Introduction: Folic acid fortification and supplementation to prevent neural tube defects has led to concerns regarding increased risk of colorectal cancer. The results of existing studies have been inconclusive. The purpose was to examine the relationship between level of folate intake and the incidence of colorectal cancer. Methods: A systematic review and meta analysis were conducted. MEDLINE, Embase, and SCOPUS were searched from inception to October 2009 with the following search terms "folic acid," "folate", "colorectal cancer," "colon neoplasms," rectal neoplasms." Observational studies in adult populations were included that defined levels of folate intake and incidence of colorectal cancer. Result: Out of 6427 references, 27 studies met our inclusion criteria. The summary risk estimate for case control studies comparing high versus low total folate intake was 0.85 (CI 95% 0.74-0.99) with no significant heterogeneity among studies. Similarly, for cohort studies, the resulting summary risk estimate for high versus low dietary folate intake was 0.92 (CI 95% 0.81-1.05) with no significant heterogeneity. However, defining what represents a higher intake of folic acid is difficult as there is variability in the upper limit of folic acid intake used in the studies. Discussion: These results suggest that higher folate intake levels offer a reduction in one of the perceived risks associated with developing colorectal cancer. These data can serve to help reassure women planning a pregnancy to increase folic intake during the preconception period to levels sufficient to prevent neural tube defects.
Bibliographical noteFunding Information:
Deborah Kennedy is supported by a career development grant from the Sickkids Foundation. Gideon Koren holds the Research Leadership for Better Pharmacotherapy During Pregnancy and Breastfeeding (Sickkids Hospital) and the Ivey Chair in Molecular Toxicology (University of Western Ontario). The Motherisk Program is conducting research supported by Duchesnay Inc, manufacturer of prenatal vitamins. These vitamins were not utilized in any of the studies included in this meta analysis. The remaining authors have no financial interests to declare. The authors have no conflict of interest to declare.
- Colorectal neoplasms
- Folic acid
- Systematic review