Prediagnostic calcium intake and lung cancer survival: A pooled analysis of 12 cohort studies

Danxia Yu, Yumie Takata, Stephanie A. Smith-Warner, William Blot, Norie Sawada, Emily White, Neal Freedman, Kim Robien, Edward Giovannucci, Xuehong Zhang, Yikyung Park, Yu Tang Gao, Rowan T. Chlebowski, Arnulf Langhammer, Gong Yang, Gianluca Severi, Jonas Manjer, Kay Tee Khaw, Elisabete Weiderpass, Linda M. LiaoNeil Caporaso, Steinar Krokstad, Kristian Hveem, Rashmi Sinha, Regina Ziegler, Shoichiro Tsugane, Yong Bing Xiang, Mattias Johansson, Wei Zheng, Xiao Ou Shu

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: Lung cancer is the leading cause of cancer death. Little is known about whether prediagnostic nutritional factors may affect survival. We examined the associations of prediagnostic calcium intake from foods and/or supplements with lung cancer survival. Methods: The present analysis included 23,882 incident, primary lung cancer patients from 12 prospective cohort studies. Dietary calcium intake was assessed using food-frequency questionnaires at baseline in each cohort and standardized to caloric intake of 2,000 kcal/d for women and 2,500 kcal/d for men. Stratified, multivariable-adjusted Cox regression was applied to compute hazard ratios (HR) and 95% confidence intervals (CI). Results: The 5-year survival rates were 56%, 21%, and 5.7% for localized, regional, and distant stage lung cancer, respectively. Low prediagnostic dietary calcium intake (<500-600 mg/d, less than half of the recommendation) was associated with a small increase in risk of death compared with recommended calcium intakes (800-1,200 mg/d); HR (95% CI) was 1.07 (1.01-1.13) after adjusting for age, stage, histology, grade, smoking status, pack-years, and other potential prognostic factors. The association between low calcium intake and higher lung cancer mortality was evident primarily among localized/regional stage patients, with HR (95% CI) of 1.15 (1.04-1.27). No association was found for supplemental calcium with survival in the multivariable-adjusted model. Conclusions: This large pooled analysis is the first, to our knowledge, to indicate that low prediagnostic dietary calcium intake may be associated with poorer survival among early-stage lung cancer patients. Impact: This multinational prospective study linked low calcium intake to lung cancer prognosis.

Original languageEnglish
Pages (from-to)1060-1070
Number of pages11
JournalCancer Epidemiology Biomarkers and Prevention
Volume26
Issue number7
DOIs
StatePublished - Jul 1 2017

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