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Antioxidant status and risk of cancer in the SU.VI.MAX study: is the effect of supplementation dependent on baseline levels?

  • Pilar Galan (a1), Serge Briançon (a2), Alain Favier (a3) (a4), Sandrine Bertrais (a1), Paul Preziosi (a1), Henri Faure (a4), Josiane Arnaud (a4), Nathalie Arnault (a1), Sébastien Czernichow (a1), Louise Mennen (a1) and Serge Hercberg (a1) (a5)...

The SUpplementation en VItamines et Mineraux AntioXydants (SU.VI.MAX) study, a randomised double-blind, primary-prevention trial showed that after 7·5 years, low-dose antioxidant supplementation lowered the total cancer incidence in men, but not in women. To explain this difference in the impact of antioxidant supplementation in men and women, we hypothesised that the effect of supplementation is dependent on initial antioxidant status; 12 741 French adults (7713 females aged 35–60 years; 5028 males aged 45–60 years) received daily antioxidant supplementation (120 mg vitamin C, 30 mg vitamin E, 6 mg β-carotene, 100 μg Se, 20 mg Zn daily) or a matching placebo. Cut-off limits for baseline serum concentrations of the different antioxidant vitamins and minerals were defined as follows for both men and women: 0·3 μmol/l for β-carotene, 11·4 μmol/l for vitamin C, 15 μmol/l for vitamin E, 0·75 μmol/l for Se and 10·7 μmol/l for Zn. The percentage of men with serum concentrations under cut-off limits was higher for vitamins C and E and β-carotene in those who developed a cancer than in those who did not. The risk of cancer was higher in men with baseline concentrations of serum vitamin C or vitamin E under cut-off limits, but not in women. The effect of supplementation was greater in men with baseline serum concentrations of vitamin C, vitamin E and β-carotene below the cut-off limits compared with those above it. This effect was maintained only for vitamin E after adjustment for age, tobacco, and alcohol consumption and BMI. No effect of supplementation could be seen in women. Baseline antioxidant status is related to the risk of cancer in men but not in women and therefore does not entirely explain the differences observed in the effect of antioxidant supplementation on cancer risk between sexes in the SU.VI.MAX study.

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      Antioxidant status and risk of cancer in the SU.VI.MAX study: is the effect of supplementation dependent on baseline levels?
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Corresponding author
*Corresponding author: Dr Pilar Galan, fax +33 1 53018070, email
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Anonymous (1994) The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group. N Eng J Med 330, 10291035.
Arnaud, J, Bellanger, J, Bienvenu, F, Chappuis, P & Favier, A (1986) Méthode recommandée de dosage du zinc sérique par absorption atomique en flamme (Recommended method for assaying serum zinc with flame atomic absorption). Ann Biol Clin 44, 7787.
Arnaud, J, Prual, A, Preziosi, P, Favier, A & Hercberg, S (1993) Selenium determination in human milk in Niger: influence of maternal status. J Trace Elem Electrolytes Health Dis 7, 199204.
Benton, D, Haller, J & Fordy, J (1997) The vitamin status of young British adults. Int J Vit Nutr Res 67, 3440.
Blot, WJ, Li, JY, Taylor, PR, et al. (1993) Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst 85, 14831492.
Bourgeois, CF, Chartois, RR, Counstans, MF & George, PR (1989) Automated determination of vitamin C in foodstuffs and biological tissues. Analysis 9, 519525.
Carbajal, A, Nunez, C & Moreiras, O (1996) Energy intake as a determinant factor of vitamin status in healthy young women. Int J Vit Nutr Res 66, 227231.
Comstock, GW, Helzsouer, KJ & Bush, TL (1991) Prediagnostic serum levels of carotenoids and vitamin E as related to subsequent cancer in Washington County, Maryland. Am J Clin Nutr 53, Suppl., 260S264S.
Connett, JE, Kuller, LH, Kjelsberg, MO, Polk, BF & Rider, A (1989) Relationship between carotenoids and cancer. The multiple risk factor intervention trial (MRFIT) study. Cancer 64, 126134.
Curran-Celentano, J, Hammond, BR, Ciulla, TA, Cooper, DA, Pratt, LM & Danis, RB (2001) Relation between dietary intake, serum concentrations, and retinal concentrations of luthein and zeaxanthin in adults in Midwest population. Am J Clin Nutr 74, 796802.
De Waart, FG, Schouten, EG, Stalenhoef, AFH & Kok, FJ (2001) Serum carotenoids, α-tocopherol and mortality risk in a prospective study among Dutch elderly. Int J Epidemiol 30, 136143.
Eischholzer, M, Stahelin, HB, Gey, KF, Ludin, E & Bernasconi, F (1996) Prediction of male cancer mortality by plasma levels of interacting vitamins: 17-year follow-up of the prospective Basel study. Int J Cancer 66, 145150.
Enstrom, JE, Kanim, LE & Klein, MA (1992) Vitamin C intake and mortality among a sample of the United States population. Epidemiology 3, 194202.
Hennekens, CH, Buring, JE, Manson, JE, et al. (1996) Lack of effect of long-term supplementation with beta-carotene on the incidence of malignant neoplasms and cardiovascular disease. N Eng J Med 334, 11451149.
Hercberg, S, Galan, P, Preziosi, P, Bertrais, S, Mennen, L, Malvy, D, Roussel, AM, Favier, A & Briançon, S (2004) The SU.VI.MAX study: a randomised, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med 164, 18.
Hercberg, S, Galan, P, Preziosi, P, Roussel, AM, Arnaud, J, Richard, MJ, Malvy, D, Paul-Dauphin, A, Briancon, S & Favier, A (1998 a) Background and rationale behind the SU.VI.MAX Study, a prevention trial using nutritional doses of a combination of antioxidant vitamins and minerals to reduce cardiovascular diseases and cancers. Int J Vit Nutr Res 68, 320.
Hercberg, S, Preziosi, P, Briançon, S, Galan, P, Triol, I, Malvy, D, Roussel, AM & Favier, A (1998 b) A primary-prevention trial of nutritional doses of antioxidant vitamins and minerals on cardiovascular diseases and cancers in general population: The SU.VI.MAX Study. Design, methods and participant characteristics. Control Clin Trials 19, 336351.
Hercberg, S, Preziosi, P, Galan, P, Devanlay, M, Keller, H, Bourgeois, C, Potier de Courcy, G & Cherouvrier, F (1994) Vitamin status of a healthy French population: dietary intakes and biochemical markers. Int J Vit Nutr Res 64, 220232.
Hsing, AW, Comstock, GW, Abbey, H & Polk, BF (1990) Serologic precursors of cancer. Retinol, carotenoids, and tocopherol and risk of prostate cancer. J Natl Cancer Inst 82, 941946.
Khaw, KT, Bingham, S, Welch, A, Luben, R, Wareham, N, Oakes, S & Day, N (2001) Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. Lancet 357, 657663.
Knekt, P (1988) Serum vitamin E level and risk of female cancers. Int J Epidemiol 17, 281286.
Knekt, P, Aromaa, A, Maatela, J, et al. (1988 a) Serum vitamin E and risk of cancer among Finnish men during a 10-year follow-up. Am J Epidemiol 127, 2833.
Knekt, P, Aromaa, A, Maatela, J, Alfthan, G, Aaran, RK, Teppo, L & Hakama, M (1988 b) Serum vitamin E, serum selenium and the risk of gastrointestinal cancer. Int J Cancer 42, 846850.
Lee, IM, Cook, NR, Manson, JE, Buring, JE & Hennekens, CH (1999) Betacarotene supplementation and incidence of cancer and cardiovascular disease: The Women's Health Study. J Natl Cancer Inst 24, 21022106.
Loria, CM, Klag, MJ, Caulfield, LE & Whelton, PK (2000) Vitamin C status and mortality in US adults. Am J Clin Nutr 72, 139145.
Millet, P, Guilland, JC, Fuchs, F & Klepping, J (1989) Nutrient intake and vitamin status of healthy French vegetarians and non vegetarians. Am J Clin Nutr 50, 718727.
Nomura, AMY, Stemmermann, GN, Heilbrun, LK, Salkeld, RM & Vuilleumier, JP (1985) Serum vitamin levels and the risk of cancer of specific sites in men of Japanese ancestry in Hawaii. Cancer Res 45, 23692372.
Olmedilla, B, Granado, F, Blanco, I & Rojas-Hidalgo, E (1994) Seasonal and sex-related variations in six serum carotenoids, retinol, and alpha-tocopherol. Am J Clin Nutr 60, 106110.
Olmedilla, B, Granado, F, Southon, S, et al. (2002) A European multicentre, placebo-controlled supplementation study with α-tocopherol, carotene-rich palm oil, lutein or lycopene: analysis of serum responses. Clin Sci 102, 447456.
Omenn, GS, Goodman, GE, Thornquist, MD, et al. (1996) Effects of a combination of beta-carotene and vitamin A on lung cancer and cardiovascular disease. N Eng J Med 334, 11501155.
Orentreich, N, Matias, JR, Vogelman, JH & Salked, RM (1991) The predictive value of serum β-carotene for subsequent development of lung cancer. Nutr Cancer 15, 167168.
Pilch, SM & Senti, FR (1985) Analysis of zinc data from the second National Health and Nutrition Examination Survey (NHANES II). J Nutr 115, 13931397.
Stähelin, HB, Gey, KF, Eichlolzer, M, Ludin, E, Bernasconi, F, Thurneysen, J & Brubacher, G (1991) Plasma antioxidant vitamins and subsequent cancer mortality in the 12-year follow-up of the prospective Basel study. Am J Epidemiol 133, 766775.
Van Dael, P & Deelstra, H (1993) Selenium. Int J Vit Nutr Res 63, 312316.
Van Poppel, G & Goldbohm, RA (1995) Epidemiologic evidence for β-carotene and cancer prevention. Am J Clin Nutr 62, Suppl., 1393S1402S.
Vuilleumier, JP, Keller, HE, Gysel, D & Hunziker, F (1983) Clinical chemical methods for the routine assessment of the vitamin status in human population. Part I: the fat-soluble vitamins A and E and beta-carotene. Int J Vitam Nutr Res 53, 265272.
Wald, NJ, Thompson, SG, Densem, JW, Boreham, J & Bailey, A (1988) Serum β-carotene and subsequent risk of cancer: results from the BUPA study. Br J Cancer 57, 428433.
Wallström, P, Wirfalt, E, Lahmann, PH, Gullberg, B, Janzon, L & Berglund, G (2001) Serum concentration of β-carotene and α-tocopherol are associated with diet, smoking, and general and central adiposity. Am J Clin Nutr 73, 777785.
World Health Organization (1993) Classification Statistique Internationale des Maladies et des Problèmes de Santé Connexes, 10th revision vol. 1, Geneva: WHO.
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
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