Association Between Vitamin B12 Intake and Mortality in Patients with Colorectal Cancer: The US National Health and Nutrition Examination Survey, 1999-2018

Abstract

Vitamin B12 plays a role in DNA methylation, influencing the 1-carbon cycle; However, its effect on colorectal cancer (CRC) mortality remains uncertain. This study assessed the relationship between vitamin B12 intake and all-cause and cancer-specific mortality among CRC patients. We analyzed data from the NHANES from 1999 to 2018, using multivariable Cox regression, competing risk model, Kaplan-Meier survival curves, and stratified analysis with interaction effects. The studied involved 4,554 cancer patients (mean age 65.8 years, 47.6% males). Results from multivariate Cox regression indicated that each additional 1 mcg/day of dietary vitamin B12 independently increased the risk of all-cause (HR, 1.07; 95% CI: 1.04–1.09, p < 0.001) and cancer-specific mortality (HR, 1.04; 95% CI, 1.02-1.06; p < 0.001). Kaplan-Meier curves indicated a higher risk of all-cause mortality with increased vitamin B12 intake (Log rank p = 0.01). Subgroup analysis suggested that higher vitamin B12 intake correlated with increased all-cause mortality risk, especially in individuals with higher protein (HR, 1.04; 95% CI, 1.02-1.06; p = 0.019) or carbohydrate intake (HR, 1.03; 95% CI, 1.01-1.05; p = 0.04). Thus, higher vitamin B12 intake correlates with increased all-cause and cancer-specific mortality in CRC patients, particularly those with higher protein or carbohydrate intake.

Acknowledgments

We thank all staff for helping with the instruction of data analysis and writing. We thank Jie Liu, PhD (Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital) for his helpful comments regarding the manuscript.

Disclosure Statement

The authors declare that they have no conflicts of interest.

Author Contributions

Yuanchen Zhou: Conceptualization, Data curation, Investigation, methodology, Software, Formal Analysis, Writing - original draft. Qianqian Wang, Tengfei Yin, Dongyan Zhao, Geyujia Zhou, Xizhen Sun and Chang Tan: Methodology, Writing - review & editing. Lei Zhou: Supervision, Writing - review & editing. Shukun Yao: Conceptualization, Methodology, Supervision, Funding acquisition, Writing - review & editing.

Availability of Data and Materials

The datasets analyzed during the current study are available on the website of the National Health and Nutrition Examination Survey of the United States, [https://www.cdc.gov/nchs/nhanes/index.htm].

Additional information

Funding

This work was supported by National Key Development Plan for Precision Medicine Research (Grant No.2017YFC0910002).