Background: Colorectal cancer is a commonly diagnosed cancer and the cause of many cancer deaths worldwide. Nutrients might be crucial in the pathogenesis and development of colorectal cancer. Although a number of studies have demonstrated the potential effects of nutrients, many challenges still remain. Summary: A tremendous amount of research has emerged concerning the roles of nutrients in colorectal cancer during the past decades. Here, we review the latest research progress on nutrients, including vitamins, folic acid, calcium, selenium and dietary fiber, involved in colorectal cancer prevention. Key Message: Nutrients are commonly consumed in foods or dietary supplements. It is clear that nutrients could play an important role and influence colorectal cancer outcomes. The relationship between nutrients and colorectal risk is complex. Vitamins, folic acid, calcium, selenium and dietary fiber have been proposed as potential agents to prevent colorectal cancer. However, some studies found that these nutrients did not reduce the incidence of colorectal cancer. Practical Implications: The supplementary dose of nutrients, the length of time required to observe the effects and confounding factors during the study might influence the role of nutrients in the prevention of colorectal cancer. Therefore, more evidence from ongoing clinical trials with different population groups and longer follow-up periods is critical to determine the relationship between nutrients and colorectal cancer.

1.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A: Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108.
2.
Masri OA, Chalhoub JM, Sharara AI: Role of vitamins in gastrointestinal diseases. World J Gastroenterol 2015;21:5191-5209.
3.
Kirkali G, Keles D, Canda AE, Terzi C, Reddy PT, Jaruga P, Dizdaroglu M, Oktay G: Evidence for upregulated repair of oxidatively induced DNA damage in human colorectal cancer. DNA Repair (Amst) 2011;10:1114-1120.
4.
Xu X, Yu E, Liu L, Zhang W, Wei X, Gao X, Song N, Fu C: Dietary intake of vitamins A, C, and E and the risk of colorectal adenoma: a meta-analysis of observational studies. Eur J Cancer Prev 2013;22:529-539.
5.
Bjelakovic G, Nikolova D, Simonetti RG, Gluud C: Antioxidant supplements for preventing gastrointestinal cancers. Cochrane Database Syst Rev 2008;3:CD004183.
6.
Chan AT, Giovannucci EL: Primary prevention of colorectal cancer. Gastroenterology 2010;138:2029-2043.e10.
7.
Jenab M, Bueno-de-Mesquita HB, Ferrari P, van Duijnhoven FJ, Norat T, Pischon T, Jansen EH, Slimani N, Byrnes G, Rinaldi S, Tjønneland A, Olsen A, Overvad K, Boutron-Ruault MC, Clavel-Chapelon F, Morois S, Kaaks R, Linseisen J, Boeing H, Bergmann MM, Trichopoulou A, Misirli G, Trichopoulos D, Berrino F, Vineis P, Panico S, Palli D, Tumino R, Ros MM, van Gils CH, Peeters PH, Brustad M, Lund E, Tormo MJ, Ardanaz E, Rodríguez L, Sánchez MJ, Dorronsoro M, Gonzalez CA, Hallmans G, Palmqvist R, Roddam A, Key TJ, Khaw KT, Autier P, Hainaut P, Riboli E: Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: a nested case-control study. BMJ 2010;340:b5500.
8.
Mezawa H, Sugiura T, Watanabe M, Norizoe C, Takahashi D, Shimojima A, Tamez S, Tsutsumi Y, Yanaga K, Urashima M: Serum vitamin D levels and survival of patients with colorectal cancer: post-hoc analysis of a prospective cohort study. BMC Cancer 2010;10:347.
9.
Ma Y, Zhang P, Wang F, Yang J, Liu Z, Qin H: Association between vitamin D and risk of colorectal cancer: a systematic review of prospective studies. J Clin Oncol 2011;29:3775-3782.
10.
Gandini S, Boniol M, Haukka J, Byrnes G, Cox B, Sneyd MJ, Mullie P, Autier P: Meta-analysis of observational studies of serum 25-hydroxyvitamin D levels and colorectal, breast and prostate cancer and colorectal adenoma. Int J Cancer 2011;128:1414-1424.
11.
Touvier M, Chan DS, Lau R, Aune D, Vieira R, Greenwood DC, Kampman E, Riboli E, Hercberg S, Norat T: Meta-analyses of vitamin D intake, 25-hydroxyvitamin D status, vitamin D receptor polymorphisms, and colorectal cancer risk. Cancer Epidemiol Biomarkers Prev 2011;20:1003-1016.
12.
Wactawski-Wende J, Kotchen JM, Anderson GL, Assaf AR, Brunner RL, O'Sullivan MJ, Margolis KL, Ockene JK, Phillips L, Pottern L, Prentice RL, Robbins J, Rohan TE, Sarto GE, Sharma S, Stefanick ML, Van Horn L, Wallace RB, Whitlock E, Bassford T, Beresford SA, Black HR, Bonds DE, Brzyski RG, Caan B, Chlebowski RT, Cochrane B, Garland C, Gass M, Hays J, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Jackson RD, Johnson KC, Judd H, Kooperberg CL, Kuller LH, LaCroix AZ, Lane DS, Langer RD, Lasser NL, Lewis CE, Limacher MC, Manson JE; Women's Health Initiative Investigators: Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med 2006;354:684-696.
13.
Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Krstic G, Wetterslev J, Gluud C: Vitamin D supplementation for prevention of cancer in adults. Cochrane Database Syst Rev 2014;6:CD007469.
14.
Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M, Newmark HL, Giovannucci E, Wei M, Holick MF: Vitamin D and prevention of colorectal cancer. J Steroid Biochem Mol Biol 2005;97:179-194.
15.
Tárraga López PJ, Albero JS, Rodríguez-Montes JA: Primary and secondary prevention of colorectal cancer. Clin Med Insights Gastroenterol 2014;7:33-46.
16.
Sanjoaquin MA, Allen N, Couto E, Roddam AW, Key TJ: Folate intake and colorectal cancer risk: a meta-analytical approach. Int J Cancer 2005;113:825-828.
17.
Giovannucci E: Epidemiologic studies of folate and colorectal neoplasia: a review. J Nutr 2002;132(8 suppl):2350S-2355S.
18.
Baggott JE, Oster RA, Tamura T: Meta-analysis of cancer risk in folic acid supplementation trials. Cancer Epidemiol 2012;36:78-81.
19.
Cole BF, Baron JA, Sandler RS, Haile RW, Ahnen DJ, Bresalier RS, McKeown-Eyssen G, Summers RW, Rothstein RI, Burke CA, Snover DC, Church TR, Allen JI, Robertson DJ, Beck GJ, Bond JH, Byers T, Mandel JS, Mott LA, Pearson LH, Barry EL, Rees JR, Marcon N, Saibil F, Ueland PM, Greenberg ER; Polyp Prevention Study Group: Folic acid for the prevention of colorectal adenomas: a randomized clinical trial. JAMA 2007;297:2351-2359.
20.
Farias N, Ho N, Butler S, Delaney L, Morrison J, Shahrzad S, Coomber BL: The effects of folic acid on global DNA methylation and colonosphere formation in colon cancer cell lines. J Nutr Biochem 2015;26:818-826.
21.
Kim YI: Will mandatory folic acid fortification prevent or promote cancer? Am J Clin Nutr 2004;80:1123-1128.
22.
Wu K, Willett WC, Fuchs CS, Colditz GA, Giovannucci EL: Calcium intake and risk of colon cancer in women and men. J Natl Cancer Inst 2002;94:437-446.
23.
Cho E, Smith-Warner SA, Spiegelman D, Beeson WL, van den Brandt PA, Colditz GA, Folsom AR, Fraser GE, Freudenheim JL, Giovannucci E, Goldbohm RA, Graham S, Miller AB, Pietinen P, Potter JD, Rohan TE, Terry P, Toniolo P, Virtanen MJ, Willett WC, Wolk A, Wu K, Yaun SS, Zeleniuch-Jacquotte A, Hunter DJ: Dairy foods, calcium, and colorectal cancer: a pooled analysis of 10 cohort studies. J Natl Cancer Inst 2004;96:1015-1022.
24.
Fedirko V, Bostick RM, Flanders WD, Long Q, Shaukat A, Rutherford RE, Daniel CR, Cohen V, Dash C: Effects of vitamin D and calcium supplementation on markers of apoptosis in normal colon mucosa: a randomized, double-blind, placebo-controlled clinical trial. Cancer Prev Res (Phila) 2009;2:213-223.
25.
Fedirko V, Bostick RM, Flanders WD, Long Q, Sidelnikov E, Shaukat A, Daniel CR, Rutherford RE, Woodard JJ: Effects of vitamin D and calcium on proliferation and differentiation in normal colon mucosa: a randomized clinical trial. Cancer Epidemiol Biomarkers Prev 2009;18:2933-2941.
26.
Feig B, Berger D, Furnham G: Oncología quirúrgica. Madrid, Editorial Marbán Libros SL, 2005, p 212.
27.
Peters U, Chatterjee N, Church TR, Mayo C, Sturup S, Foster CB, Schatzkin A, Hayes RB: High serum selenium and reduced risk of advanced colorectal adenoma in a colorectal cancer early detection program. Cancer Epidemiol Biomarkers Prev 2006;15:315-320.
28.
Reid ME, Duffield-Lillico AJ, Sunga A, Fakih M, Alberts DS, Marshall JR: Selenium supplementation and colorectal adenomas: an analysis of the Nutritional Prevention of Cancer trial. Int J Cancer 2006;118:1777-1781.
29.
Peters U, Takata Y: Selenium and the prevention of prostate and colorectal cancer. Mol Nutr Food Res 2008;52:1261-1272.
30.
Takata Y, Kristal AR, King IB, Song X, Diamond AM, Foster CB, Hutter CM, Hsu L, Duggan DJ, Langer RD, Petrovitch H, Shikany JM, Vaughan TL, Lampe JW, Prentice RL, Peters U: Serum selenium, genetic variation in selenoenzymes, and risk of colorectal cancer: primary analysis from the Women's Health Initiative Observational Study and meta-analysis. Cancer Epidemiol Biomarkers Prev 2011;20:1822-1830.
31.
Waters DJ, Chiang EC, Cooley DM, Morris JS: Making sense of sex and supplements: differences in the anticarcinogenic effects of selenium in men and women. Mutat Res 2004;551:91-107.
32.
Lippman SM, Klein EA, Goodman PJ, Lucia MS, Thompson IM, Ford LG, Parnes HL, Minasian LM, Gaziano JM, Hartline JA, Parsons JK, Bearden JD 3rd, Crawford ED, Goodman GE, Claudio J, Winquist E, Cook ED, Karp DD, Walther P, Lieber MM, Kristal AR, Darke AK, Arnold KB, Ganz PA, Santella RM, Albanes D, Taylor PR, Probstfield JL, Jagpal TJ, Crowley JJ, Meyskens FL Jr, Baker LH, Coltman CA Jr: Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2009;301:39-51.
33.
Steinbrenner H, Speckmann B, Sies H: Toward understanding success and failures in the use of selenium for cancer prevention. Antioxid Redox Signal 2013;19:181-191.
34.
Papaioannou D, Cooper KL, Carroll C, Hind D, Squires H, Tappenden P, Logan RF: Antioxidants in the chemoprevention of colorectal cancer and colorectal adenomas in the general population: a systematic review and meta-analysis. Colorectal Dis 2011;13:1085-1099.
35.
Rayman MP: Selenium and human health. Lancet 2012;379:1256-1268.
36.
Fu Z, Shrubsole MJ, Smalley WE, Ness RM, Zheng W: Associations between dietary fiber and colorectal polyp risk differ by polyp type and smoking status. J Nutr 2014;144:592-598.
37.
Aune D, Chan DSM, Lau R, Vieira R, Greenwood DC, Kampman E, Norat T: Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ 2011;343:d6617.
38.
Murphy N, Norat T, Ferrari P, Jenab M, Bueno-de-Mesquita B, Skeie G, Dahm CC, Overvad K, Olsen A, Tjønneland A, Clavel-Chapelon F, Boutron-Ruault MC, Racine A, Kaaks R, Teucher B, Boeing H, Bergmann MM, Trichopoulou A, Trichopoulos D, Lagiou P, Palli D, Pala V, Panico S, Tumino R, Vineis P, Siersema P, van Duijnhoven F, Peeters PH, Hjartaker A, Engeset D, González CA, Sánchez MJ, Dorronsoro M, Navarro C, Ardanaz E, Quirós JR, Sonestedt E, Ericson U, Nilsson L, Palmqvist R, Khaw KT, Wareham N, Key TJ, Crowe FL, Fedirko V, Wark PA, Chuang SC, Riboli E: Dietary fibre intake and risks of cancers of the colon and rectum in the European Prospective Investigation into Cancer and Nutrition (EPIC). PLoS One 2012;7:e39361.
39.
Galas A, Augustyniak M, Sochacka-Tatara E: Does dietary calcium interact with dietary fiber against colorectal cancer? A case-control study in Central Europe. Nutr J 2013;12:134.
40.
Nomura AM, Hankin JH, Henderson BE, Wilkens LR, Murphy SP, Pike MC, Le Marchand L, Stram DO, Monroe KR, Kolonel LN: Dietary fiber and colorectal cancer risk: the multiethnic cohort study. Cancer Causes Control 2007;18:753-764.
41.
Hansen L, Skeie G, Landberg R, Lund E, Palmqvist R, Johansson I, Dragsted LO, Egeberg R, Johnsen NF, Christensen J, Overvad K, Tjønneland A, Olsen A: Intake of dietary fiber, especially from cereal foods, is associated with lower incidence of colon cancer in the HELGA cohort. Int J Cancer 2012;131:469-478.
42.
Jacobs ET, Lanza E, Alberts DS, Hsu CH, Jiang R, Schatzkin A, Thompson PA, Martínez ME: Fiber, sex, and colorectal adenoma: results of a pooled analysis. Am J Clin Nutr 2006;83:343-349.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.