Vitamin D, magnesium, calcium, and their interaction in relation to colorectal cancer recurrence and all-cause mortality
Wesselink E, Kok DE, Bours MJL, de Wilt JHW, van Baar H, van Zutphen M, Geijsen AMJR, Keulen ETP, Hansson BME, van den Ouweland J, Witkamp RF, Weijenberg MP, Kampman E, van Duijnhoven FJB
The American journal of clinical nutrition · 41 citations
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Independent funding
- Nonprofit
- World Cancer Research Fund International
- Nonprofit
- Health Foundation Limburg
- Government
- ZonMw
- University or hospital
- Universiteit Maastricht
- University or hospital
- Maastricht Universitair Medisch Centrum
- Nonprofit
- KWF Kankerbestrijding
- University or hospital
- Radboud Universitair Medisch Centrum
- Nonprofit
- Wereld Kanker Onderzoek Fonds
- University or hospital
- Wageningen University and Research
- Nonprofit
- Alpe d'Huzes/Dutch Cancer Society
- Nonprofit
- Leven met kanker” of the Dutch Cancer Society
- Government
- ERA-NET on Translational Cancer Research
- Nonprofit
- Dutch Cancer Society
- Nonprofit
- Kankeronderzoekfonds Limburg
- Government
- Netherlands Organization for Health Research and Development
- Grants
- KWF Kankerbestrijding (UW2014-6877); KWF Kankerbestrijding (UW2013‐6397); World Cancer Research Fund International (2014/1179); Health Foundation Limburg (00005739)
Based on 15 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2020-02-25 · Am J Clin Nutr · vol. 111 · issue 5 · pp. 1007–1017
- Publisher
- Elsevier BV
- Cited
- 63 citations · more than 95% of similar papers · 4.3× the field average
- Impact
- Top 10% most cited in its field
- References
- 43 works
- Access
- Open access (hybrid journal) · CC-BY-NC
- Research areas
- Vitamin D Research Studies · Magnesium in Health and Disease · Parathyroid Disorders and Treatments
- Keywords
- Magnesium, Vitamin D and neurology, Medicine, Calcium, Hazard ratio, Proportional hazards model, Internal medicine, Colorectal cancer, Gastroenterology, Vitamin, Endocrinology, Population, Cancer, Chemistry, Confidence interval
- MeSH
- humans, colorectal neoplasms, neoplasm recurrence, local, calcium, magnesium, calcifediol, vitamin d, neoplasm staging, longitudinal studies, prospective studies, dietary supplements, aged, middle aged, female, male
14 authors
From NL
- Evertine Wesselink · correspondingWageningen University & Research
- Dieuwertje E. G. KokWageningen University & Research
- Martijn J.L. BoursMaastricht University
- Johannes H.W. de WiltRadboud University Nijmegen; Radboud University Medical Center
- Harm van BaarWageningen University & Research
- Moniek van ZutphenWageningen University & Research
Abstract
Background
Higher concentrations of 25-hydroxyvitamin D3 [25(OH)D3] at diagnosis are associated with a lower mortality risk in colorectal cancer (CRC) patients. However, magnesium and calcium are important in vitamin D metabolism.
Objectives
We aimed to investigate 25(OH)D3, magnesium, or calcium and their interaction among patients with CRC in relation to recurrence and all-cause mortality.
Methods
The study population included 1169 newly diagnosed stage I-III CRC patients from 2 prospective cohorts. Associations between 25(OH)D3 concentrations, magnesium or calcium intake through diet and/or supplements at diagnosis, and recurrence and all-cause mortality were evaluated using multivariable Cox proportional hazard models. The interaction between 25(OH)D3 and magnesium or calcium was assessed by investigating 1) joint compared with separate effects, using a single reference category; and 2) the effect estimates of 1 factor across strata of another.
Results
Serum 25(OH)D3, calcium, and magnesium, alone and their interactions, were not associated with recurrence. Serum 25(OH)D3 concentrations seemed to be associated with all-cause mortality. An inverse association between magnesium intake (HRQ3 vs. Q1: 0.55; 95% CI: 0.32, 0.95 and HRQ4 vs. Q1: 0.65; 95% CI: 0.35, 1.21), but not calcium intake, and all-cause mortality was observed. When investigating the interaction between 25(OH)D3 and magnesium, we observed the lowest risk of all-cause mortality in patients with sufficient vitamin D concentrations (≥50 nmol/L) and a high magnesium intake (median split) (HR: 0.53; 95% CI: 0.31, 0.89) compared with patients who were vitamin D deficient (<50 nmol/L) and had a low magnesium intake. No interactions between calcium and vitamin D in relation to all-cause mortality were observed.
Conclusions
Our findings suggest that the presence of an adequate status of 25(OH)D3 in combination with an adequate magnesium intake is essential in lowering the risk of mortality in CRC patients, yet the underlying mechanism should be studied. In addition, diet and lifestyle intervention studies are needed to confirm our findings. The COLON study was registered at clinicaltrials.gov as NCT03191110. The EnCoRe study was registered at trialregister.nl as NTR7099.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC).
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