Colon to Rectum
Gastroenterology. 2023;165(4):920–31
Serum 25-hydroxyvitamin D levels and risk of colorectal cancer: An age-stratified analysis
Background and aims: The role of circulating 25-hydroxyvitamin D (25(OH)D) in the prevention of early-onset colorectal cancer (CRC) in young adults aged < 50 years is uncertain. The authors evaluated the age-stratified associations (< 50 vs. ≥ 50 years) between circulating 25(OH)D levels and the risk of CRC in a large sample of Korean adults.
Methods: This cohort study included 236,382 participants (mean age, 38.0 years [standard deviation 9.0]) who underwent a comprehensive health examination, including measurement of serum 25(OH)D levels. Serum 25(OH)D levels were categorized as < 10, 10–20, and ≥ 20 ng/ml. CRC, along with the histologic subtype, site, and invasiveness, was ascertained through linkage with the national cancer registry. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CRC according to the serum 25(OH)D status, with adjustment for potential confounders.
Results: During the 1,393,741 person-years of follow-up (median, 6.5 years; interquartile range, 4.5–7.5 years), 341 participants developed CRC (incidence rate, 19.2 per 105 person-years). Among young individuals aged < 50 years, serum 25(OH)D levels were inversely associated with the risk of incident CRC with HRs of 0.61 (95% CI: 0.43–0.86) and 0.41 (95% CI: 0.27–0.63) for 25(OH)D 10–19 ng/ml and ≥ 20 ng/ml, respectively, with respect to the reference (< 10 ng/ml) (ptrend < 0.001, time-dependent model). Significant associations were evident for adenocarcinoma, colon cancer, and invasive cancers. For those aged ≥ 50 years, associations were similar, although slightly attenuated compared with younger individuals.
Conclusions: Serum 25-hydroxyvitamin D levels may have beneficial associations with the risk of developing colorectal cancer for both early-onset and late-onset disease.