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One‐carbon metabolism biomarkers and risk of urothelial cell carcinoma in the European prospective investigation into cancer and nutrition
Author(s) -
Vrieling Alina,
BuenoDeMesquita H. Bas,
Ros Martine M.,
Kampman Ellen,
Aben Katja K.,
Büchner Frederike L.,
Jansen Eugène H.,
Roswall Nina,
Tjønneland Anne,
BoutronRuault MarieChristine,
Cadeau Claire,
ChangClaude Jenny,
Kaaks Rudolf,
Weikert Steffen,
Boeing Heiner,
Trichopoulou Antonia,
Lagiou Pagona,
Trichopoulos Dimitrios,
Sieri Sabina,
Palli Domenico,
Panico Salvatore,
Peeters Petra H.,
Weiderpass Elisabete,
Skeie Guri,
Jakszyn Paula,
Chirlaque MaríaDolores,
Ardanaz Eva,
Sánchez MaríaJosé,
Ehrnström Roy,
Malm Johan,
Ljungberg Börje,
Khaw KayTee,
Wareham Nick J.,
Brennan Paul,
Johansson Mattias,
Riboli Elio,
Kiemeney Lambertus A.
Publication year - 2019
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.32165
Subject(s) - european prospective investigation into cancer and nutrition , medicine , odds ratio , prospective cohort study , quartile , bladder cancer , confounding , homocysteine , vitamin b12 , case control study , cancer , confidence interval , gastroenterology , physiology
Published associations between dietary folate and bladder cancer risk are inconsistent. Biomarkers may provide more accurate measures of nutrient status. This nested case–control analysis within the European Prospective Investigation into Cancer and Nutrition (EPIC) investigated associations between pre‐diagnostic serum folate, homocysteine, vitamins B6 and B12 and the risk of urothelial cell carcinomas of the bladder (UCC). A total of 824 patients with newly diagnosed UCC were matched with 824 cohort members. Serum folate, homocysteine, and vitamins B6 and B12 were measured. Odds ratios (OR) and 95% confidence intervals (CI) for total, aggressive, and non‐aggressive UCC were estimated using conditional logistic regression with adjustment for smoking status, smoking duration and intensity, and other potential confounders. Additionally, statistical interaction with smoking status was assessed. A halving in serum folate concentrations was moderately associated with risk of UCC (OR: 1.18; 95% CI: 0.98–1.43), in particular aggressive UCC (OR: 1.34; 95% CI: 1.02–1.75; p ‐heterogeneity = 0.19). Compared to never smokers in the highest quartile of folate concentrations, this association seemed only apparent among current smokers in the lowest quartile of folate concentrations (OR: 6.26; 95% CI: 3.62–10.81, p ‐interaction = 0.07). Dietary folate was not associated with aggressive UCC (OR: 1.26; 95% CI: 0.81–1.95; p ‐heterogeneity = 0.14). No association was observed between serum homocysteine, vitamins B6 and B12 and risk of UCC. This study suggests that lower serum folate concentrations are associated with increased UCC risk, in particular aggressive UCC. Residual confounding by smoking cannot be ruled out and these findings require confirmation in future studies with multiple measurements.