Calcium Supplements for the Prevention of Colorectal Adenomas

doi:10.1056/NEJM199901143400204

Volume 340:101-107		January 14, 1999		Number 2

Calcium Supplements for the Prevention of Colorectal Adenomas

J.A. Baron, M.D., M. Beach, M.D., Ph.D., J.S. Mandel, Ph.D., R.U. van Stolk, M.D., R.W. Haile, Dr.P.H., R.S. Sandler, M.D., M.P.H., R. Rothstein, M.D., R.W. Summers, M.D., D.C. Snover, M.D., G.J. Beck, Ph.D., J.H. Bond, M.D., E.R. Greenberg, M.D., H. Frankl, M.D., L. Pearson, M.Phil., for The Calcium Polyp Prevention Study Group

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ABSTRACT

Background and Methods Laboratory, clinical, and epidemiologicevidence suggests that calcium may help prevent colorectal adenomas.We conducted a randomized, double-blind trial of the effectof supplementation with calcium carbonate on the recurrenceof colorectal adenomas. We randomly assigned 930 subjects (meanage, 61 years; 72 percent men) with a recent history of colorectaladenomas to receive either calcium carbonate (3 g [1200 mg ofelemental calcium] daily) or placebo, with follow-up colonoscopiesone and four years after the qualifying examination. The primaryend point was the proportion of subjects in whom at least oneadenoma was detected after the first follow-up endoscopy butup to (and including) the second follow-up examination. Riskratios for the recurrence of adenomas were adjusted for age,sex, lifetime number of adenomas before the study, clinicalcenter, and length of the surveillance period.

Results The subjects in the calcium group had a lower risk ofrecurrent adenomas. Among the 913 subjects who underwent atleast one study colonoscopy, the adjusted risk ratio for anyrecurrence of adenoma with calcium as compared with placebowas 0.85 (95 percent confidence interval, 0.74 to 0.98; P=0.03).The main analysis was based on the 832 subjects (409 in thecalcium group and 423 in the placebo group) who completed bothfollow-up examinations. At least one adenoma was diagnosed betweenthe first and second follow-up endoscopies in 127 subjects inthe calcium group (31 percent) and 159 subjects in the placebogroup (38 percent); the adjusted risk ratio was 0.81 (95 percentconfidence interval, 0.67 to 0.99; P=0.04). The adjusted ratioof the average number of adenomas in the calcium group to thatin the placebo group was 0.76 (95 percent confidence interval,0.60 to 0.96; P=0.02). The effect of calcium was independentof initial dietary fat and calcium intake.

Conclusions Calcium supplementation is associated with a significant— though moderate — reduction in the risk of recurrentcolorectal adenomas.

Source Information

From the Departments of Medicine (J.A.B., R.R.), Community and Family Medicine (J.A.B.), and Anesthesia (M.B.) and the Norris Cotton Cancer Center (E.R.G.), Dartmouth–Hitchcock Medical Center, Lebanon, N.H.; the Veterans Affairs Medical Center, White River Junction, Vt. (M.B.); the Department of Environmental and Occupational Health, School of Public Health and School of Medicine (J.S.M.), and the Departments of Pathology (D.C.S.) and Medicine (J.H.B.), School of Medicine, University of Minnesota, and the Veterans Affairs Medical Center (J.H.B.), Minneapolis; the Center for Colon Polyps and Colon Cancer, Department of Gastroenterology (R.U.S.), and the Department of Biostatistics and Epidemiology (G.J.B.), Cleveland Clinic Foundation, Cleveland; the Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles (R.W.H.); the Department of Medicine, University of North Carolina, Chapel Hill, N.C. (R.S.S.); the James A. Clifton Center for Digestive Diseases, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City (R.W.S.); and the Department of Pathology, Fairview Southdale Hospital, Minneapolis (D.C.S.). Other authors were H. Frankl, M.D., Department of Internal Medicine, Southern California Permanente Group, Los Angeles; and L. Pearson, M.Phil., Department of Community and Family Medicine, Dartmouth–Hitchcock Medical Center, Lebanon, N.H.

Address reprint requests to Dr. Baron at 7927 Rubin Bldg., Dartmouth–Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756.

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