© 2004 by Oxford University Press
© 2004 Oxford University Press
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Dairy Foods, Calcium, and Colorectal Cancer: A Pooled Analysis of 10 Cohort Studies
Affiliations of authors: Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (EC, GAC, EG, WCW, DJH); Harvard School of Public Health, Departments of Nutrition (SASW, SSY, WCW, KW, DJH), Epidemiology (SASW, GAC, DJH, DS, WCW), and Biostatistics (DS), Boston, MA; The Center for Health Research, Loma Linda University School of Medicine, Loma Linda, CA (WLB, GEF); Department of Epidemiology, Maastricht University, Maastricht, The Netherlands (PAB); Harvard Center for Cancer Prevention, Boston, MA (GAC, WCW, DJH); Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (ARF); Department of Social and Preventive Medicine, University at Buffalo, State University of New York, Buffalo (JLF, SG); Department of Epidemiology, TNO Nutrition and Food Research Institute, Zeist, The Netherlands (RAG); Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Canada (ABM); Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland (PP, MV); Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA (JDP); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC (P. Terry); Department of Obstetrics/Gynecology, New York University School of Medicine, New York, NY (P. Toniolo); Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Stockholm, Sweden (AW); Nelson Institute of Environmental Medicine and Kaplan Cancer Center, New York University School of Medicine, New York (AZJ).
Correspondence to: Eunyoung Cho, ScD, Channing Laboratory, 181 Longwood Ave., Boston, MA 02115 (e-mail: eunyoung.cho{at}channing.harvard.edu)
Background: Studies in animals have suggested that calcium may reduce the risk of colorectal cancer. However, results from epidemiologic studies of intake of calcium or dairy foods and colorectal cancer risk have been inconclusive. Methods: We pooled the primary data from 10 cohort studies in five countries that assessed usual dietary intake by using a validated food frequency questionnaire at baseline. For most studies, follow-up was extended beyond that in the original publication. The studies included 534 536 individuals, among whom 4992 incident cases of colorectal cancer were diagnosed between 6 and 16 years of follow-up. Pooled multivariable relative risks for categories of milk intake and quintiles of calcium intake and 95% confidence intervals (CIs) were calculated. All statistical tests were two-sided. Results: Milk intake was related to a reduced risk of colorectal cancer. Compared with the lowest category of intake (<70 g/day), relative risks of colorectal cancer for increasing categories (70–174, 175–249, and 
250 g/day) of milk intake were 0.94 (95% CI = 0.86 to 1.02), 0.88 (95% CI = 0.81 to 0.96), and 0.85 (95% CI = 0.78 to 0.94), respectively (Ptrend<.001). Calcium intake was also inversely related to the risk of colorectal cancer. The relative risk for the highest versus the lowest quintile of intake was 0.86 (95% CI = 0.78 to 0.95; Ptrend = .02) for dietary calcium and 0.78 (95% CI = 0.69 to 0.88; Ptrend<.001) for total calcium (combining dietary and supplemental sources). These results were consistent across studies and sex. The inverse association for milk was limited to cancers of the distal colon (Ptrend<.001) and rectum (Ptrend = .02). Conclusion: Higher consumption of milk and calcium is associated with a lower risk of colorectal cancer.
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