Postdiagnostic intake of one-carbon nutrients and alcohol in relation to colorectal cancer survival

Paul Lochhead, Reiko Nishihara, Zhi Rong Qian, Kosuke Mima, Yin Cao, Yasutaka Sukawa, Sun A. Kim, Kentaro Inamura, Xuehong Zhang, Kana Wu, Edward Giovannucci, Jeffrey A. Meyerhardt, Andrew T. Chan, Charles S. Fuchs, Shuji Ogino

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


Background: Observational data have suggested that intakes of nutrients involved in one-carbon metabolism are inversely associated with risk of colorectal carcinoma and adenomas. In contrast, results from some preclinical studies and cardiovascular and chemoprevention trials have raised concerns that high folate intake may promote carcinogenesis by facilitating the progression of established neoplasia. Objective: We tested the hypothesis that higher total folate intake (including food folate and folic acid from fortified foods and supplements) or other one-carbon nutrient intakes might be associated with poorer survival after a diagnosis of colorectal cancer. Design: We used rectal and colon cancer cases within the following 2 US prospective cohort studies: the Nurses' Health Study and the Health Professionals Follow-Up Study. Biennial questionnaires were used to gather information on medical history and lifestyle factors, including smoking and alcohol consumption. B-vitamin and methionine intakes were derived from food-frequency questionnaires. Data on tumor molecular characteristics (including microsatellite instability, CpG island methylator phenotype, KRAS, BRAF, and PIK3CA mutations, and long interspersed nucleotide element 1 methylation level) were available for a subset of cases. We assessed colorectal cancer-specific mortality according to postdiagnostic intakes of one-carbon nutrients with the use of multivariable Cox proportional hazards regression models. Results: In 1550 stage I-III colorectal cancer cases with a median follow-up of 14.9 y, we documented 641 deaths including 176 colorectal cancer-specific deaths. No statistically significant associations were observed between postdiagnostic intakes of folate or other one-carbon nutrients and colorectal cancer-specific mortality (multivariate P-trend ≥ 0.21). In an exploratory molecular pathologic epidemiology survival analysis, there was no significant interaction between one-carbon nutrients or alcohol and any of the tumor molecular biomarkers examined. Conclusions: Higher postdiagnostic intakes of one-carbon nutrients are not associated with the prognosis in stage I-III colorectal cancer. Our findings do not support the hypothesis that higher folate intake after colorectal cancer diagnosis might increase risk of cancerrelated death.

Original languageEnglish
Pages (from-to)1134-1141
Number of pages8
JournalAmerican Journal of Clinical Nutrition
Issue number5
Publication statusPublished - 2015 Nov 1


  • Alcohol
  • Colorectal carcinoma
  • Micronutrients
  • Public health
  • Survivorship

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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