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Folic acid supplements linked to prostate cancer risk
Last Updated: Tuesday, March 10, 2009 | 4:10 PM ET Comments22Recommend21
CBC News
Folate is found in leafy vegetables. Folate is found in leafy vegetables. (Eric Risberg/AP Photo)
Men who take daily supplements of folic acid could be increasing their risk of getting prostate cancer, a trial suggests.
In Tuesday's online issue of the Journal of the National Cancer Institute, researchers at the University of Southern California analyzed the results of a trial of 643 men who took either one milligram a day of folic acid or a placebo.
Those who took the supplements were three times more likely to be diagnosed with prostate cancer over 10 years, compared with men who took sugar pills, the researchers reported.
But it's also possible that the results were due to chance, they said.
The benefits of folic acid for reducing serious birth defects such as spina bifida are well documented, but its effects on other diseases are less clear.
Adequate levels of folate may be beneficial, but too much folate is unlikely to be beneficial.'Ñ Prof. Jane Figueiredo
Folate is a B vitamin that the body uses to make healthy new cells. The synthetic version, folic acid, is used to fortify grain products such as white flour.
"We know that adequate folate levels are important in the prevention of several cancer types, cardiovascular and neurological diseases," said the study's lead author, Jane Figueiredo, an assistant professor of preventive medicine at the Keck School of Medicine.
Figueiredo and her team estimated the prostate cancer risk was 9.7 per cent at 10 years in men assigned to take folate, compared with 3.3 per cent for those in the placebo group.
Natural sources vs. supplements
"Adequate levels of folate may be beneficial, but too much folate is unlikely to be beneficial," she said.
"The possibility of different effects from folic acid-containing supplements versus natural sources of folate definitely merits further investigation."
The synthetic form, folic acid, is more readily available to the body, compared with folate from foods, Figueiredo noted.
The trial was not originally designed to look at prostate cancer risk. Earlier results suggested people taking folic acid supplements had a higher risk for polyps linked to colon cancer and that aspirin reduced the risk.
Foods that are rich in B vitamins and folate include: meat, poultry, fortified cereals, beans, nuts, leafy vegetables, spinach and peas.
The research was funded by the U.S. National Cancer Institute and the U.S. National Institutes of Health.
JNCI JOURNAL OF THE NATIONAL CANCER INSTITUTE
JAN 16, 2009
Folic Acid and Risk of Prostate Cancer: Results From a Randomized Clinical Trial
Jane C. Figueiredo, Maria V. Grau, Robert W. Haile, Robert S. Sandler, Robert W. Summers, Robert S. Bresalier, Carol A. Burke, Gail E. McKeown-Eyssen, John A. Baron
Affiliations of authors: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (JCF, RWH); Departments of Medicine and Community and Family Medicine, Dartmouth Medical School, Hanover, NH (MVG, JAB); Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC (RSS); Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA (RWS); Department of Gastrointestinal Medicine and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX (RSB); Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH (CAB); Dalla Lana School of Public Health and Department of Nutritional Sciences, University of Toronto, Toronto, Canada (GEM-E)
Correspondence to: Jane C. Figueiredo, PhD, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (e-mail: janefigu@usc.edu).
Data regarding the association between folate status and risk of prostate cancer are sparse and conflicting. We studied prostate cancer occurrence in the Aspirin/Folate Polyp Prevention Study, a placebo-controlled randomized trial of aspirin and folic acid supplementation for the chemoprevention of colorectal adenomas conducted between July 6, 1994, and December 31, 2006. Participants were followed for up to 10.8 (median = 7.0, interquartile range = 6.0Ð7.8) years and asked periodically to report all illnesses and hospitalizations. Aspirin alone had no statistically significant effect on prostate cancer incidence, but there were marked differences according to folic acid treatment. Among the 643 men who were randomly assigned to placebo or supplementation with folic acid, the estimated probability of being diagnosed with prostate cancer over a 10-year period was 9.7% (95% confidence interval [CI] = 6.5% to 14.5%) in the folic acid group and 3.3% (95% CI = 1.7% to 6.4%) in the placebo group (age-adjusted hazard ratio = 2.63, 95% CI = 1.23 to 5.65, Wald test P = .01). In contrast, baseline dietary folate intake and plasma folate in nonmultivitamin users were inversely associated with risk of prostate cancer, although these associations did not attain statistical significance in adjusted analyses. These findings highlight the potential complex role of folate in prostate cancer and the possibly different effects of folic acidÐcontaining supplements vs natural sources of folate.
CONTEXT AND CAVEATS
Prior knowledge
Some observational studies had suggested that increased folate in the diet might lower the risk of prostate cancer.
Study design
This study addressed the effect of folic acid supplementation on risk of prostate cancer in the context of a double-blind randomized clinical trial of folic acid and/or aspirin for prevention of colorectal adenoma. Dietary intake of folate was assessed at baseline.
Contribution
Folic acid supplementation was associated with increased risk of prostate cancer. By contrast, baseline dietary folate was inversely associated with prostate cancer risk.
Implications
Folate metabolism may have a complex role in prostate cancer; the effects of folic acidÐcontaining supplements on the risk of prostate cancer may be different those of natural dietary sources.
Limitations
Given the small number of prostate cancers in this study, the estimates of prostate cancer risk in the placebo and folic acid groups should be interpreted with caution.
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