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Systemic folate status, rectal mucosal folate concentration and dietary intake in patients at differential risk of bowel cancer (The FAB2 Study)

Lookup NU author(s): Dr Liz Williams, Dr Mark Welfare, Dr Alison Spiers, Wendy Bal, Eileen Gibney, Yvonne Duckworth, Professor John Mathers


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Folate has been strongly implicated in the aetiology of colorectal cancer. However, the relationship between dietary folate intake, rectal mucosal folate status and colorectal cancer risk is uncertain. The study aimed to estimate nutrient intakes and measure systemic folate status and rectal mucosal folate concentration in people at differential risk of developing colorectal cancer.Two hundred and twenty-eight individuals were recruited from gastroenterology clinics and subdivided into three patient groups: untreated colorectal cancer (n = 43), adenomatous polyps (n = 90) or normal bowel (n = 95). Biopsies from macroscopically normal rectal mucosa and blood were collected and used for the measurement of rectal mucosal 5-methyltetrahydrofolate (5-MeTHF) and systemic markers of folate status, respectively. Nutrient intake was estimated using a validated food frequency questionnaire.Dietary intake variables, plasma 5-MeTHF and red cell folate and plasma homocysteine concentrations were similar in all three subject groups and 95 % CI fell within normal range for each variable. Rectal mucosal 5-MeTHF concentration was higher in the normal mucosa of adenomatous polyp patients than in normal subjects (P = 0.055). Rectal mucosal 5-MeTHF was associated significantly with plasma folate (P < 0.001, r = 0.294), red cell folate (P = 0.014, r = 0.305), plasma homocysteine (P = 0.017, r = -0.163) and dietary folate intake (P = 0.036, r = 0.152).This study demonstrates adequate folate status of patients attending gastroenterology clinics for the investigation of bowel symptoms, with no significant difference in dietary intakes or systemic folate status indices according to diagnosis. Rectal mucosal 5-MeTHF concentrations were elevated in adenomatous polyp patients, but failed to reach significance. Further studies are required to determine the biological significance of this observation.

Publication metadata

Author(s): Williams EA, Welfare M, Spiers A, Hill MH, Bal W, Gibney ER, Duckworth Y, Powers HJ, Mathers JC

Publication type: Article

Publication status: Published

Journal: European Journal of Nutrition

Year: 2013

Volume: 52

Issue: 7

Pages: 1801-1810

Print publication date: 01/10/2013

Online publication date: 28/12/2012

Acceptance date: 09/12/2012

ISSN (print): 1436-6207

ISSN (electronic): 1436-6215

Publisher: Springer Berlin Heidelberg


DOI: 10.1007/s00394-012-0483-5


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Funder referenceFunder name
Biotechnology and Biological Sciences Research Council
N12002/7Food Standards Agency, UK