© 1998 by Oxford University Press
Journal Of The National Cancer Institute, Vol 90, 57-62, Copyright © 1998 by Oxford University Press
JA Baron, RS Sandler, RW Haile, JS Mandel, LA Mott and ER Greenberg
BACKGROUND: Recent evidence suggests that folic acid (and derivatives)
could contribute to the protective effect of fruits and vegetables against
the risk of large-bowel cancer. Other evidence indicates that alcohol
drinking and cigarette smoking may impair the biologic actions of folate.
We used data from an adenoma prevention trial to investigate the occurrence
of colorectal adenomas (possible precursors of colorectal cancer) in
association with folate intake, alcohol consumption, and cigarette smoking.
METHODS: Patients with at least one recent large-bowel adenoma were
followed with colonoscopy 1 year and 4 years after their qualifying colon
examinations. Adenomas detected after the year 1 examination were used as
end points. A food-frequency questionnaire was administered at study entry
and at study completion; nutrient intake at study entry was used in this
analysis. All statistical tests were two-sided. RESULTS: After adjustment
for caloric intake, dietary folate had a significant protective association
with the risk of recurrence of large-bowel adenoma (P for trend = .04).
However, this inverse association was attenuated by further adjustment for
intake of dietary fiber and fat. Use of folate supplements was not
associated with a reduction in risk. Alcohol intake (seven or more
drinks/week) was associated with increased risk (odds ratio = 2.04; 95%
confidence interval = 1.28-3.26). Cigarette smoking, even smoking for long
duration, was not related to adenoma recurrence. CONCLUSIONS: These data
provide only modest support for previous findings suggesting beneficial
effects of folate on colorectal adenoma risk. We find no evidence that
cigarette smoking increases risk. These findings do suggest a substantial
increase in risk with alcohol consumption.
ARTICLES
Folate intake, alcohol consumption, cigarette smoking, and risk of colorectal adenomas
Department of Community and Family Medicine, Dartmouth Medical School, and the Norris Cotton Cancer Center, Hanover, NH, USA. John.Baron@dartmouth.edu
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