Plasma vitamin B6 and the risk of colorectal cancer and adenoma in women

Background. Vitamin B-6, whose main circulating form is pyridoxal 5'-phosphate (PLP), is important in one-carbon metabolism, which is critical for DNA synthesis and DNA methylation, both of which are potentially involved in colorectal carcinogenesis. However, no previous epidemiologic studies have directly evaluated the association of plasma PLP with risk for colorectal neoplasia. Methods: We conducted a prospective nested case-control study of 32826 female participants of the Nurses'Health Study who provided blood specimens in 1989-1990. From 1989-1990 to 2000 (1998 for adenoma), a total of 194 incident colorectal cancer cases and 410 incident colorectal adenoma cases were identified from medical records. Multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs) were calculated using logistic regression. All statistical tests were two-sided. Results: A suggestive inverse association was observed between plasma PLP concentration and risk for colorectal cancer when comparing the highest quartile versus the lowest (RR = 0.56, 95% CI = 0.31 to 1.01; P-trend =.07); the association of PLP concentration with colon cancer was statistically significant (RR = 0.42, 95% CI = 0.21 to 0.85; P-trend =.02). Both associations were statistically significant\ and stronger after controlling for intakes of folate, of multivitamins, and of methionine (for colorectal cancer, RR = 0.48, 95% CI 0.25 to 0.92; P-trend =.03; for colon cancer, RR = 0.38, 95% CI 0.18 to 0.80; P-trend =.01). Total vitamin B-6 intake was also statistically significantly inversely associated with colon cancer risk (RR = 0.51, 95% CI = 0.27 to 0.97; P-trend =.007). There was a suggestive inverse association between plasma PLP concentration and advanced distal colorectal adenoma (RR = 0.65, 95% CI = 0.37 to 1-11; P-trend =.08), but the association with early-stage adenoma was weaker (RR = 0.85, 95% CI = 0.52 to 1.38; P-trend =.52). Conclusions: Our results suggest that vitamin B6 may be inversely associated with risk of colorectal neoplasia.