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Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg)

Li, Kuanrong ; Kaaks, Rudolf ; Linseisen, Jakob ; Rohrmann, Sabine

In: European Journal of Nutrition, 2012, vol. 51, no. 4, p. 407-413

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    Title
    • Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg)
    Author
    • Li, Kuanrong. Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
    • Kaaks, Rudolf. Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
    • Linseisen, Jakob. Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
    • Rohrmann, Sabine. Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:313647
    Summary
    Purpose: To prospectively evaluate the association of vitamin/mineral supplementation with cancer, cardiovascular, and all-cause mortality. Methods: In the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg), which was recruited in 1994-1998, 23,943 participants without pre-existing cancer and myocardial infarction/stroke at baseline were included in the analyses. Vitamin/mineral supplementation was assessed at baseline and during follow-up. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: After an average follow-up time of 11years, 1,101 deaths were documented (cancer deaths=513 and cardiovascular deaths=264). After adjustment for potential confounders, neither any vitamin/mineral supplementation nor multivitamin supplementation at baseline was statistically significantly associated with cancer, cardiovascular, or all-cause mortality. However, baseline users of antioxidant vitamin supplements had a significantly reduced risk of cancer mortality (HR: 0.52; 95% CI: 0.28, 0.97) and all-cause mortality (HR: 0.58; 95% CI: 0.38, 0.88). In comparison with never users, baseline non-users who started taking vitamin/mineral supplements during follow-up had significantly increased risks of cancer mortality (HR: 1.74; 95% CI: 1.09, 2.77) and all-cause mortality (HR: 1.58; 95% CI: 1.17, 2.14). Conclusions: Based on limited numbers of users and cases, this cohort study suggests that supplementation of antioxidant vitamins might possibly reduce cancer and all-cause mortality. The significantly increased risks of cancer and all-cause mortality among baseline non-users who started taking supplements during follow-up may suggest a "sick-user effect,” which researchers should be cautious of in future observational studies