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© 2004 Oxford University Press
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Effect of Calcium Supplementation on the Risk of Large Bowel Polyps
Affiliations of authors: Departments of Community and Family Medicine (KW, JAB, BFC, MRK, LHP), Medicine (JAB, RR), and Anesthesia (MAB), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Medicine, University of North Carolina, Chapel Hill (RSS); Department of Preventative Medicine, University of Southern California School of Medicine, Los Angeles (RWH); Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH (CAB); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (JSM); Department of Pathology, Fairview Southdale Hospital, and Department of Pathology, University of Minnesota, Minneapolis (DCS)
Correspondence to: John A. Baron, MD, Dartmouth Medical School, Evergreen Center, Suite 300, 46 Centerra Parkway, Lebanon, NH 03756 (e-mail: john.a.baron{at}dartmouth.edu)
Background: Clinical trials have shown that calcium supplementation modestly decreases the risk of colorectal adenomas. However, few studies have examined the effect of calcium on the risk of different types of colorectal lesions or dietary determinants of this effect. Methods: Our analysis used patients from the Calcium Polyp Prevention Study, a randomized, double-blind, placebo-controlled chemoprevention trial among patients with a recent colorectal adenoma. Nine hundred thirty patients were randomly assigned to calcium carbonate (1200 mg/day) or placebo. Follow-up colonoscopies were conducted approximately 1 and 4 years after the qualifying examination. We used general estimating equation (GEE) and generalized linear regression analyses to compute risk ratios and 95% confidence intervals (CIs) to assess the effect of calcium treatment versus placebo on the risk of hyperplastic polyps, tubular adenomas, and more advanced lesions. Additionally, we used GEE analyses to compare the calcium treatment effects for various types of polyps with that for tubular adenomas. We also examined the interaction between calcium treatment and baseline intake of dietary calcium, fat, and fiber. All P values were obtained using Wald tests based on the corresponding models. All tests of statistical significance were two-sided. Results: The calcium risk ratio for hyperplastic polyps was 0.82 (95% CI = 0.67 to 1.00), that for tubular adenomas was 0.89 (95% CI = 0.77 to 1.03), and that for histologically advanced neoplasms was 0.65 (95% CI = 0.46 to 0.93) compared with patients assigned to placebo. There were no statistically significant differences between the risk ratio for tubular adenomas and that for other types of polyps. The effect of calcium supplementation on adenoma risk was most pronounced among individuals with high dietary intakes of calcium and fiber and with low intake of fat, but the interactions were not statistically significant. Conclusion: Our results suggest that calcium supplementation may have a more pronounced antineoplastic effect on advanced colorectal lesions than on other types of polyps.
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Editorial about this Article
- Advancing the Calcium–Colorectal Cancer Hypothesis
- Arthur Schatzkin and Ulrike Peters
J Natl Cancer Inst 2004 96: 893-894.[Extract] [Full Text] [PDF]
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