargreaves, William J. Blot, Qiuyin Cai

Published in: European Journal of Nutrition | Issue 2/2020

Abstract

Purpose

We prospectively examined associations of lung cancer risk with food intake of B vitamins involved in one-carbon metabolism and the use of folic acid-containing supplements among a low-income population of black and white adults in the Southeastern US.

Methods

Within the Southern Community Cohort Study, we included 1064 incident lung cancer cases among 68,236 participants aged 40–79 years at study enrollment. Food intake and the use of folic acid-containing supplements were assessed using a validated food frequency questionnaire at study enrollment. Multivariate Cox regression was used to estimate hazards ratios (HRs) and the 95% confidence intervals (CIs).

Results

Folate and/or folic acid intake from food were not associated with lung cancer risk; HRs (95% CI) for highest compared with lowest quartile were 1.08 (0.91–1.29) for total dietary folate, 1.00 (0.84–1.19) for food folate, and 1.09 (0.91–1.30) for food folic acid, respectively. Similarly, no associations were observed after stratifying by sex, race and smoking status, except for a positive association with total dietary folate intake among black women (HR 1.46, 95% CI 1.04–2.05 for the highest quartile compared with the lowest quartile, P trend = 0.02). Neither the use of folic acid-containing supplements nor food intake of vitamin B₆, vitamin B₁₂ and riboflavin were associated with lung cancer risk.

Conclusions

Our findings do not support a protective effect of folate or folic acid for lung cancer prevention in a low-income population of black and white adults in the Southeastern US. Our finding of a positive association with total dietary folate intake among black women needs to be interpreted with caution and replicated in other studies.

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Blom HJ, Shaw GM, den Heijer M, Finnell RH (2006) Neural tube defects and folate: case far from closed. Nat Rev Neurosci 7(9):724–731. https://doi.org/10.1038/nrn1986 CrossRefPubMedPubMedCentral

Ames BN (2001) DNA damage from micronutrient deficiencies is likely to be a major cause of cancer. Mutat Res 475(1–2):7–20CrossRefPubMed

Lee MS, Asomaning K, Su L, Wain JC, Mark EJ, Christiani DC (2012) MTHFR polymorphisms, folate intake and carcinogen DNA adducts in the lung. Int J Cancer 131(5):1203–1209. https://doi.org/10.1002/ijc.27338 CrossRefPubMedPubMedCentral

Choi SW, Mason JB (2000) Folate and carcinogenesis: an integrated scheme. J Nutr 130(2):129–132. https://doi.org/10.1093/jn/130.2.129 CrossRefPubMed

Tinker SC, Hamner HC, Qi YP, Crider KS (2015) U.S. women of childbearing age who are at possible increased risk of a neural tube defect-affected pregnancy due to suboptimal red blood cell folate concentrations, National Health and Nutrition Examination Survey 2007 to 2012. Birth Defects Res A Clin Mol Teratol 103(6):517–526. https://doi.org/10.1002/bdra.23378 CrossRefPubMedPubMedCentral

Crider KS, Bailey LB, Berry RJ (2011) Folic acid food fortification-its history, effect, concerns, and future directions. Nutrients 3(3):370–384. https://doi.org/10.3390/nu3030370 CrossRefPubMedPubMedCentral

US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW Jr, Garcia FA, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phillips WR, Phipps MG, Pignone MP, Silverstein M, Tseng CW (2017) Folic acid supplementation for the prevention of neural tube defects: US preventive services task force recommendation statement. JAMA 317 (2):183–189. https://doi.org/10.1001/jama.2016.19438 CrossRef

Bailey RL, Dodd KW, Gahche JJ, Dwyer JT, McDowell MA, Yetley EA, Sempos CA, Burt VL, Radimer KL, Picciano MF (2010) Total folate and folic acid intake from foods and dietary supplements in the United States: 2003–2006. Am J Clin Nutr 91(1):231–237. https://doi.org/10.3945/ajcn.2009.28427 CrossRefPubMed

Williams J, Mai CT, Mulinare J, Isenburg J, Flood TJ, Ethen M, Frohnert B, Kirby RS, Centers for Disease C, Prevention (2015) Updated estimates of neural tube defects prevented by mandatory folic Acid fortification—United States, 1995–2011. MMWR Morb Mortal Wkly Rep 64(1):1–5PubMedPubMedCentral

10.

Keum N, Giovannucci EL (2014) Folic acid fortification and colorectal cancer risk. Am J Prev Med 46(3 Suppl 1):S65–S72. https://doi.org/10.1016/j.amepre.2013.10.025 CrossRefPubMed

11.

Vollset SE, Clarke R, Lewington S, Ebbing M, Halsey J, Lonn E, Armitage J, Manson JE, Hankey GJ, Spence JD, Galan P, Bonaa KH, Jamison R, Gaziano JM, Guarino P, Baron JA, Logan RF, Giovannucci EL, den Heijer M, Ueland PM, Bennett D, Collins R, Peto R, Collaboration BVTT (2013) Effects of folic acid supplementation on overall and site-specific cancer incidence during the randomised trials: meta-analyses of data on 50,000 individuals. Lancet 381(9871):1029–1036. https://doi.org/10.1016/S0140-6736(12)62001-7 CrossRefPubMed

12.

Zhang YF, Zhou L, Zhang HW, Hou AJ, Gao HF, Zhou YH (2014) Association between folate intake and the risk of lung cancer: a dose-response meta-analysis of prospective studies. PLoS One 9(4):e93465. https://doi.org/10.1371/journal.pone.0093465 CrossRefPubMedPubMedCentral

13.

Shen H, Wei Q, Pillow PC, Amos CI, Hong WK, Spitz MR (2003) Dietary folate intake and lung cancer risk in former smokers: a case-control analysis. Cancer Epidemiol Biomark Prev 12(10):980–986

14.

Hartman TJ, Woodson K, Stolzenberg-Solomon R, Virtamo J, Selhub J, Barrett MJ, Albanes D (2001) Association of the B-vitamins pyridoxal 5′-phosphate (B(6)), B(12), and folate with lung cancer risk in older men. Am J Epidemiol 153(7):688–694CrossRefPubMed

15.

Johansson M, Relton C, Ueland PM, Vollset SE, Midttun O, Nygard O, Slimani N, Boffetta P, Jenab M, Clavel-Chapelon F, Boutron-Ruault MC, Fagherazzi G, Kaaks R, Rohrmann S, Boeing H, Weikert C, Bueno-de-Mesquita HB, Ros MM, van Gils CH, Peeters PH, Agudo A, Barricarte A, Navarro C, Rodriguez L, Sanchez MJ, Larranaga N, Khaw KT, Wareham N, Allen NE, Crowe F, Gallo V, Norat T, Krogh V, Masala G, Panico S, Sacerdote C, Tumino R, Trichopoulou A, Lagiou P, Trichopoulos D, Rasmuson T, Hallmans G, Riboli E, Vineis P, Brennan P (2010) Serum B vitamin levels and risk of lung cancer. JAMA 303(23):2377–2385. https://doi.org/10.1001/jama.2010.808 CrossRefPubMed

16.

Durda K, Kaklewski K, Gupta S, Szydlowski M, Baszuk P, Jaworska-Bieniek K, Sukiennicki G, Kaczmarek K, Waloszczyk P, Narod S, Lubinski J, Jakubowska A (2017) Serum folate concentration and the incidence of lung cancer. PLoS One 12(5):e0177441. https://doi.org/10.1371/journal.pone.0177441 CrossRefPubMedPubMedCentral

17.

Cho E, Hunter DJ, Spiegelman D, Albanes D, Beeson WL, van den Brandt PA, Colditz GA, Feskanich D, Folsom AR, Fraser GE, Freudenheim JL, Giovannucci E, Goldbohm RA, Graham S, Miller AB, Rohan TE, Sellers TA, Virtamo J, Willett WC, Smith-Warner SA (2006) Intakes of vitamins A, C and E and folate and multivitamins and lung cancer: a pooled analysis of 8 prospective studies. Int J Cancer 118(4):970–978. https://doi.org/10.1002/ijc.21441 CrossRefPubMed

18.

Kabat GC, Miller AB, Jain M, Rohan TE (2008) Dietary intake of selected B vitamins in relation to risk of major cancers in women. Br J Cancer 99(5):816–821. https://doi.org/10.1038/sj.bjc.6604540 CrossRefPubMedPubMedCentral

19.

Rossi E, Hung J, Beilby JP, Knuiman MW, Divitini ML, Bartholomew H (2006) Folate levels and cancer morbidity and mortality: prospective cohort study from Busselton, Western Australia. Ann Epidemiol 16(3):206–212. https://doi.org/10.1016/j.annepidem.2005.03.010 CrossRefPubMed

20.

Slatore CG, Littman AJ, Au DH, Satia JA, White E (2008) Long-term use of supplemental multivitamins, vitamin C, vitamin E, and folate does not reduce the risk of lung cancer. Am J Respir Crit Care Med 177(5):524–530. https://doi.org/10.1164/rccm.200709-1398OC CrossRefPubMed

21.

Yuan JM, Stram DO, Arakawa K, Lee HP, Yu MC (2003) Dietary cryptoxanthin and reduced risk of lung cancer: the Singapore Chinese Health Study. Cancer Epidemiol Biomark Prev 12(9):890–898

22.

Takata Y, Cai Q, Beeghly-Fadiel A, Li H, Shrubsole MJ, Ji BT, Yang G, Chow WH, Gao YT, Zheng W, Shu XO (2012) Dietary B vitamin and methionine intakes and lung cancer risk among female never smokers in China. Cancer Causes Control 23(12):1965–1975. https://doi.org/10.1007/s10552-012-0074-z CrossRefPubMedPubMedCentral

23.

Takata Y, Xiang YB, Yang G, Li H, Gao J, Cai H, Gao YT, Zheng W, Shu XO (2013) Intakes of fruits, vegetables, and related vitamins and lung cancer risk: results from the Shanghai Men’s Health Study (2002–2009). Nutr Cancer 65(1):51–61. https://doi.org/10.1080/01635581.2013.741757 CrossRefPubMedPubMedCentral

24.

Alpha-Tocopherol BCCPSG (1994) The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 330(15):1029–1035. https://doi.org/10.1056/NEJM199404143301501 CrossRef

25.

Brasky TM, White E, Chen CL (2017) Long-term, supplemental, one-carbon metabolism-related vitamin B use in relation to lung cancer risk in the vitamins and lifestyle (VITAL) cohort. J Clin Oncol. https://doi.org/10.1200/JCO.2017.72.7735 CrossRefPubMedPubMedCentral

26.

Roswall N, Olsen A, Christensen J, Dragsted LO, Overvad K, Tjonneland A (2010) Source-specific effects of micronutrients in lung cancer prevention. Lung Cancer 67(3):275–281. https://doi.org/10.1016/j.lungcan.2009.11.010 CrossRefPubMed

27.

Centers for Disease Control and Prevention (2010) Racial/Ethnic disparities and geographic differences in lung cancer incidence—38 States and the District of Columbia, 1998–2006. MMWR Morb Mortal Wkly Rep 59(44):1434–1438

28.

Patel JD (2005) Lung cancer in women. J Clin Oncol 23(14):3212–3218. https://doi.org/10.1200/JCO.2005.11.486 CrossRefPubMed

29.

Payne PW, Sebo TJ, Doudkine A, Garner D, MacAulay C, Lam S, LeRichie JC, Palcic B (1997) Sputum screening by quantitative microscopy: a reexamination of a portion of the National Cancer Institute Cooperative Early Lung Cancer Study. Mayo Clin Proc 72(8):697–704CrossRefPubMed

30.

Bailey RL, Akabas SR, Paxson EE, Thuppal SV, Saklani S, Tucker KL (2017) Total usual intake of shortfall nutrients varies with poverty among US adults. J Nutr Educ Behav. https://doi.org/10.1016/j.jneb.2016.11.008 CrossRefPubMed

31.

Signorello LB, Buchowski MS, Cai Q, Munro HM, Hargreaves MK, Blot WJ (2010) Biochemical validation of food frequency questionnaire-estimated carotenoid, alpha-tocopherol, and folate intakes among African Americans and non-Hispanic Whites in the Southern Community Cohort Study. Am J Epidemiol 171(4):488–497. https://doi.org/10.1093/aje/kwp402 CrossRefPubMedPubMedCentral

32.

Signorello LB, Hargreaves MK, Steinwandel MD, Zheng W, Cai Q, Schlundt DG, Buchowski MS, Arnold CW, McLaughlin JK, Blot WJ (2005) Southern community cohort study: establishing a cohort to investigate health disparities. J Natl Med Assoc 97(7):972–979PubMedPubMedCentral

33.

Buchowski MS, Schlundt DG, Hargreaves MK, Hankin JH, Signorello LB, Blot WJ (2003) Development of a culturally sensitive food frequency questionnaire for use in the Southern Community Cohort Study. Cell Mol Biol (Noisy-le-grand) 49(8):1295–1304

34.

Signorello LB, Munro HM, Buchowski MS, Schlundt DG, Cohen SS, Hargreaves MK, Blot WJ (2009) Estimating nutrient intake from a food frequency questionnaire: incorporating the elements of race and geographic region. Am J Epidemiol 170(1):104–111. https://doi.org/10.1093/aje/kwp098 CrossRefPubMedPubMedCentral

35.

Schlundt DG, Buchowski MS, Hargreaves MK, Hankin JH, Signorello LB, Blot WJ (2007) Separate estimates of portion size were not essential for energy and nutrient estimation: results from the Southern Community Cohort food-frequency questionnaire pilot study. Public Health Nutr 10(3):245–251. https://doi.org/10.1017/S1368980007258574 CrossRefPubMed

36.

Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate OBV, and Choline (1998) Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. National Academics Press (US), Washington, DC

37.

Blot WJ, Cohen SS, Aldrich M, McLaughlin JK, Hargreaves MK, Signorello LB (2011) Lung cancer risk among smokers of menthol cigarettes. J Natl Cancer Inst 103(10):810–816. https://doi.org/10.1093/jnci/djr102 CrossRefPubMedPubMedCentral

38.

Epplein M, Burk RF, Cai Q, Hargreaves MK, Blot WJ (2014) A prospective study of plasma Selenoprotein P and lung cancer risk among low-income adults. Cancer Epidemiol Biomark Prev 23(7):1238–1244. https://doi.org/10.1158/1055-9965.EPI-13-1308 CrossRef

39.

Haznadar M, Cai Q, Krausz KW, Bowman ED, Margono E, Noro R, Thompson MD, Mathe EA, Munro HM, Steinwandel MD, Gonzalez FJ, Blot WJ, Harris CC (2016) Urinary metabolite risk biomarkers of lung cancer: a prospective cohort study. Cancer Epidemiol Biomark Prev 25(6):978–986. https://doi.org/10.1158/1055-9965.EPI-15-1191 CrossRef

40.

Sanderson M, Aldrich MC, Levine RS, Kilbourne B, Cai Q, Blot WJ (2018) Neighbourhood deprivation and lung cancer risk: a nested case-control study in the USA. BMJ Open 8(9):e021059. https://doi.org/10.1136/bmjopen-2017-021059 CrossRefPubMedPubMedCentral

41.

Aune D, Deneo-Pellegrini H, Ronco AL, Boffetta P, Acosta G, Mendilaharsu M, De Stefani E (2011) Dietary folate intake and the risk of 11 types of cancer: a case-control study in Uruguay. Ann Oncol 22(2):444–451. https://doi.org/10.1093/annonc/mdq356 CrossRefPubMed

42.

Bassett JK, Hodge AM, English DR, Baglietto L, Hopper JL, Giles GG, Severi G (2012) Dietary intake of B vitamins and methionine and risk of lung cancer. Eur J Clin Nutr 66(2):182–187. https://doi.org/10.1038/ejcn.2011.157 CrossRefPubMed

43.

Neuhouser ML, Patterson RE, Thornquist MD, Omenn GS, King IB, Goodman GE (2003) Fruits and vegetables are associated with lower lung cancer risk only in the placebo arm of the beta-carotene and retinol efficacy trial (CARET). Cancer Epidemiol Biomark Prev 12(4):350–358

44.

Jatoi A, Daly BD, Kramer G, Mason JB (2001) Folate status among patients with non-small cell lung cancer: a case-control study. J Surg Oncol 77(4):247–252CrossRefPubMed

45.

Bandera EV, Freudenheim JL, Marshall JR, Zielezny M, Priore RL, Brasure J, Baptiste M, Graham S (1997) Diet and alcohol consumption and lung cancer risk in the New York State Cohort (United States). Cancer Causes Control 8(6):828–840CrossRefPubMed

46.

Voorrips LE, Goldbohm RA, Brants HA, van Poppel GA, Sturmans F, Hermus RJ, van den Brandt PA (2000) A prospective cohort study on antioxidant and folate intake and male lung cancer risk. Cancer Epidemiol Biomark Prev 9(4):357–365

47.

Ito Y, Wakai K, Suzuki K, Ozasa K, Watanabe Y, Seki N, Ando M, Nishino Y, Kondo T, Ohno Y, Tamakoshi A, Group JS (2005) Lung cancer mortality and serum levels of carotenoids, retinol, tocopherols, and folic acid in men and women: a case-control study nested in the JACC Study. J Epidemiol 15(Suppl 2):S140–S149CrossRefPubMedPubMedCentral

48.

Shi Q, Zhang Z, Li G, Pillow PC, Hernandez LM, Spitz MR, Wei Q (2005) Sex differences in risk of lung cancer associated with methylene-tetrahydrofolate reductase polymorphisms. Cancer Epidemiol Biomark Prev 14(6):1477–1484. https://doi.org/10.1158/1055-9965.EPI-04-0905 CrossRef

49.

Park JY, Vollset SE, Melse-Boonstra A, Chajes V, Ueland PM, Slimani N (2013) Dietary intake and biological measurement of folate: a qualitative review of validation studies. Mol Nutr Food Res 57(4):562–581. https://doi.org/10.1002/mnfr.201200105 CrossRefPubMed

50.

Fanidi A, Carreras-Torres R, Larose TL, Yuan JM, Stevens VL, Weinstein SJ, Albanes D, Prentice R, Pettinger M, Cai Q, Blot WJ, Arslan AA, Zeleniuch-Jacquotte A, McCullough ML, Le Marchand L, Wilkens LR, Haiman CA, Zhang X, Stampfer MJ, Smith-Warner SA, Giovannucci E, Giles GG, Hodge AM, Severi G, Johansson M, Grankvist K, Langhammer A, Brumpton BM, Wang R, Gao YT, Ericson U, Bojesen SE, Arnold SM, Koh WP, Shu XO, Xiang YB, Li H, Zheng W, Lan Q, Visvanathan K, Hoffman-Bolton J, Ueland PM, Midttun O, Caporaso NE, Purdue M, Freedman ND, Buring JE, Lee IM, Sesso HD, Michael Gaziano J, Manjer J, Relton CL, Hung RJ, Amos CI, Johansson M, Brennan P, consortium LC, the Tc (2018) Is high vitamin B12 status a cause of lung cancer? Int J Cancer. https://doi.org/10.1002/ijc.32033 CrossRefPubMedPubMedCentral

51.

Dallongeville J, Marecaux N, Fruchart JC, Amouyel P (1998) Cigarette smoking is associated with unhealthy patterns of nutrient intake: a meta-analysis. J Nutr 128(9):1450–1457CrossRefPubMed

Title: Food intake of folate, folic acid and other B vitamins with lung cancer risk in a low-income population in the Southeastern United States
Authors: Yumie Takata
Xiao-Ou Shu
Maciej S. Buchowski
Heather M. Munro
Wanqing Wen
Mark D. Steinwandel
Margaret K. Hargreaves
William J. Blot
Qiuyin Cai
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Keywords: Lung Cancer
Folic Acid
Lung Cancer
Lung Cancer
Published in: European Journal of Nutrition / Issue 2/2020
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-019-01934-5

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