Review Article

Folate Intake, MTHFR Polymorphisms, and the Risk of Colorectal Cancer: A Systematic Review and Meta-Analysis

Table 1

(a) Characteristic of studies included in the systematic review and meta analysis.

StudyCountryYearStudy designSource of controlsRecruitment periodCancerSexCase/control Distribution of MTHFR C677T genotype in controlsHWE (yes/no) Distribution of MTHFR A1298C
genotype in controls
HWE (yes/no)Adjustments
CC (%)CT (%)TT (%)AA (%)AC (%)CC (%)

Park et al. [34]South Korea1999Case controlHealthy personsNot reportedCRCBoth200/46030.453.516.1NoCalculated OR, no adjustments

Delgado-Enciso et al. [15]Mexico2001Case controlNot reported1997CRCBoth74/11030.947.321.8YesCalculated OR, no adjustments

Keku et al. [35]USA2002Case controlHealthy persons1996–2000Colon-CaucBoth555/87549.241.49.4Yes 52.538.59.3YesAdjusted for sampling fraction, age, gender, and energy intake

Le Marchand et al. [23]USA2002Matched case controlHealthy persons1994–1998CRCBoth727/72739.24515.8Yes58.236.05.8NoAdjusted for age, gender, ethnicity, pack years of cigarette smoking, lifetime recreational physical activity, lifetime aspirin use, BMI 5 years ago, years of schooling, and intakes of nonstarch polysaccharides from vegetables and calcium from foods and supplements

Matsuo
et al. [16]
Japan2002Case controlHospital patients1999CRC
colon
rectal
Both142/241
72/241
70/241
33.651.514.9Yes65.131.13.7YesAdjusted for age

Shannon
et al. [36]
Australia2002Case controlHealthy persons1985–1998CRCBoth501/
1,207
44.246.49.4YesCalculated OR, no adjustments

Plaschke
et al. [37]
Germany2003Case controlHealthy personsNot reportedCRCBoth287/34643.145.911Yes44.543.611.8YesAdjusted for gender

Pufulete
et al. [38]
United Kingdom2003Case controlHospital patients2000-2001CRCBoth304/35254388Yes61.834.23.9YesAdjusted for age, gender, BMI, smoking, and ROH intake.

Toffoli
et al. [39]
Italy2003Case controlHealthy persons1999-2000ColonBoth276/27929.750.220.1Yes47.743.49YesCalculated OR, no adjustments

Jiang et al. [40]China2004Case controlHealthy person1990–2002CRCBoth126/34339.142.418.5No67.630.71.8YesAdjusted for age and sex

Miao et al. [41]China2005Case controlHealthy persons1999–2002CRCBoth198/42031.747.920.5Yes67.131.41.4NoNone reported

Ulvik et al. [20]Norway2004Nested case controlHealthy persons1992-1991CRCBoth2,168/
2,168
49.940.49.7YesAdjusted for age and gender

Yin et al. [21]Japan2004Case controlHospital patients2000–2003CRCBoth685/77835.747.217.1Yes66.231.42.4YesAdjusted for gender. 5-year age class, area and alcohol use

Jiang
et al. [42]
China2005Nested case controlHealthy persons1989-1990Colon
rectal
Both52/338
72/338
39.542.2 18.3No67.530.71.8NoAdjusted for gender, age, folate, methionine, total energy intake, smoking status, and drinking status

Landi et al. [43]Spain2005Case controlHospital patients1996–1998CRCBoth359/32035.34519.7Yes53.339.86.9YesAdjusted for age and sex

Matsuo
et al. [44]
Japan2005Matched case controlHospital patients2001–2004CRCBoth257/77137.545.117.3Yes62.533.54.0YesAdjusted for age, sex, referral patterns, smoking BMI, physical, exercise and family history of CRC

Otani et al. [45]Japan2005Matched case controlHospital patients1998–2002CRCBoth107/2242351.425.6Yes69.628.12.2YesMatching factors and adjusted for smoking, alcohol consumption, BMI, and total dietary fiber intake

Le Marchand
et al. [46]
USA
(Hawaii and California)
2005Nested case controlHealthy persons1993–1996CRC
colon
rectal
Both822/
2,021
48.938.512.6NoAdjusted for age, gender, and ethnicity

Battistelli et al. [47]Italy2006Case controlHealthy controlsNot reportedCRCBoth93/100305129YesCalculated OR, no adjustments

Van Guelpen
et al. [24]
Sweden2006Nested case controlHealthy persons1985–2002CRCBoth226/43752.838.78.5Yes45.942.012.1YesAdjusted for BMI, smoking, recreational and occupational physical activity, and alcohol intake

Wang et al. [48]India2006Case controlHealthy persons1999–2001CRC
colon
rectal
Both435/34087.612.40Yes36.146.417.5YesAdjusted for gender, age household income, education, religion, mother tongue, smoking, drinking, chewing, and vegetarianism

Lima
et al. [49]
Brazil2007Case controlHealthy persons1999–2001CRCBoth102/30047.742.310Yes63.731.05.3YesAdjusted for age, gender, and race

Chang
et al. [50]
Taiwan2007Matched case controlHospital patients2000-2001CRCBoth195/19547.244.68.2Yes61.533.35.1YesMatched on age and gender.

Curtin
et al. [51]
USA2007Matched case controlHealthy persons1991–1994ColonBoth916/
1,972
45.043.511.5Yes47.141.911YesCalculated OR, no adjustments

Hubner et al. [52]United Kingdom2007Case controlHealthy controlsNot reportedCRCBoth1,685/
2,695
43.644.312.1YesAdjusted for age, sex, family history, cancer location, stage, and grade

Jin et al. [53]China2007Case controlHealthy controls2002–2005CRCBoth449/67231.448.420.2YesAdjusted for age, sex, drinking, BMI, smoking, and family history

Murtaugh
et al. [54]
USA2007Matched case controlHealthy persons1997–2001Rectal-Men
Rectal-Women
Both
Men
Women
751/97948.2
47.5
40.1
41.4
11.7
11.1
No44.943.711.3YesAdjusted for age, BMI, activity, energy, fiber, calcium, ibuprofen use, smoking, and other MTHFR genotype

Osian et al. [55]Romania2007Matched case controlHospital patients2003–2005CRCBoth69/6770.225.44.5Yes61.137.31.5YesMatched on age and sex

Zeybek
et al. [17]
Turkey2007Case controlHospital patients2003–2005CRCBoth52/14444.445.110.4YesCalculated OR, no adjustments

Cao et al. [56]China2008Matched case controlHealthy persons2000–2002CRCBoth315/37132.749.517.8Yes64.432.13.5YesMatched on ethnicity, sex, and age

Küry et al. [57]France2008Matched case controlHealthy persons2002–2006CRCBoth1,023/1,12140.845.913.3Yes51.539.59YesMatched on age and sex

Lightfoot
et al. [58]
United Kingdom2008Matched case controlHospital patients1997–2000CRCBoth468/73445.8468.3Yes48.643.77.8YesAdjusted for gender and age

Mokarram
et al. [59]
Iran2008Case controlNot reported2003–2005ColonBoth151/8149.438.312.3YesCalculated OR, no adjustments

Sharp
et al. [60]
United Kingdom
(Scotland)
2008Matched case controlHealthy persons1998–2000CRCBoth264/40843.244.911.9Yes44.939.815.2NoAdjusted for age, gender, family history of CRC, physical activity, NAAID use, total energy intake, and type of dietary supplements

Theodoratou
et al. [61]
Scotland2008Case controlHealthy persons1999–2006CRCBoth2,028/
2,722
45.345.011.5Yes45.844.110.1YesAdjusted for age, sex, deprivation score, and family history risk

Zhang
et al. [62]
China2008Matched case controlHospital patients2003–2005CRCBoth300/30030.446.523.1Yes65.329.75YesAdjusted for age, sex, education, family history, smoking, and drinking.

El Awady
et al. [63]
Egypt2009Case controlHealthy persons2004–2007CRCBoth35/6865296Yes38548YesNone reported

Gallegos-Arreola
et al. [30]
Mexico2009Case controlHealthy persons2006–2008CRCBoth369/17033.634.132.2NoCalculated OR, no adjustments

Haghighi
et al. [22]
Iran2009Case controlHospital patients2004–2007CRCBoth234/25736.631.132.3YesNone reported

Iacopetta
et al. [18]
Australia2009Matched case controlHealthy persons2005–2007Proximal distal CRCBoth850/958454510YesMatched on gender, age, socioeconomic status, country of birth, educational level, and smoking status

Chandy
et al. [14]
India2010Matched case controlHealthy persons2006–2008CRCBoth100/8676.722.11.2Yes25.658.116.3YesMatched on age and gender

Cui et al. [28]South Korea2010Case controlHospital patients2004–2008CRCBoth1,829/
1,700
31.850.717.5YesAdjusted for age and sex

Eussen et al. [64]EPIC 2010Nested case controlHealthy persons1992–1998CRCBoth1,367/
2,325
43.145.511.5Yes46.542.611.0YesCalculated OR, no adjustments

Fernández-Peralta et al. [65]Spain2010Matched case controlHealthy persons1992–1996CRCBoth143/10342.748.68.7Yes55.342.71.9NoMatched on age and sex

Karpinski
et al. [66]
Poland2010Case controlHealthy personsNot reportedCRCBoth186/140513910YesAdjusted for age and sex

Komlósi et al. [67]Hungary2010Case controlHealthy persons2001–2007Colon
rectal
Both
Both
476/461
479/478
47
47
40
41
13
12
Yes
Yes
Adjusted for sex, age, and BMI
Adjusted for sex, age, and BMI

Naghib alhossaini
et al. [68]
Iran2010Case controlNot reportedNot reportedCRCBoth151/23042.4534.6Yes42.545.711.8YesAdjusted for age, sex, and smoking status

Promthet
et al. [69]
Thailand2010Matched case controlHealthy persons2002–2006ColonBoth130/13072.323.83.9Yes41.554.63.9NoMatched on age and sex

Wettergren
et al. [70]
Sweden2010Case controlHealthy persons1994–2004CRCBoth181/30055.935.88.4YesCalculated OR, no adjustments

Abuli et al. [71]Spain 2011Matched case controlHealthy person2000-2001CRCBoth515/51538.14813.9YesMatched on age and sex

Guimarães et al. [72]Brazil2011Case controlHealthy persons1992–2003CRCBoth113/18848.942.09Yes67.626.16.4NoAdjusted for age, sex, and ethnic origin

Jokić et al. [73]Croatia2011Case controlHealthy personsNot reportedColonBoth300/30047.343.39.3Yes46.742.710.6Yes

Pardini
et al. [25]
Czech Republic2011Case controlHospital patients2004–2006CRCBoth666/
1,377
44.545.69.9Yes42.346.311.3YesAdjusted for age and gender

Kim et al. [26]South Korea2011Case controlHospital patientsNot reportedCRCBoth67/5328.339.632.1Yes67.930.21.9YesNone reported

Sameer
et al. [74]
Kashmiri
(India)
2011Matched case controlHealthy persons2008-2009CRCBoth86/16075.616.97.5NoNone reported

Prasad and Wilkhoo [75]India2011Case controlHealthy personNot reportedCRCBoth110/24194.65.00.4YesNone reported

Zhu et al. [29]China2011Case controlHealthy persons2006–2008CRCBoth86/10049.041.010YesNone reported

Kim et al. [27]South Korea2012Case controlHospital patients1998–2004CRCBoth787/65631.344.124.7NoAdjusted for age, sex, family history, multivitamin use, BMI, smoking status, and total energy

Lee et al. [76]USA2012Nested case controlHealthy personsHealth professionals follow-up studyCRCMen173/3454439.916Yes47.742.610.3YesRR’s reported, so OR’s are calculated, no adjustments

Lee et al. [76]USA2012Nested Case ControlHealthy personsPhysicians’ health studyCRCMen240/40847.737.215Yes45.842.212.1YesRR’s reported, so OR’s are calculate, no adjustments

Lee et al. [76]USA2012Nested Case ControlHealthy personsNurse Health StudyCRCWomen189/37746.739.713.6Yes5138.310.7YesRR’s reported, so OR’s are calculated no adjustments

AA: African American, BMI: body mass index, Cauc: Caucasian CRC: colorectal cancer, HWE: Hardy Weinberg equilibrium, NSAID: nonsteroidal anti-inflammatory drug, OCP: oral contraceptive pill.
(b) Summary of cohorts studies.

Incidence rate ratio (RR) of CRC (95% CI)
StudyCountryYearStudy designSource of controlRecruitment periodCancerSexCase/controlFollow-up periodCT versus CCTT versus CCAC versus AACC versus AA

De Vogel et al. [77]Netherlands2009CohortHealthy personsRecruited in 1986CRCBoth689/1,7937.3 years1.23 (1.02–1.50)0.80
(0.56–1.15)
0.89
(0.72–1.09)
1.05
(0.79–1.38)
Adjusted for age and sex

Heijmans et al. [78]Netherlands2003CohortElderly healthy menRecruited in 1985CRCBoth18/79310 years1.16 (0.41–3.30)3.65
(1.97–12.5)
Adjusted for age