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Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Folate intake, serum folate levels, and prostate cancer risk: a meta-analysis of prospective studies

Authors: Rong Wang, Yan Zheng, Jing-Yang Huang, Ai-Qin Zhang, Yu-Hao Zhou, Jie-Ning Wang

Published in: BMC Public Health | Issue 1/2014

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Abstract

Background

Studies have reported inconsistent results concerning the existence of associations of folate intake and serum folate levels with prostate cancer risk. This study sought to summarise the evidence regarding these relationships using a dose–response meta-analysis approach.

Methods

In January 2014, we performed electronic searches of PubMed, Embase, and the Cochrane Library to identify studies examining the effect of folate on the incidence of prostate cancer. Only prospective studies that reported effect estimates with 95% confidence intervals (CIs) of the incidence of prostate cancer for more than 2 categories of folate were included.

Results

Overall, we included 10 prospective studies reporting data on 202,517 individuals. High dietary folate intake had little or no effect on prostate cancer risk (risk ratio [RR] = 1.02; 95% CI = 0.95–1.09; P = 0.598). The dose–response meta-analysis suggested that a 100 μg per day increase in dietary folate intake has no significant effect on the risk of prostate cancer (RR = 1.01; 95% CI = 0.99–1.02; P = 0.433). However, high serum folate levels were associated with an increased risk of prostate cancer (RR = 1.21; 95% CI = 1.05–1.39; P = 0.008). The dose–response meta-analysis indicated that a 5 nmol/L increment of serum folate levels was also associated with an increased risk of prostate cancer (RR = 1.04; 95% CI = 1.00–1.07; P = 0.042).

Conclusions

Our study indicated that dietary folate intake had little or no effect on prostate cancer risk. However, increased serum folate levels have potentially harmful effects on the risk of prostate cancer.
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Literature
1.
go back to reference Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ: Cancer statistics, 2006. CA Cancer J Clin. 2006, 56: 106-130. 10.3322/canjclin.56.2.106.CrossRefPubMed Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ: Cancer statistics, 2006. CA Cancer J Clin. 2006, 56: 106-130. 10.3322/canjclin.56.2.106.CrossRefPubMed
2.
go back to reference Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010, 127: 2893-2917. 10.1002/ijc.25516.CrossRefPubMed Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010, 127: 2893-2917. 10.1002/ijc.25516.CrossRefPubMed
3.
go back to reference Gronberg H: Prostate cancer epidemiology. Lancet. 2003, 361: 859-864. 10.1016/S0140-6736(03)12713-4.CrossRefPubMed Gronberg H: Prostate cancer epidemiology. Lancet. 2003, 361: 859-864. 10.1016/S0140-6736(03)12713-4.CrossRefPubMed
4.
go back to reference Shirai T, Asamoto M, Takahashi S, Imaida K, et al: Diet and prostate cancer. Toxicology. 2002, 181–182: 89-94.CrossRefPubMed Shirai T, Asamoto M, Takahashi S, Imaida K, et al: Diet and prostate cancer. Toxicology. 2002, 181–182: 89-94.CrossRefPubMed
5.
go back to reference Shimizu H, Ross RK, Bernstein L, Yatani R, Henderson BE, Mack TM: Cancers of the prostate and breast among Japanese and white immigrants in Los Angeles County. Br J Cancer. 1991, 63: 963-966. 10.1038/bjc.1991.210.CrossRefPubMedPubMedCentral Shimizu H, Ross RK, Bernstein L, Yatani R, Henderson BE, Mack TM: Cancers of the prostate and breast among Japanese and white immigrants in Los Angeles County. Br J Cancer. 1991, 63: 963-966. 10.1038/bjc.1991.210.CrossRefPubMedPubMedCentral
6.
go back to reference Bailey LB, Gregory JF: Folate metabolism and requirements. J Nutr. 1999, 129: 779-782.PubMed Bailey LB, Gregory JF: Folate metabolism and requirements. J Nutr. 1999, 129: 779-782.PubMed
7.
go back to reference Hultdin J, Guelpen BV, Bergh A, Hallmans G, Stattin P: Plasma folate, vitamin B12, and homocysteine and prostate cancer risk: A prospective study. Int J Cancer. 2005, 113: 819-824. 10.1002/ijc.20646.CrossRefPubMed Hultdin J, Guelpen BV, Bergh A, Hallmans G, Stattin P: Plasma folate, vitamin B12, and homocysteine and prostate cancer risk: A prospective study. Int J Cancer. 2005, 113: 819-824. 10.1002/ijc.20646.CrossRefPubMed
8.
go back to reference Weinstein SJ, Stolzenberg-Solomon R, Pietinen P, Taylor PR, Virtamo J, Albanes D: Dietary factors of one-carbon metabolism and prostate cancer risk. Am J Clin Nutr. 2006, 84: 929-935.PubMed Weinstein SJ, Stolzenberg-Solomon R, Pietinen P, Taylor PR, Virtamo J, Albanes D: Dietary factors of one-carbon metabolism and prostate cancer risk. Am J Clin Nutr. 2006, 84: 929-935.PubMed
9.
go back to reference Stevens VL, Rodriguez C, Pavluck AL, McCullough ML, Thun MJ, Calle EE: Folate Nutrition and Prostate Cancer Incidence in a Large Cohort of US Men. Am J Epidemiol. 2006, 163: 989-996. 10.1093/aje/kwj126.CrossRefPubMed Stevens VL, Rodriguez C, Pavluck AL, McCullough ML, Thun MJ, Calle EE: Folate Nutrition and Prostate Cancer Incidence in a Large Cohort of US Men. Am J Epidemiol. 2006, 163: 989-996. 10.1093/aje/kwj126.CrossRefPubMed
10.
go back to reference Bassett JK, Severi G, Hodge AM, Baglietto L, Hopper JL, English DR, Giles GG: Dietary intake of B vitamins and methionine and prostate cancer incidence and mortality. Cancer Causes Control. 2012, 23: 855-863. 10.1007/s10552-012-9954-5.CrossRefPubMed Bassett JK, Severi G, Hodge AM, Baglietto L, Hopper JL, English DR, Giles GG: Dietary intake of B vitamins and methionine and prostate cancer incidence and mortality. Cancer Causes Control. 2012, 23: 855-863. 10.1007/s10552-012-9954-5.CrossRefPubMed
11.
go back to reference Verhage BAJ, Cremers P, Schouten LJ, Goldbohm RA, van den Brandt PA: Dietary folate and folate vitamers and the risk of prostate cancer in The Netherlands Cohort Study. Cancer Causes Control. 2012, 23: 2003-2011. 10.1007/s10552-012-0079-7.CrossRefPubMed Verhage BAJ, Cremers P, Schouten LJ, Goldbohm RA, van den Brandt PA: Dietary folate and folate vitamers and the risk of prostate cancer in The Netherlands Cohort Study. Cancer Causes Control. 2012, 23: 2003-2011. 10.1007/s10552-012-0079-7.CrossRefPubMed
12.
go back to reference Roswall N, Larsen SB, Friis S, Outzen M, Olsen A, Christensen J, Dragsted LO, Tjønneland A: Micronutrient intake and risk of prostate cancer in a cohort of middle-aged, Danish men. Cancer Causes Control. 2013, 24: 1129-1135. 10.1007/s10552-013-0190-4.CrossRefPubMed Roswall N, Larsen SB, Friis S, Outzen M, Olsen A, Christensen J, Dragsted LO, Tjønneland A: Micronutrient intake and risk of prostate cancer in a cohort of middle-aged, Danish men. Cancer Causes Control. 2013, 24: 1129-1135. 10.1007/s10552-013-0190-4.CrossRefPubMed
13.
go back to reference Johansson M, Appleby PN, Allen NE, Travis RC, Roddam AW, Egevad L, Jenab M, Rinaldi S, Kiemeney LA, Bueno-de-Mesquita HB, Vollset SE, Ueland PM, Sánchez MJ, Quirós JR, González CA, Larraiaga N, Chirlaque MD, Ardanaz E, Sieri S, Palli D, Vineis P, Tumino R, Linseisen J, Kaaks R, Boeing H, Pischon T, Psaltopoulou T, Trichopoulou A, Trichopoulos D, Khaw KT, et al: Circulating Concentrations of Folate and Vitamin B12 in Relation to Prostate Cancer Risk: Results from the European Prospective Investigation into Cancer and Nutrition Study. Cancer Epidemiol Biomarkers Prev. 2008, 17: 279-285. 10.1158/1055-9965.EPI-07-0657.CrossRefPubMed Johansson M, Appleby PN, Allen NE, Travis RC, Roddam AW, Egevad L, Jenab M, Rinaldi S, Kiemeney LA, Bueno-de-Mesquita HB, Vollset SE, Ueland PM, Sánchez MJ, Quirós JR, González CA, Larraiaga N, Chirlaque MD, Ardanaz E, Sieri S, Palli D, Vineis P, Tumino R, Linseisen J, Kaaks R, Boeing H, Pischon T, Psaltopoulou T, Trichopoulou A, Trichopoulos D, Khaw KT, et al: Circulating Concentrations of Folate and Vitamin B12 in Relation to Prostate Cancer Risk: Results from the European Prospective Investigation into Cancer and Nutrition Study. Cancer Epidemiol Biomarkers Prev. 2008, 17: 279-285. 10.1158/1055-9965.EPI-07-0657.CrossRefPubMed
14.
go back to reference Beilby J, Ambrosini GL, Rossi E, de Klerk NH, Musk AW: Serum levels of folate, lycopene, b-carotene, retinol and vitamin E and prostate cancer risk. Eur J Clin Nutr. 2010, 64: 1235-1238. 10.1038/ejcn.2010.124.CrossRefPubMed Beilby J, Ambrosini GL, Rossi E, de Klerk NH, Musk AW: Serum levels of folate, lycopene, b-carotene, retinol and vitamin E and prostate cancer risk. Eur J Clin Nutr. 2010, 64: 1235-1238. 10.1038/ejcn.2010.124.CrossRefPubMed
15.
go back to reference Vogel S, Meyer K, Fredriksen A, Ulvik A, Ueland PM, Nygård O, Vollset SE, Tell GS, Tretli S, Bjørge T: Serum folate and vitamin B12 concentrations in relation to prostate cancer risk—a Norwegian population-based nested case–control study of 3000 cases and 3000 controls within the JANUS cohort. Int J Epidemiol. 2013, 42: 201-210. 10.1093/ije/dys199.CrossRefPubMed Vogel S, Meyer K, Fredriksen A, Ulvik A, Ueland PM, Nygård O, Vollset SE, Tell GS, Tretli S, Bjørge T: Serum folate and vitamin B12 concentrations in relation to prostate cancer risk—a Norwegian population-based nested case–control study of 3000 cases and 3000 controls within the JANUS cohort. Int J Epidemiol. 2013, 42: 201-210. 10.1093/ije/dys199.CrossRefPubMed
16.
go back to reference Weinstein SJ, Hartman TJ, Stolzenberg-Solomon R, Pietinen P, Barrett MJ, Taylor PR, Virtamo J, Albanes D: Null Association between Prostate Cancer and Serum Folate, Vitamin B6, Vitamin B12, and Homocysteine. Cancer Epidemiol Biomarkers Prev. 2003, 12: 1271-1272.PubMed Weinstein SJ, Hartman TJ, Stolzenberg-Solomon R, Pietinen P, Barrett MJ, Taylor PR, Virtamo J, Albanes D: Null Association between Prostate Cancer and Serum Folate, Vitamin B6, Vitamin B12, and Homocysteine. Cancer Epidemiol Biomarkers Prev. 2003, 12: 1271-1272.PubMed
17.
go back to reference Wien TN, Pike E, Wisloff T, Staff A, Smeland S, Klemp M: Cancer risk with folic acid supplements: a systematic review and meta-analysis. BMJ Open. 2012, 2: e000653-CrossRefPubMedPubMedCentral Wien TN, Pike E, Wisloff T, Staff A, Smeland S, Klemp M: Cancer risk with folic acid supplements: a systematic review and meta-analysis. BMJ Open. 2012, 2: e000653-CrossRefPubMedPubMedCentral
18.
go back to reference Tio M, Andrici J, Cox MR, Eslick GD: Folate intake and the risk of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2014, 17 (3): 213-219. 10.1038/pcan.2014.16.CrossRefPubMed Tio M, Andrici J, Cox MR, Eslick GD: Folate intake and the risk of prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2014, 17 (3): 213-219. 10.1038/pcan.2014.16.CrossRefPubMed
21.
go back to reference DerSimonian R, Laird N: Meta-analysis in clinical trials. Control Clin Trials. 1986, 7: 177-188. 10.1016/0197-2456(86)90046-2.CrossRefPubMed DerSimonian R, Laird N: Meta-analysis in clinical trials. Control Clin Trials. 1986, 7: 177-188. 10.1016/0197-2456(86)90046-2.CrossRefPubMed
22.
go back to reference Ades AE, Lu G, Higgins JP: The interpretation of random-effects metaanalysis in decision models. Med Decis Making. 2005, 25: 646-654. 10.1177/0272989X05282643.CrossRefPubMed Ades AE, Lu G, Higgins JP: The interpretation of random-effects metaanalysis in decision models. Med Decis Making. 2005, 25: 646-654. 10.1177/0272989X05282643.CrossRefPubMed
23.
go back to reference Orsini N, Bellocco R: Generalized least squares for trend estimation of summarized dose–response data. Stata J. 2006, 6: 40-57. Orsini N, Bellocco R: Generalized least squares for trend estimation of summarized dose–response data. Stata J. 2006, 6: 40-57.
24.
go back to reference Greenland S, Longnecker MP: Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am J Epidemiol. 1992, 135: 1301-1309.PubMed Greenland S, Longnecker MP: Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am J Epidemiol. 1992, 135: 1301-1309.PubMed
25.
go back to reference Deeks JJ, Higgins JPT, Altman DG: Analyzing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions 5.0.1. Edited by: Higgins J, Green S. 2008, Oxford, UK: The Cochrane Collaboration, chap 9 Deeks JJ, Higgins JPT, Altman DG: Analyzing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions 5.0.1. Edited by: Higgins J, Green S. 2008, Oxford, UK: The Cochrane Collaboration, chap 9
26.
27.
go back to reference Tobias A: Assessing the influence of a single study in meta-analysis. Stata Tech Bull. 1999, 47: 15-17. Tobias A: Assessing the influence of a single study in meta-analysis. Stata Tech Bull. 1999, 47: 15-17.
28.
go back to reference Egger M, Davey Smith G, Schneider M, Minder C: Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997, 315: 629-634. 10.1136/bmj.315.7109.629.CrossRefPubMedPubMedCentral Egger M, Davey Smith G, Schneider M, Minder C: Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997, 315: 629-634. 10.1136/bmj.315.7109.629.CrossRefPubMedPubMedCentral
29.
go back to reference Begg CB, Mazumdar M: Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994, 50: 1088-1101. 10.2307/2533446.CrossRefPubMed Begg CB, Mazumdar M: Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994, 50: 1088-1101. 10.2307/2533446.CrossRefPubMed
30.
go back to reference Schlesselman JJ: Case–control studies. Design, conduct, analysis. 1982, New York, USA: Oxford University Press Schlesselman JJ: Case–control studies. Design, conduct, analysis. 1982, New York, USA: Oxford University Press
31.
go back to reference Vlajinac HD, Marinkovic JM, Ilic MD, Kocev NI: Diet and prostate cancer: a case–control study. Eur J Cancer. 1997, 33: 101-107. 10.1016/S0959-8049(96)00373-5.CrossRefPubMed Vlajinac HD, Marinkovic JM, Ilic MD, Kocev NI: Diet and prostate cancer: a case–control study. Eur J Cancer. 1997, 33: 101-107. 10.1016/S0959-8049(96)00373-5.CrossRefPubMed
32.
go back to reference Key TJ, Silcocks PB, Davey GK, Appleby PN, Bishop DT: A casecontrol study of diet and prostate cancer. Br J Cancer. 1997, 76: 678-687. 10.1038/bjc.1997.445.CrossRefPubMedPubMedCentral Key TJ, Silcocks PB, Davey GK, Appleby PN, Bishop DT: A casecontrol study of diet and prostate cancer. Br J Cancer. 1997, 76: 678-687. 10.1038/bjc.1997.445.CrossRefPubMedPubMedCentral
33.
go back to reference Rossi E, Hung J, Beilby JP, Knuiman MW, Divitini ML, Bartholomew H: Folate levels and cancer morbidity and mortality: prospective cohort study from Busselton, Western Australia. Ann Epidemiol. 2006, 16: 206-212. 10.1016/j.annepidem.2005.03.010.CrossRefPubMed Rossi E, Hung J, Beilby JP, Knuiman MW, Divitini ML, Bartholomew H: Folate levels and cancer morbidity and mortality: prospective cohort study from Busselton, Western Australia. Ann Epidemiol. 2006, 16: 206-212. 10.1016/j.annepidem.2005.03.010.CrossRefPubMed
34.
go back to reference Pelucchi C, Galeone C, Talamini R, Negri E, Parpinel M, Franceschi S, Montella M, La Vecchia C: Dietary folate and risk of prostate cancer in Italy. Cancer Epidemiol Biomarkers Prev. 2005, 14: 944-948. 10.1158/1055-9965.EPI-04-0787.CrossRefPubMed Pelucchi C, Galeone C, Talamini R, Negri E, Parpinel M, Franceschi S, Montella M, La Vecchia C: Dietary folate and risk of prostate cancer in Italy. Cancer Epidemiol Biomarkers Prev. 2005, 14: 944-948. 10.1158/1055-9965.EPI-04-0787.CrossRefPubMed
Metadata
Title
Folate intake, serum folate levels, and prostate cancer risk: a meta-analysis of prospective studies
Authors
Rong Wang
Yan Zheng
Jing-Yang Huang
Ai-Qin Zhang
Yu-Hao Zhou
Jie-Ning Wang
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-1326

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