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Review | Clinician's Corner

Vitamin B6 and Risk of Colorectal Cancer A Meta-analysis of Prospective Studies

Susanna C. Larsson, PhD; Nicola Orsini, PhD; Alicja Wolk, DMSc
JAMA. 2010;303(11):1077-1083. doi:10.1001/jama.2010.263.
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Published online

Context Mounting evidence indicates that vitamin B6, a coenzyme involved in nearly 100 enzymatic reactions, may reduce the risk of colorectal cancer.

Objective To conduct a systematic review with meta-analysis of prospective studies assessing the association of vitamin B6 intake or blood levels of pyridoxal 5′-phosphate (PLP; the active form of vitamin B6) with risk of colorectal cancer.

Data Sources Relevant studies were identified by a search of MEDLINE and EMBASE databases to February 2010, with no restrictions. We also reviewed reference lists from retrieved articles.

Study Selection We included prospective studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the association between vitamin B6 intake or blood PLP levels and the risk of colorectal, colon, or rectal cancer.

Data Extraction Two authors independently extracted data and assessed study quality. Study-specific RRs were pooled using a random-effects model.

Data Synthesis Nine studies on vitamin B6 intake and 4 studies on blood PLP levels were included in the meta-analysis. The pooled RRs of colorectal cancer for the highest vs lowest category of vitamin B6 intake and blood PLP levels were 0.90 (95% CI, 0.75-1.07) and 0.52 (95% CI, 0.38-0.71), respectively. There was heterogeneity among studies of vitamin B6 intake (P = .01) but not among studies of blood PLP levels (P = .95). Omitting 1 study that contributed substantially to the heterogeneity among studies of vitamin B6 intake yielded a pooled RR of 0.80 (95% CI, 0.69-0.92). The risk of colorectal cancer decreased by 49% for every 100-pmol/mL increase (approximately 2 SDs) in blood PLP levels (RR, 0.51; 95% CI, 0.38-0.69).

Conclusion Vitamin B6 intake and blood PLP levels were inversely associated with the risk of colorectal cancer in this meta-analysis.

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Figure 1. Selection of Studies for Inclusion in Meta-analysis
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Figure 2. Adjusted Relative Risks of Colorectal Cancer for the Highest vs Lowest Categories of Vitamin B6 Intake or Blood PLP Level
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CI indicates confidence interval; PLP, pyridoxal 5′-phosphate. The size of each square is proportional to the study's weight (inverse of variance).
aThe range is the difference in the midpoint between the highest and lowest categories of exposure.
bExclusion of the study by de Vogel et al,20 which appeared to explain the study heterogeneity, yielded a pooled relative risk of 0.80 (95% CI, 0.69-0.92) with no heterogeneity among studies (P = .23; I2 = 24%; 95% CI, 0%-64%).

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Figure 3. Dose-Response Relationship Between Blood PLP Level and Relative Risk of Colorectal Cancer
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Adjusted relative risks and 95% confidence intervals (CIs; dashed lines) are reported. Blood pyridoxal 5′-phosphate (PLP) levels were modeled with a linear trend in a random-effects meta-regression model. The median value of the lowest reference range (12.7 pmol/mL) was used to estimate all relative risks. The vertical axis is on a log scale.

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