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The conundrum of folate and colorectal cancer (CRC) risk

European Journal of Clinical Nutrition volume 64, page 1501 (2010)Cite this article

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We read with great interest the article by Kim et al. (2009) in which the authors show an inverse relationship between high folate intake and colorectal cancer (CRC) risk in a case–control Korean population. This of course is a welcome study, particularly as most of the previous studies have addressed this issue in Western populations. The authors have been thorough in assessing for known co-variates, but a striking point is the lack of adjustment for fibre intake in this study. This is vital as the European Prospective Investigation into Cancer and Nutrition study (Bingham et al., 2003) has shown a strong protective effect of fibre against CRC, which subsequently held even after adjusting for total folate levels.

Until recently, folate was one of the nutrients most strongly implicated in terms of protection against CRC. An inverse relationship between folate intake and risk of colorectal adenoma was demonstrated in the Health Professionals Follow-Up study and in the Nurses Health study, in which the relative risk of adenomas was 0.66 for women and 0.63 for men in those with a higher intake of folate. Similarly, in a review of 11 case–control and cohort studies, a 40% risk reduction of CRC was seen in the highest consumers of folate. Conversely, recent results from the Polyp Prevention Group (Cole et al., 2007) have shown no reduction (relative risk 1.13 at 3–5 years follow-up) in risk of adenoma recurrence with folic acid supplementation (1 mg/day) even in susceptible individuals (those with low baseline folate status and those who consumed alcohol).

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References

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  1. Clinical Sciences Research Institute, University of Warwick, Medical School, Coventry, UK

    R P Arasaradnam

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  1. R P Arasaradnam
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Correspondence to R P Arasaradnam.

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Arasaradnam, R. The conundrum of folate and colorectal cancer (CRC) risk. Eur J Clin Nutr 64, 1501 (2010). https://doi.org/10.1038/ejcn.2010.183

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