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JU INSIGHT Regular, Long-Duration Multivitamin Use and Risk of Overall and Aggressive Prostate Cancer in the Health Professionals Follow-Up Study
By: Yiwen Zhang, SM; Mingyang Song, MD, ScD; Lorelei A. Mucci, MPH, ScD; Edward L. Giovannucci, MD, ScD | Posted on: 01 Sep 2022
Zhang Y, Song M, Mucci LA et al: Regular, long-duration multivitamin use and risk of overall and aggressive prostate cancer in the health professionals follow-up study. J Urol. 2022; 208(3):633-640.
Study Need and Importance
Evidence on multivitamin use and risk of prostate cancer has been limited and inconsistent, and some studies suggested regular or long-term multivitamin use was associated with increased risk of clinically important subtypes of prostate cancer, characterized by disease progression and poorer survival. Because multivitamins are the most widely used dietary supplements among older men in the United States, any possible increased association warrants further investigation. Therefore, leveraging data from a large prospective cohort, the Health Professionals Follow-Up Study, with 30 years of followup and detailed repeated assessments of multivitamin use, we evaluated the association between multivitamin use frequency and duration in relation to overall and aggressive prostate cancer.
What We Found
We observed no association between multivitamin use and risk of overall and aggressive prostate cancer (see Table). Compared to never-users, men who used multivitamins regularly or for 15 or more years were not at higher risk of overall, advanced or lethal prostate cancer. The results remain unchanged in various sensitivity analyses.
Table. Multivariable hazard ratios (and 95% confidence intervals, CI) of prostate cancer in relation to multivitamin use frequency in the Health Professionals Follow-Up Study, 1986–2016
| Risk of prostate cancer | Multivitamin Use Dosage | ||||||
|---|---|---|---|---|---|---|---|
| Never Use | Past Use | 1-2 Tablets/Week | 3-5 Tablets/Week | 6-9 Tablets/Week | ≥10 Tablets/Week | P for Trend | |
| All prostate cancer | |||||||
| Full model | 1.0 | 1.05 (0.97, 1.14) | 1.03 (0.88, 1.21) | 1.02 (0.91, 1.14) | 1.05 (0.97, 1.14) | 1.05 (0.93, 1.18) | 0.30 |
| Advanced prostate cancer | |||||||
| Full model | 1.0 | 1.00 (0.77, 1.30) | 1.21 (0.74, 1.99) | 0.88 (0.58, 1.32) | 1.01 (0.77, 1.33) | 1.14 (0.77, 1.70) | 0.46 |
| Lethal prostate cancer | |||||||
| Full model | 1.0 | 0.94 (0.78, 1.14) | 0.98 (0.67, 1.45) | 0.95 (0.72, 1.27) | 1.01 (0.82, 1.23) | 1.07 (0.80, 1.44) | 0.59 |
| Multivitamin Use Duration | |||||||
| Never Use | Past Use of Any Duration | 1-4 Years | 5-9 Years | 10-14 Years | ≥15 Years | P for Trend | |
| All prostate cancer | |||||||
| Full model | 1.0 | 1.05 (0.97, 1.14) | 1.04 (0.94, 1.15) | 1.14 (1.03, 1.26) | 1.00 (0.91, 1.10) | 1.03 (0.94, 1.13) | 0.80 |
| Advanced prostate cancer | |||||||
| Full model | 1.0 | 1.01 (0.78, 1.31) | 1.03 (0.73, 1.47) | 1.04 (0.72, 1.50) | 0.94 (0.68, 1.29) | 1.10 (0.80, 1.50) | 0.46 |
| Lethal prostate cancer | |||||||
| Full model | 1.0 | 0.94 (0.78, 1.14) | 0.84 (0.65, 1.10) | 1.03 (0.79, 1.33) | 1.08 (0.86, 1.35) | 1.04 (0.83, 1.31) | 0.13 |
| Trend was calculated using median value for each category, past use as missing. | |||||||
Limitations
As an observational study, we cannot entirely rule out the possibility of unmeasured or residual confounding. However, the homogeneity of the study population and comprehensive data on the risk factors may help minimize potential confounding. Second, there were potential measurement errors in the self-reported questionnaires. Third, the commercial forms of multivitamins have changed over time and add to heterogeneity. Finally, most of our study participants were White and health professionals who were expected to be nutrient sufficient. The results of our study may not be generalizable to different ethnic groups or to populations with different underlying nutrient status.
Interpretation for Patient Care
We found no evidence to suggest regular or long-duration multivitamin use was associated with risk of overall or aggressive prostate cancer in a well-nourished adult male population.