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Prospective association between dietary folate intake and skin cancer risk: results from the Supplémentation en Vitamines et Minéraux Antioxydants cohort.
Am J Clin Nutr 2015; 102(2):471-8AJ

Abstract

BACKGROUND

The role of folate in skin carcinogenesis is unclear, with experimental data suggesting potentially protective but also deleterious effects.

OBJECTIVE

Our main objective was to investigate the prospective association between dietary folate intake and risks of skin cancer (overall), nonmelanoma skin cancer (NMSC), and basal cell carcinoma (BCC). As an exploratory analysis, we also investigated the prospective association between erythrocyte folate concentration and skin cancer risk.

DESIGN

In this study, we included 5880 participants in the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) cohort (follow-up: 1994-2007) who completed at least six 24-h dietary records during the first 2 y of the study. Associations between sex-specific tertiles of dietary and erythrocyte folate and skin cancer risk were assessed by using multivariate Cox proportional hazards models.

RESULTS

After a median follow-up of 12.6 y, 144 incident skin cancers were diagnosed. Dietary folate intake was associated with increased risk of overall skin cancer [HR for tertile 3 compared with tertile 1 (HR(T3vs.T1)): 1.79; 95% CI: 1.07, 2.99; P-trend = 0.03], NMSC (HR(T3vs.T1): 1.85; 95% CI: 1.06, 3.23; P-trend = 0.03), and BCC (HR(T3vs.T1): 1.78; 0.98, 3.24; P-trend = 0.05). This association was observed in women (corresponding P-trend = 0.007, 0.009, and 0.009, respectively) but not in men (P-trend = 0.8, 0.8, and 0.9, respectively). P-interaction values between tertiles of dietary folate intake and sex were 0.04, 0.02, and 0.02 for overall skin cancer, NMSC, and BCC, respectively. Erythrocyte folate concentration was directly associated with increased risk of overall skin cancer (HR(T3vs.T1): 2.54; 95% CI: 0.95, 6.81; P-trend = 0.03), NMSC (HR(T3vs.T1): 3.49; 95% CI: 1.11, 11.0; P-trend = 0.01), and BCC (HR(T3vs.T1): 7.44; 95% CI: 1.57, 35.3; P-trend = 0.004) (men and women combined).

CONCLUSIONS

This prospective study suggests an association between dietary folate intake and erythrocyte folate concentration and increased risk of overall skin cancer, NMSC, and BCC. Although several mechanistic hypotheses and 2 previous large prospective studies on BCC are in line with these results, epidemiologic literature is limited, and future research is needed to better elucidate the potential role of folate in the cause of skin cancers.

Authors+Show Affiliations

Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France;Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France; Public Health Department, Avicenne Hospital, Bobigny, France; and.Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France; Dermatology Department, Saint André Hospital, Bordeaux, France.Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, French National Institute of Health and Medical Research U1153, French National Institute for Agricultural Research U1125, Cnam, Paris 13 University, Nutritional Epidemiology Research Team, Bobigny, France; m.touvier@eren.smbh.univ-paris13.fr.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26156743

Citation

Donnenfeld, Mathilde, et al. "Prospective Association Between Dietary Folate Intake and Skin Cancer Risk: Results From the Supplémentation En Vitamines Et Minéraux Antioxydants Cohort." The American Journal of Clinical Nutrition, vol. 102, no. 2, 2015, pp. 471-8.
Donnenfeld M, Deschasaux M, Latino-Martel P, et al. Prospective association between dietary folate intake and skin cancer risk: results from the Supplémentation en Vitamines et Minéraux Antioxydants cohort. Am J Clin Nutr. 2015;102(2):471-8.
Donnenfeld, M., Deschasaux, M., Latino-Martel, P., Diallo, A., Galan, P., Hercberg, S., ... Touvier, M. (2015). Prospective association between dietary folate intake and skin cancer risk: results from the Supplémentation en Vitamines et Minéraux Antioxydants cohort. The American Journal of Clinical Nutrition, 102(2), pp. 471-8. doi:10.3945/ajcn.115.109041.
Donnenfeld M, et al. Prospective Association Between Dietary Folate Intake and Skin Cancer Risk: Results From the Supplémentation En Vitamines Et Minéraux Antioxydants Cohort. Am J Clin Nutr. 2015;102(2):471-8. PubMed PMID: 26156743.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective association between dietary folate intake and skin cancer risk: results from the Supplémentation en Vitamines et Minéraux Antioxydants cohort. AU - Donnenfeld,Mathilde, AU - Deschasaux,Mélanie, AU - Latino-Martel,Paule, AU - Diallo,Abou, AU - Galan,Pilar, AU - Hercberg,Serge, AU - Ezzedine,Khaled, AU - Touvier,Mathilde, Y1 - 2015/07/08/ PY - 2015/02/10/received PY - 2015/05/27/accepted PY - 2015/7/10/entrez PY - 2015/7/15/pubmed PY - 2015/10/20/medline KW - BCC KW - NMSC KW - folate KW - prospective study KW - skin cancer risk SP - 471 EP - 8 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 102 IS - 2 N2 - BACKGROUND: The role of folate in skin carcinogenesis is unclear, with experimental data suggesting potentially protective but also deleterious effects. OBJECTIVE: Our main objective was to investigate the prospective association between dietary folate intake and risks of skin cancer (overall), nonmelanoma skin cancer (NMSC), and basal cell carcinoma (BCC). As an exploratory analysis, we also investigated the prospective association between erythrocyte folate concentration and skin cancer risk. DESIGN: In this study, we included 5880 participants in the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) cohort (follow-up: 1994-2007) who completed at least six 24-h dietary records during the first 2 y of the study. Associations between sex-specific tertiles of dietary and erythrocyte folate and skin cancer risk were assessed by using multivariate Cox proportional hazards models. RESULTS: After a median follow-up of 12.6 y, 144 incident skin cancers were diagnosed. Dietary folate intake was associated with increased risk of overall skin cancer [HR for tertile 3 compared with tertile 1 (HR(T3vs.T1)): 1.79; 95% CI: 1.07, 2.99; P-trend = 0.03], NMSC (HR(T3vs.T1): 1.85; 95% CI: 1.06, 3.23; P-trend = 0.03), and BCC (HR(T3vs.T1): 1.78; 0.98, 3.24; P-trend = 0.05). This association was observed in women (corresponding P-trend = 0.007, 0.009, and 0.009, respectively) but not in men (P-trend = 0.8, 0.8, and 0.9, respectively). P-interaction values between tertiles of dietary folate intake and sex were 0.04, 0.02, and 0.02 for overall skin cancer, NMSC, and BCC, respectively. Erythrocyte folate concentration was directly associated with increased risk of overall skin cancer (HR(T3vs.T1): 2.54; 95% CI: 0.95, 6.81; P-trend = 0.03), NMSC (HR(T3vs.T1): 3.49; 95% CI: 1.11, 11.0; P-trend = 0.01), and BCC (HR(T3vs.T1): 7.44; 95% CI: 1.57, 35.3; P-trend = 0.004) (men and women combined). CONCLUSIONS: This prospective study suggests an association between dietary folate intake and erythrocyte folate concentration and increased risk of overall skin cancer, NMSC, and BCC. Although several mechanistic hypotheses and 2 previous large prospective studies on BCC are in line with these results, epidemiologic literature is limited, and future research is needed to better elucidate the potential role of folate in the cause of skin cancers. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/26156743/Prospective_association_between_dietary_folate_intake_and_skin_cancer_risk:_results_from_the_Supplémentation_en_Vitamines_et_Minéraux_Antioxydants_cohort_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.115.109041 DB - PRIME DP - Unbound Medicine ER -