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Higher intakes of dietary vitamin D, calcium and dairy products are inversely associated with the risk of colorectal cancer: a case–control study in China

  • Xin Zhang (a1) (a2), Yu-Jing Fang (a3) (a4), Xiao-Li Feng (a1), Alinuer Abulimiti (a1), Chu-Yi Huang (a1), Hong Luo (a1), Nai-Qi Zhang (a1), Yu-Ming Chen (a1) and Cai-Xia Zhang (a1) (a2)...


The effects of dietary vitamin D, Ca and dairy products intakes on colorectal cancer risk remain controversial. The present study investigated the association between these dietary intakes and the risk of colorectal cancer in Guangdong, China. From July 2010 to December 2018, 2380 patients with colorectal cancer and 2389 sex- and age-matched controls were recruited. Dietary intake data were collected through face-to-face interviews using a validated FFQ. Unconditional multivariable logistic regression models were used to calculate the OR and 95 % CI after adjusting for various confounders. Higher dietary vitamin D and Ca intakes were associated with 43 and 52 % reductions in colorectal cancer risk, with OR of 0·57 (95 % CI 0·46, 0·70) and 0·48 (95 % CI 0·39, 0·61), respectively, for the highest quartile (v. the lowest quartile) intakes. A statistically significant inverse association was observed between total dairy product intake and colorectal cancer risk, with an adjusted OR of 0·32 (95 % CI 0·27, 0·39) for the highest v. the lowest tertile. Subjects who drank milk had a 48 % lower risk of colorectal cancer than those who did not (OR 0·52, 95 % CI 0·45, 0·59). The inverse associations of dietary vitamin D, Ca, total dairy products and milk intakes with the risk of colorectal cancer were independent of sex and cancer site. Our study supports the protective effects of high dietary vitamin D, Ca and dairy products intakes against colorectal cancer in a Chinese population.


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*Corresponding author: Professsor Cai-Xia Zhang, fax +86-20-87330446, email


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These authors contributed equally to this work.



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1.GLOBOCAN (2018) Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2018. (accessed January 2019).
2.Huxley, RR, Ansary-Moghaddam, A, Clifton, P, et al. (2009) The impact of dietary and lifestyle risk factors on risk of colorectal cancer: a quantitative overview of the epidemiological evidence. Int J Cancer 125, 171180.
3.McCullough, ML, Robertson, AS, Rodriguez, C, et al. (2003) Calcium, vitamin D, dairy products, and risk of colorectal cancer in the Cancer Prevention Study II Nutrition Cohort (United States). Cancer Causes Control 14, 112.
4.Godos, J, Tieri, M, Ghelfi, F, et al. (2019) Dairy foods and health: an umbrella review of observational studies. Int J Food Sci Nutr 14, 114.
5.Garland, CF & Garland, FC (1980) Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol 9, 227231.
6.Chen, A, Davis, BH, Sitrin, MD, et al. (2002) Transforming growth factor-beta 1 signaling contributes to Caco-2 cell growth inhibition induced by 1,25(OH)2D3. Am J Physiol Gastrointest Liver Physiol 283, G864G874.
7.Liu, M, Lee, MH, Cohen, M, et al. (1996) Transcriptional activation of the Cdk inhibitor p21 by vitamin D3 leads to the induced differentiation of the myelomonocytic cell line U937. Gene Dev 10, 142153.
8.Pálmer, HG, González-Sancho, JM, Espada, J, et al. (2001) Vitamin D3 promotes the differentiation of colon carcinoma cells by the induction of E-cadherin and the inhibition of β-catenin signaling. J Cell Biol 154, 369388.
9.Bao, AY & Li, Y (2013) Advance in research on the mechanisms of vitamin D against cancers. Int J Lab Med 34, 31913193.
10.Kaler, P, Galea, V, Augenlicht, L, et al. (2010) Tumor associated macrophages protect colon cancer cells from TRAIL-induced apoptosis through IL-1beta-dependent stabilization of snail in tumor cells. PLoS ONE 5, e11700.
11.Diaz, GD, Paraskeva, C, Thomas, MG, et al. (2000) Apoptosis is induced by the active metabolite of vitamin D3 and its analogue EB1089 in colorectal adenoma and carcinoma cells: possible implications for prevention and therapy. Cancer Res 60, 23042312.
12.Fleet, JC, Desmet, M, Johnson, R, et al. (2012) Vitamin D and cancer: a review of molecular mechanisms. Biochem J 441, 6176.
13.Ferrer-Mayorga, G, Larriba, MJ, Crespo, P, et al. (2019) Mechanisms of action of vitamin D in colon cancer. J Steroid Biochem Mol Biol 185, 16.
14.Lapre, JA, De Vries, HT, Koeman, JH, et al. (1993) The antiproliferative effect of dietary calcium on colonic epithelium is mediated by luminal surfactants and dependent on the type of dietary fat. Cancer Res 53, 784789.
15.Lamprecht, SA & Lipkin, M (2001) Cellular mechanisms of calcium and vitamin D in the inhibition of colorectal carcinogenesis. Ann N Y Acad Sci 952, 7387.
16.Narisawa, T, Reddy, BS & Weisburger, JH (1978) Effect of bile acids and dietary fat on large bowel carcinogenesis in animal models. Gastroenterol Jpn 13, 206212.
17.Ma, Y, Zhang, P, Wang, F, et al. (2011) Association between vitamin D and risk of colorectal cancer: a systematic review of prospective studies. J Clin Oncol 29, 37753782.
18.Theodoratou, E, Farrington, SM, Tenesa, A, et al. (2008) Modification of the inverse association between dietary vitamin D intake and colorectal cancer risk by a Fok I variant supports a chemoprotective action of vitamin D intake mediated through VDR binding. Int J Cancer 123, 21702179.
19.Murphy, N, Norat, T, Ferrari, P, et al. (2013) Consumption of dairy products and colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). PLOS ONE 8, e72715.
20.Huncharek, M, Muscat, J & Kupelnick, B (2009) Colorectal cancer risk and dietary intake of calcium, vitamin D, and dairy products: a meta-analysis of 26,335 cases from 60 observational studies. Nutr Cancer 61, 4769.
21.Kesse, E, Boutron-Ruault, M, Norat, T, et al. (2005) Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study. Int J Cancer 117, 137144.
22.Tantamango-Bartley, Y, Knutsen, SF, Jaceldo-Siegl, K, et al. (2017) Independent associations of dairy and calcium intakes with colorectal cancers in the Adventist Health Study-2 cohort. Public Health Nutr 20, 25772586.
23.Kampman, E, Goldbohm, RA, van den Brandt, PA, et al. (1994) Fermented dairy products, calcium, and colorectal cancer in the Netherlands Cohort Study. Cancer Res 54, 31863190.
24.Jarvinen, R, Knekt, P, Hakulinen, T, et al. (2001) Prospective study on milk products, calcium and cancers of the colon and rectum. Eur J Clin Nutr 55, 10001007.
25.Mizoue, T, Kimura, Y, Toyomura, K, et al. (2008) Calcium, dairy foods, vitamin D, and colorectal cancer risk: the Fukuoka Colorectal Cancer Study. Cancer Epidemiol Biomarkers Prev 17, 28002807.
26.Sun, ZY (2009) Calcium, vitamin D and risk of colorectal cancer in Canadian populations. Master’s Thesis, Tianjin Medical University.
27.Tayyem, RF, Bawadi, HA, Shehadah, I, et al. (2016) Meats, milk and fat consumption in colorectal cancer. J Hum Nutr Diet 29, 746756.
28.Green, CJ, de Dauwe, P, Boyle, T, et al. (2014) Tea, coffee, and milk consumption and colorectal cancer risk. J Epidemiol 24, 146153.
29.Ashmore, JH, Gallagher, CJ, Lesko, SM, et al. (2015) No association between vitamin D intake, VDR polymorphisms, and colorectal cancer in a population-based case–control study. Cancer Epidemiol Biomar 24, 16351637.
30.Jenab, M, Bueno-de-Mesquita, HB, Ferrari, P, et al. (2010) Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: a nested case–control study. BMJ 340, b5500.
31.Zhang, XY, Shu, L, Si, CJ, et al. (2015) Dietary patterns and risk of stroke in adults: a systematic review and meta-analysis of prospective cohort studies. J Stroke Cerebrovasc Dis 24, 21732182.
32.Zhang, J & Kesteloot, H (2005) Milk consumption in relation to incidence of prostate, breast, colon, and rectal cancers: is there an independent effect? Nutr Cancer 53, 6572.
33.Butler, LM, Wang, R, Koh, W, et al. (2008) Prospective study of dietary patterns and colorectal cancer among Singapore Chinese. Br J Cancer 99, 15111516.
34.Zhong, X, Fang, YJ, Pan, ZZ, et al. (2013) Dietary fat, fatty acid intakes and colorectal cancer risk in Chinese adults. Eur J Cancer Prev 22, 438447.
35.Luo, H, Zhang, NQ, Huang, J, et al. (2019) Different forms and sources of iron in relation to colorectal cancer risk: a case–control study in China. Br J Nutr 121, 735747.
36.Nimptsch, K, Zhang, X, Cassidy, A, et al. (2016) Habitual intake of flavonoid subclasses and risk of colorectal cancer in 2 large prospective cohorts. Am J Clin Nutr 103, 184191.
37.Ainsworth, BE, Haskell, WL, Whitt, MC, et al. (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32, S498S504.
38.Ainsworth, BE, Haskell, WL, Herrmann, SD, et al. (2011) 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 43, 15751581.
39.Zhang, CX & Ho, SC (2009) Validity and reproducibility of a food frequency questionnaire among Chinese women in Guangdong province. Asia Pac J Clin Nutr 18, 240250.
40.US Department of Agriculture (2015) USDA National Nutrient Database for Standard Reference, release 28. (accessed December 2018).
41.Yang, YX, Wang, G & Pan, XC (2002) China Food Composition. Beijing: Peking University Medical Press.
42.Willett, WC, Howe, GR & Kushi, LH (1997) Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 65, 1220S1228S, 1229S–1231S.
43.Liao, XP, Zhang, ZL, Zhang, HH, et al. (2014) Application guideline for vitamin D and bone health in adult Chinese (2014 Standard Edition). Chin J Osteoporos 30, 10111030.
44.Holick, MF (2004) Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80, 1678S1688S.
45.Ekmekcioglu, C, Haluza, D & Kundi, M (2017) 25-Hydroxyvitamin D status and risk for colorectal cancer and type 2 diabetes mellitus: a systematic review and meta-analysis of epidemiological studies. Int J Environ Res Public Health 14, 127.
46.Garland, CF & Gorham, ED (2017) Dose–response of serum 25-hydroxyvitamin D in association with risk of colorectal cancer: a meta-analysis. J Steroid Biochem Mol Biol 168, 18.
47.Cho, E, Smith-Warner, SA, Spiegelman, D, et al. (2004) Dairy foods, calcium, and colorectal cancer: a pooled analysis of 10 cohort studies. J Natl Cancer Inst 96, 10151022.
48.Wu, K, Willett, WC, Fuchs, CS, et al. (2002) Calcium intake and risk of colon cancer in women and men. J Natl Cancer Inst 94, 437446.
49.Park, SY, Murphy, SP, Wilkens, LR, et al. (2007) Calcium and vitamin D intake and risk of colorectal cancer: the Multiethnic Cohort Study. Am J Epidemiol 165, 784793.
50.Luo, WP, Fang, YJ, Lu, MS, et al. (2015) High consumption of vegetable and fruit colour groups is inversely associated with the risk of colorectal cancer: a case–control study. Br J Nutr 113, 11291138.
51.Ralston, RA, Truby, H, Palermo, CE, et al. (2014) Colorectal cancer and nonfermented milk, solid cheese, and fermented milk consumption: a systematic review and meta-analysis of prospective studies. Crit Rev Food Sci Nutr 54, 11671179.
52.Norat, T & Riboli, E (2003) Dairy products and colorectal cancer. A review of possible mechanisms and epidemiological evidence. Eur J Clin Nutr 57, 117.
53.Gueguen, L & Pointillart, A (2000) The bioavailability of dietary calcium. J Am Coll Nutr 19, 119S136S.
54.Lin, J, Zhang, SM, Cook, NR, et al. (2005) Intakes of calcium and vitamin D and risk of colorectal cancer in women. Am J Epidemiol 161, 755764.
55.Hjartåker, A, Lagiou, A, Slimani, N, et al. (2002) Consumption of dairy products in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort: data from 35955 24-hour dietary recalls in 10 European countries. Public Health Nutr 5, 12591271.
56.Christakos, S (2012) Recent advances in our understanding of 1,25-dihydroxyvitamin D3 regulation of intestinal calcium absorption. Arch Biochem Biophys 523, 7376.
57.Lamprecht, SA & Lipkin, M (2003) Chemoprevention of colon cancer by calcium, vitamin D and folate: molecular mechanisms. Nat Rev Cancer 3, 601614.
58.Ishihara, J, Inoue, M, Iwasaki, M, et al. (2008) Dietary calcium, vitamin D, and the risk of colorectal cancer. Am J Clin Nutr 88, 15761583.
59.Lipworth, L, Bender, TJ, Rossi, M, et al. (2009) Dietary vitamin D intake and cancers of the colon and rectum: a case–control study in Italy. Nutr Cancer 61, 7075.
60.Park, Y, Leitzmann, MF, Subar, AF, et al. (2009) Dairy food, calcium, and risk of cancer in the NIH-AARP Diet and Health Study. Arch Intern Med 169, 391401.
61.Slattery, ML, Neuhausen, SL, Hoffman, M, et al. (2004) Dietary calcium, vitamin D, VDR genotypes and colorectal cancer. Int J Cancer 111, 750756.
62.Larsson, SC, Bergkvist, L, Rutegard, J, et al. (2006) Calcium and dairy food intakes are inversely associated with colorectal cancer risk in the Cohort of Swedish Men. Am J Clin Nutr 83, 667673, 728–729.
63.Aune, D, Lau, R, Chan, DSM, et al. (2012) Dairy products and colorectal cancer risk: a systematic review and meta-analysis of cohort studies. Ann Oncol 23, 3745.
64.Xu, AG, Jiang, B, Zhong, XH, et al. (2006) The trend of clinical characteristics of colorectal cancer during the past 20 years in Guangdong province (article in Chinese). Natl Med J China/Zhonghua Yi Xue Za Zhi 86, 272275.
65.Dai, Z, Zheng, RS, Zou, XN, et al. (2012) Analysis and prediction of colorectal cancer incidence trend in China. Chin J Prev Med 46, 598603.
66.Gong, W, Liu, A, Yao, Y, et al. (2018) Nutrient supplement use among the Chinese population: a cross-sectional study of the 2010–2012 China Nutrition and Health Surveillance. Nutrients 10, 1733.


Higher intakes of dietary vitamin D, calcium and dairy products are inversely associated with the risk of colorectal cancer: a case–control study in China

  • Xin Zhang (a1) (a2), Yu-Jing Fang (a3) (a4), Xiao-Li Feng (a1), Alinuer Abulimiti (a1), Chu-Yi Huang (a1), Hong Luo (a1), Nai-Qi Zhang (a1), Yu-Ming Chen (a1) and Cai-Xia Zhang (a1) (a2)...


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