Calcium and vitamin D supplementation and increased risk of serrated polyps: results from a randomised clinical trial.
Calcium and vitamin D supplementation and increased risk of serrated polyps: results from a randomised clinical trial.
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DOI：
10.1136/gutjnl-2017-315242
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发表时间：
2019-03
期刊：
影响因子：
24.5
通讯作者：
Baron JA
中科院分区：
文献类型：
--
作者：
Crockett SD;Barry EL;Mott LA;Ahnen DJ;Robertson DJ;Anderson JC;Wallace K;Burke CA;Bresalier RS;Figueiredo JC;Snover DC;Baron JA
无柄锯齿状腺瘤或息肉(SSA/Ps)等锯齿状病变是重要的结直肠癌先兆，但这些病变的病因尚不清楚。我们的目的是确定补充钙和维生素D对锯齿状息肉(SPS)发生率的影响，特别是对增生性息肉和SSA/Ps的影响。基线时患有一个或多个腺瘤的受试者被随机分为两组，分别接受1200毫克/天的元素钙和1000国际单位/天的维生素D3，或者两者都不接受。治疗持续3或5年，通过监测结肠镜检查确定息肉的风险(治疗阶段)。停止治疗后的结果也被评估(观察阶段)。调整后的危险比(ARR)通过多变量广义线性模型确定。在2058名参与者中，有565人(27.5%)在治疗阶段被诊断出SPS，329/1108人(29.7%)在观察阶段被诊断出。在随访期间，总共确定了211个SSA/Ps。在治疗阶段，钙或维生素D对SSA/Ps的发生率没有影响。然而，在后来的观察阶段，我们观察到与单独钙和钙+维生素D治疗相关的SSA/Ps风险增加[ARR(95%CI)：2.66(1.44-4.89)和3.82(分别为1.26-11.57])。在一项大型的多中心化学预防研究中，我们发现了补充钙和维生素D会增加SSA/Ps风险的证据。这似乎是一种晚期效应：补充开始后6-10年。这些可能的风险必须与补充钙和维生素D的好处进行权衡。
Serrated lesions such as sessile serrated adenomas or polyps (SSA/Ps) are important colorectal cancer precursors, but etiological factors for these lesions are largely unknown. We aimed to determine the effects of calcium and vitamin D supplementation on the incidence of serrated polyps (SPs) in general and hyperplastic polyps and SSA/Ps specifically. Participants with one or more adenoma at baseline were randomized to receive 1200 mg/day of elemental calcium, 1,000 IU/day of vitamin D3, both, or neither agent. Treatment continued for 3 or 5 years, when risk of polyps was determined from surveillance colonoscopy (treatment phase). Outcomes after treatment ceased were also assessed (observational phase). Adjusted risk ratios (aRRs) of SPs were determined via multivariable generalized linear models. SPs were diagnosed in 565 of 2058 (27.5%) participants during the treatment phase, and 329/1108 (29.7%) during the observational phase. In total, 211 SSA/Ps were identified during follow up. In the treatment phase, there was no effect of either calcium or vitamin D on incidence of SSA/Ps. However, during the later observational phase, we observed elevated risks of SSA/Ps associated with calcium alone and calcium + vitamin D treatment [aRR (95% CI): 2.66 (1.44–4.89) and 3.82 (1.26–11.57 respectively]. In a large multicenter chemoprevention study, we found evidence that calcium and vitamin D supplementation increased the risk of SSA/Ps. This appeared to be a late effect: 6–10 years after supplementation began. These possible risks must be weighed against the benefits of calcium and vitamin D supplementation.
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