Search PubMed⌕ Search

Biomedical subjects

P van 't Veer

Publications and source records attributed to P van 't Veer.

At least 19 recordsLinked to original sources

Meat consumption and meat preparation in relation to colorectal adenomas among sporadic and HNPCC family patients in The Netherlands.

Meat consumption and meat preparation methods are thought to be associated with the risk of sporadic colorectal cancer, and possibly adenomas. As the same somatic mutations occur in sporadic adenomas and hereditary non-polyposis colorectal cancer (HNPCC)-related adenomas, similar exogenous factors may play a role in the development of both types of adenoma. In a case control study among 57 sporadic colorectal adenoma cases and 62 adenoma cases from HNPCC families (and 148 adenoma-free controls) from the Netherlands, we examined whether meat consumption and preparation are similarly associated with sporadic and suspected HNPCC colorectal adenomas. Frequency of meat consumption was not significantly associated with adenoma risk in our population of sporadic and HNPCC family cases and controls (Odds Ratios (OR) for high versus low consumption were 1.0 and 0.6, respectively). Interestingly, consumption of red meat and specific preparation methods (i.e., "not adding any water" and " closed lid with most meat types") slightly, but non-significantly, increased the risk of adenomas in the sporadic group only (OR, 95% Confidence Interval (CI): 4.1, 0.7-23.0, 2.0, 0.6-6.5 and 2.6, 0.9-7.2, respectively). This is the first study to examine possible differences or similarities in risk factors for sporadic and HNPCC colorectal carcinogenesis. Our results do not provide support for meat consumption as a risk factor for adenoma formation in HNPCC family members. Some characteristics of habitual meat preparation in the Netherlands may, however, increase the risk of sporadic adenomas.

Adenoma↗

Alcohol intake assessment: the sober facts.

Recent recommendations in regard to the level of alcohol intake have mainly been based on epidemiologic studies which relied on self-reported amounts of alcohol consumed. Therefore, it is important to be aware of the quality of self-reported measures of alcohol intake. Alcohol intake assessment methods were reviewed with respect to their capacity to rank individuals according to alcohol intake and their ability to explain the variation in the level of intake in population samples. In 33 methodological papers published after 1984, alcohol intake was assessed by five main methods: quantity frequency, extended quantity frequency, retrospective diary, prospective diary, and 24-hour recalls. The mean level of alcohol intake differed by 20% between these methods. It was also found that when researchers asked specifically about intake of beer, wine, and liquor, this resulted in 20% higher estimates of intake. These percentages were similar among populations with low and high mean alcohol consumption (4 vs. 10 drinks per week). It was found that ranking of individuals according to intake was satisfactory, with weighted correlation coefficients between methods ranging from 0.63 to 0.73. The authors conclude that, when there is sufficient evidence that alcohol intake is underestimated in a population, methods that enquire about both the frequency and amount consumed, for beer, wine, and liquor, separately, will yield the most realistic levels of intake.

Alcohol Drinking↗

Dietary intake of antioxidant (pro)-vitamins, respiratory symptoms and pulmonary function: the MORGEN study.

BACKGROUND: A study was undertaken to investigate the relationships between the intake of the antioxidant (pro)-vitamins C, E and beta-carotene and the presence of respiratory symptoms and lung function. METHODS: Complete data were collected in a cross sectional study in a random sample of the Dutch population on 6555 adults during 1994 and 1995. Antioxidant intake was assessed by a semi-quantitative food frequency questionnaire and respiratory symptoms (cough, phlegm, productive cough, wheeze, shortness of breath) were assessed by a self-administered questionnaire. Prevalence odds ratios for symptoms were calculated using logistic regression analysis. Linear regression analysis was used for forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). The results are presented as a comparison between the 90th and 10th percentiles of antioxidant intake. RESULTS: Vitamin C intake was not associated with most symptoms but was inversely related with cough. Subjects with a high intake of vitamin C had a 53 ml (95% CI 23 to 83) higher FEV1 and 79 ml (95% CI 42 to 116) higher FVC than those with a low vitamin C intake. Vitamin E intake showed no association with most symptoms and lung function, but had a positive association with productive cough. The intake of beta-carotene was not associated with most symptoms but had a positive association with wheeze. However, subjects with a high intake of beta-carotene had a 60 ml (95% CI 31 to 89) higher FEV1 and 75 ml (95% CI 40 to 110) higher FVC than those with a low intake of beta-carotene. CONCLUSIONS: The results of this study suggest that a high intake of vitamin C or beta-carotene is protective for FEV1 and FVC compared with a low intake, but not for respiratory symptoms.

Adult↗

Association between toenail selenium and risk of acute myocardial infarction in European men. The EURAMIC Study. European Antioxidant Myocardial Infarction and Breast Cancer.

The association between selenium status and risk of acute myocardial infarction was examined in a multicenter case-control study in 10 centers from Europe and Israel in 1991-1992. Selenium in toenails was assessed for 683 nonfatal male cases with first acute myocardial infarction and 729 controls less than 70 years of age. Median toenail selenium content was 0.553 microgram/g for cases and 0.590 microgram/g for controls. After adjustment for age, center, and smoking, the odds ratio for myocardial infarction in the highest quintile of selenium as compared with the lowest was 0.63 (95 percent confidence interval 0.37-1.07, p for trend = 0.08). The observed inverse trend was somewhat stronger when the authors adjusted for vitamin E status (p = 0.05). Analysis stratified for smoking habits showed an inverse association in former smokers (odds ratio for the 75th-25th percentile contrast = 0.63 (95 percent confidence interval 0.43-0.94)), but not in current smokers (odds ratio = 0.97 (0.71-1.32)) or in those who had never smoked (odds ratio = 1.55 (0.87-2.76)). Analysis stratified by center showed a significant inverse association between selenium levels and risk of myocardial infarction for Germany (Berlin) only (75th to 25th percentile odds ratio = 0.62 (95 percent confidence interval 0.42-0.91)), which was the center with the lowest selenium levels. It appears that the increased risk of acute myocardial infarction at low levels of selenium intake is largely explained by cigarette smoking; selenium status does not appear to be an important determinant of risk of myocardial infarction at the levels observed in a large part of Europe.

Case-Control Studies↗

Vitamins C and E, retinol, beta-carotene and dietary fibre in relation to breast cancer risk: a prospective cohort study.

Association between breast cancer risk and the intake of vitamins C and E, retinol, beta (beta)-carotene, dietary fibre, vegetables, fruit and potatoes was examined in The Netherlands Cohort Study, for 62,573 women aged 55-69 years. After 4.3 years of follow-up, 650 incident breast cancer cases were identified. After adjusting for traditional risk factors, breast cancer risk was not influenced by the intake of beta-carotene, vitamin E, dietary fibre, supplements with vitamin C, vegetables or potatoes. Fruit consumption showed a non-significant inverse association with breast cancer risk (RR highest/lowest quintile = 0.76, 95% CI 0.54-1.08). A small reduction in risk was also observed with increasing intake of dietary vitamin C (RR highest/lowest quintile = 0.77, 95% CI 0.55-1.08). For retinol, a weak positive association was observed (RR highest/lowest quintile = 1.24, 95% CI 0.83-1.83). Among subjects with a high intake of polyunsaturated fatty acids (PUFAs), both beta-carotene and vitamin C intake showed a non-significant inverse association with breast cancer risk (P-trend = 0.15 and 0.16 respectively). Our findings do not suggest a strong role, if any, for intake of vitamins C and E, beta-carotene, retinol, dietary fibre, vegetables, fruit and potatoes in the aetiology of breast cancer.

Aged↗

Adipose tissue trans fatty acids and breast cancer in the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer.

To investigate the relationship between trans fatty acids and postmenopausal breast cancer in European populations differing greatly in their dietary fat intakes, a case control study using adipose tissue stores of trans fatty acids as a biomarker of exposure was conducted. Subjects included 698 postmenopausal incident cases of primary breast cancer and controls randomly drawn from local population and patient registries, ages 50-74 Concentrations of individual trans fatty acids in gluteal fat biopsies were measured in these women. The adipose concentration of trans fatty acids showed a positive association with breast cancer. The covariate-adjusted association with breast cancer. The covariate-adjusted OR was 1.40 (95% confidence interval: 1.02, 1.93) for the difference between the 75th and 25th percentiles of total adipose trans. The adjusted OR for trans in the lowest tertile of polyunsaturated fatty acid reached 3.6 (2.2, 6.1). These associations were not attributable to differences in age, body mass index, exogenous hormone use, or socioeconomic status. These findings suggest an association of adipose stores of trans fatty acids with postmenopausal breast cancer in European women. They require confirmation in other populations, with concomitant consideration of the potential roles of dietary saturated and monounsaturated fats.

Adipose Tissue↗

Calcium does not protect against colorectal neoplasia.

Calcium could decrease risk of colorectal neoplasia by binding bowel-irritating compounds and diminishing mucosal proliferation. This study quantitatively summarizes epidemiologic studies addressing this hypothesis and aims to explain heterogeneity between studies. Twenty-four articles reported 43 measures of relative risks (RRs). The weighted mean, according to a random effects model, did not indicate substantial protection by calcium [RR = 0.89; 95% confidence interval (CI) = 0.79-1.01]. Results from different studies showed substantial heterogeneity, with the "true" underlying RRs ranging from about 0.50 to 1.60. Summary RRs for cohort and case-control studies were 0.90 and 0.88, respectively. For adenomas and carcinomas, RRs were 1.13 (95% CI = 0.91-1.39) and 0.86 (95% CI = 0.74-0.98), respectively, both falling within the range of between study heterogeneity. With respect to subsites, lower RRs were observed for estimates that included proximal colon as one of the subsites (RR = 0.67), whereas the RR was close to 1.0 for distal (RR = 0.97) and rectal subsites (RR = 0.99). Stratification on study characteristics and weighted regression analysis yielded RRs slightly below 1.0, with considerable heterogeneity. These results do not support the hypothesis that calcium prevents colorectal neoplasia.

Adenoma↗

Tissue antioxidants and postmenopausal breast cancer: the European Community Multicentre Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast (EURAMIC).

Antioxidants may protect against free radical mediated carcinogenesis. Epidemiological studies have not confirmed this hypothesis for breast cancer, possibly because of methodological limitations. Time-integrated exposure of alpha-tocopherol and beta-carotene in adipose tissue, and selenium in toenails was investigated in a case-control study among postmenopausal women, ages 50-74 years, from five European countries. The study group comprised 347 incident breast cancer cases and 374 controls. Mean antioxidant levels, adjusted for age and center, did not significantly differ for alpha-tocopherol (cases were 4.5% higher than controls), beta-carotene (3.0% lower), or selenium (1.8% lower). Odds ratios for highest versus lowest tertiles of exposure, adjusted for potential confounders, were 1.15 (95% confidence interval, 0.75-1.77), 0.74 (0.45-1.23), and 0.96 (0.63-1.47), respectively, without evidence for a decreasing trend. No statistically significant interactions were observed. Moreover, a provisional antioxidant score, indicating whether concentrations were above the median for zero, one, two, or all three antioxidants, yielded odds ratios of 1.00 (reference; all below median), 1.58, 1.58, and 1.21, respectively (chi2 for association = 4.00; P = 0.26). These results do not support the hypothesis that antioxidants are important determinants of this hormone-related malignancy among postmenopausal women.

Adipose Tissue↗

Alcohol and breast cancer: results from The Netherlands Cohort Study.

Although the results of cohort studies on the association between alcohol and breast cancer are rather consistent, the current evidence is based solely on North American cohorts. Therefore, this association was evaluated in the Netherlands Cohort Study on diet and cancer, conducted since 1986 among 62,573 women aged 55-69 years. After 3.3 years of follow-up (1986-1989), 422 incident breast cancer cases for which there were complete alcohol consumption data were available for analysis. In multivariate case-cohort analyses, the rate ratio for breast cancer in drinkers versus nondrinkers was 1.31 (95 percent confidence interval 1.00-1.71). When separate alcohol intake categories were compared with nondrinking, the rate ratios were 1.30, 1.29, 1.28, and 1.72 for women who consumed < 5, 5-14, 15-29, and > or = 30 g of alcohol per day, respectively (trend p = 0.047). Whereas beer consumption was not associated with breast cancer risk, increased risks were found at higher levels of both wine and liquor consumption. The alcohol-breast cancer association was found to be stronger among women with a history of benign breast disease, women with a history of breast cancer among sister(s), and women with an early menopause, and it varied considerably according to age at first birth. These results support a positive association between alcohol and breast cancer among postmenopausal women. The increased risk was particularly found among women who consumed 30 g or more of alcohol daily.

Aged↗

Relations between antioxidant vitamins in adipose tissue, plasma, and diet.

For an evaluation of fat-soluble vitamin concentrations in adipose tissue as biomarkers of intake, estimates of usual intake of beta-carotene, total vitamin A, and vitamin E (assessed by food frequency questionnaire) were compared with plasma and adipose tissue concentrations of beta-carotene, retinol, and alpha-tocopherol, respectively. Data were collected in 1992 in the Netherlands for 85 healthy, nonsmoking volunteers aged 50-70 years (38 males and 47 females). For alpha-tocopherol, a significant age- and sex-adjusted partial correlation (r = 0.24, p < 0.05) was observed between adipose tissue levels and intake. For beta-carotene, the partial r was 0.20. Adipose tissue retinol did not reflect intake (partial r = 0.08). Correlations of adipose tissue vitamin levels with plasma vitamin levels were higher overall (r = 0.34 for alpha-tocopherol, r = 0.56 for beta-carotene, and r = 0.17 for retinol) than correlations with intake. Plasma concentrations of alpha-tocopherol, beta-carotene, and retinol were not associated with dietary intake (partial r's were 0.05, 0.17, and -0.12, respectively). Pearson correlations of repeated measurements in adipose tissue (after 4 months) were 0.24 for retinol, 0.50 for beta-carotene, and 0.78 for alpha-tocopherol. Adipose tissue beta-carotene was shown to increase sixfold after 6 months' supplementation with 30 mg of beta-carotene daily. It is concluded that adipose tissue vitamin concentrations are an acceptable alternative to plasma levels as relatively stable indicators of dietary intake. However, both plasma and adipose tissue levels are more useful as markers of internal dose, taking into account variations in absorption and metabolism, than of dietary intake.

Adipose Tissue↗

Vegetable and animal products as determinants of colon cancer risk in Dutch men and women.

To examine the relationship between colon cancer and food groups from vegetable or animal sources and their possible interactions with gender, we analyzed data from a Dutch case-control study. Dietary patterns were assessed for 232 colon cancer cases and 259 population controls. In multivariate analyses, the consumption of vegetables was associated significantly with reduced colon-cancer risk (odds ratio [OR] for highest cf lowest quartile of consumption = 0.4, 95 percent confidence interval [CI] = 0.2-0.7, P-trend = 0.0004). Consumption of fresh red meat was associated positively with risk in women (OR = 2.4, 95% CI = 1.0-5.7, P-trend = 0.04), especially for those with a high consumption of red meat relative to the consumption of vegetables and fruits (OR = 3.1). For men, no association with consumption of fresh red meat was found (OR = 0.9). No clear associations were found for other products of vegetable or animal origin. The results of this Dutch case-control study support the preventive potential of a high-vegetable diet in colon cancer risk. This study suggest this may be important for women consuming a diet high in red meat.

Aged↗

Association between beta-carotene and acute myocardial infarction depends on polyunsaturated fatty acid status. The EURAMIC Study. European Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast.

Because antioxidants may play a role in the prevention of coronary heart disease by inhibiting the peroxidation of polyunsaturated fatty acids (PUFAs), the combined association of diet-derived antioxidants and PUFAs with acute myocardial infarction (MI) was investigated. This multicenter case-control study included 674 patients and 725 control subjects in eight European countries and Israel. Fatty acid composition and alpha-tocopherol and beta-carotene levels were determined in adipose tissue; selenium level was determined in toenails. For alpha-tocopherol no association with MI was observed at any PUFA level. The overall multivariate odds ratio (OR) for low (10th percentile) versus high (90th percentile) beta-carotene was 1.98 (95% confidence interval [CI], 1.39 to 2.82). The strength of this inverse association with MI was dependent on PUFA levels (in tertiles): for low PUFA, the OR for low versus high beta-carotene was 1.79 (95% CI, 0.98 to 3.25), for medium PUFA the OR was 1.76 (95% CI, 1.00 to 3.11), and for high PUFA 3.47 (95% CI, 1.93 to 6.24). For selenium increased risk was observed only at the lowest PUFA tertile (OR, 2.49; 95% CI, 1.22 to 5.09). This interaction between selenium and PUFAs was not significant and may at least partly be explained by a higher proportion of smokers at the low PUFA level. These findings support the hypothesis that beta-carotene plays a role in the protection of PUFAs against oxidation and subsequently in the protection against MI. No evidence was found that alpha-tocopherol or selenium may protect against MI at any level of PUFA intake.

Adipose Tissue↗

Reproducibility of a food frequency questionnaire and stability of dietary habits determined from five annually repeated measurements.

OBJECTIVES: In studies on diet and cancer, diet assessment should address long-term intake. Therefore, the authors determined the 5-year reproducibility of a self-administered 150-item food frequency questionnaire (FFQ) used to assess dietary habits in the Netherlands Cohort Study on diet and cancer. Since the FFQ was repeated more than once, the pure test-retest reliability of the FFQ could be distinguished from the intra-individual change in nutrient intake over time. These results were furthermore used to investigate the measurement error structure of the FFQ. DESIGN: After baseline administration in 1986, the FFQ was annually repeated from 1987 to 1991 in independent random samples of the cohort (n = 400). Pearson correlation coefficients (r) between baseline and repeated measurements of nutrient intake, calculated for each time interval, were regressed on time interval to provide separate estimates of the test-retest correlation (intercept of regression line) and of the decline in correlation over time (slope). The proportion of correlated measurement error was derived from combining the test-retest results with those from a validation study, in which the FFQ was validated against three 3-day diet records. RESULTS AND CONCLUSIONS: Response was stable at 82%. The test-retest r ranged from 0.42 for selenium intake to 0.90 for alcohol intake. The slopes of the regression lines were relatively flat, but negative for most nutrients; on average, the decline in r amounted to 0.07 after 5 years, indicating that the potential of a single FFQ measurement to rank subjects according to nutrient intake dropped only slightly over time. This is important for studies on cancer since a long induction period may be involved. It was furthermore shown that the proportion of within-subject (error) variance of the FFQ method that could be attributed to correlated error ranged from 0 to 50%. This finding confirms that a reliability study may underestimate the measurement error of a method. SPONSORSHIP: Dutch Cancer Society (grants CIVO 86-1 and CIVO 90-3).

Aged↗

Fermented dairy products, dietary calcium and colon cancer: a case-control study in The Netherlands.

To examine whether the consumption of fermented dairy products or the dietary intake of calcium decreases colon cancer risk, a case-control study was conducted in the The Netherlands. Dietary patterns were assessed in detail (for cases before diagnosis or symptoms occurred) using a structured dietary history questionnaire. After adjustment for potential confounding variables, consumption of fermented dairy products, hard cheese and unfermented dairy products was not significantly associated with risk of colon cancer: an odds ratio (OR) of 1.1 was found for individuals consuming more than one serving of fermented dairy products per day as compared to those consuming less than 10% of one serving a day. Adjustment for dietary calcium attenuated the associations. Total dietary calcium was positively but non-significantly associated with colon cancer risk after adjustment for age, gender, urbanization level and total energy intake. Additional adjustment for a positive family history of colorectal cancer, cholecystectomy and energy-adjusted intake of total fat, dietary fibre, vitamin C and alcohol increased the association. No differences were observed between calcium from fermented and from unfermented dairy sources. The observed associations for fermented dairy products and dietary calcium differed between men and women: positive significant associations were observed in men, while in women non-significant inverse associations were found. Our results do not support the hypothesis that an increased intake of commercially available, commonly used fermented dairy products or dietary calcium decreases the risk of colon cancer.

Aged↗

Fermented dairy products, calcium, and colorectal cancer in The Netherlands Cohort Study.

Experimental studies suggest that an increased consumption of fermented dairy products and calcium might decrease the risk of colorectal cancer. The associations between fermented dairy products, dietary calcium, and colorectal cancer risk were investigated in a population with a wide variation in intake of dairy products. The Netherlands Cohort Study of diet and cancer started in 1986 when 120,852 Dutch men and women, ages 55-69, filled out a questionnaire concerning dietary patterns and lifestyle. The present analysis is based on 3.3 years of follow-up and includes 215 incident cases of colon cancer and 111 incident cases of rectal cancer, excluding cases diagnosed in the first year of follow-up. After adjustment for potential confounding variables, colorectal cancer risk was weakly inversely associated with the consumption of fermented milk [relative rate (RR) in the highest category of intake compared to nonusers, 0.89; 95% confidence interval (CI), 0.60, 1.33], unfermented milk (RR, 0.86; 95% CI, 0.57, 1.29), and cheese (RR, 0.88; 95% CI, 0.59, 1.33). However, category-specific relative rates and tests for trends were not statistically significant. For fermented milk, the inverse association was limited to colon cancer (RR, 0.70; 95% CI, 0.43, 1.15; trend, P = 0.33). In crude and multivariate models, total dietary calcium intake (highest versus lowest quintile, RR, 0.92; 95% CI, 0.64, 1.34) and calcium from fermented dairy products (RR, 1.14; 95% CI, 0.77, 1.68) were not significantly associated with colorectal cancer risk. Calcium from unfermented dairy products was inversely associated with rectal cancer risk (RR, 0.55; 95% CI, 0.30, 1.04; trend, P = 0.03). After 3.3 years of follow-up, these data are not consistent with a substantially decreased risk of colorectal cancer with increased intake of fermented dairy products and dietary calcium.

Aged↗

A prospective cohort study on the relation between meat consumption and the risk of colon cancer.

The high incidence of colon cancer in affluent societies has often been attributed to a high fat diet and, more in particular, the consumption of meat. The association of the consumption of meat and the intake of fat with risk of colon cancer was investigated in a prospective cohort study on diet and cancer, which is being conducted in the Netherlands since 1986 among 120,852 men and women, aged 55-69. The analysis was based on 215 incident cases of colon cancer (105 men and 110 women) accumulated in 3.3 years of follow-up, excluding cases diagnosed in the first year of follow-up. Dietary habits were assessed at baseline with a 150-item semiquantitative food frequency questionnaire. No trends in relative rates of colon cancer were detected for intake of energy or for the energy-adjusted intake of fats, protein, fat from meat, and protein from meat. Consumption of total fresh meat, beef, pork, minced meat, chicken, and fish was not associated with risk of colon cancer either. Processed meats, however, were associated with an increased risk in men and women (relative rate, 1.17 per increment of 15 g/day; 95% confidence interval, 1.03-1.33). The increased risk appeared to be attributable to one of the five questionnaire items on processed meat, which comprised mainly sausages. This study does not support a role of fresh meat and dietary fat in the etiology of colon cancer in this population. As an exception, some processed meats may increase the risk, but the mechanism is not yet clear.

Age Factors↗

Calcium, vitamin D, dairy foods, and the occurrence of colorectal adenomas among men and women in two prospective studies.

A high intake of calcium, vitamin D, or specific dairy products is thought to reduce the incidence of colorectal cancer. The association of these nutrients and foods with the occurrence of colorectal adenomas, precursors of cancer, was studied in two large US cohort studies. Cases were patients with a diagnosis of adenomatous polyps of the left colon or rectum (331 men, 1986-1990; 350 women, 1980-1988), and controls were persons with endoscopic findings negative for adenoma (9,159 men and 8,585 women). After adjustment for age, total energy, family history of colorectal cancer, body mass index, alcohol consumption, folate, intake of saturated fat and fiber, indications for endoscopy, and previous endoscopy, total calcium intake was not associated with the risk for adenoma (relative risk (RR), highest vs. lowest quintile of intake: men, 1.13, 95% confidence interval (CI) 0.76-1.66; women, 1.17, 95% CI 0.81-1.69). Total vitamin D intake was unrelated to the risk for adenoma in men (RR = 1.29, 95% CI 0.87-1.93). An inverse nonsignificant association was observed in women in the 1980-1988 analyses (RR = 0.68, 95% CI 0.41-1.13, trend p = 0.09), mainly attributable to the intake of multivitamin supplements, but an analysis of 4-year data (1984-1988) using a more detailed dietary assessment showed no association with vitamin D (RR = 1.04, 95% CI 0.65-1.67). Milk consumption and intake of total fermented dairy products were not related to adenoma risk. In conclusion, the occurrence of colorectal adenoma was neither related to calcium intake nor to milk consumption, whereas vitamin D from supplements but not diet was slightly, but not significantly, inversely associated with risk among women only.

Adenoma↗