~ 013009 Higher Vitamin E Levels in Smokers Linked with Reduced Pancreatic Cancer Risk

The February, 2009 issue of the American Journal of Clinical Nutrition reported the finding of researchers at the National Cancer Institute, the University of Michigan, and the National Public Health Institute in Helsinki, Finland, of an association between higher concentrations of alpha-tocopherol (the most biologically active and plentiful form of vitamin E in most human tissues) and a lower risk of pancreatic cancer in smokers. Smoking, diabetes and obesity are among the known risk factors for this deadly form of cancer.

Rachel Z. Stolzenberg-Solomon and colleagues evaluated data from 29,092 men who participated in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a double-blind placebo-controlled trial which sought to determine the effect of alpha-tocopherol and beta-carotene supplementation on the prevention of cancers in smokers between 1985 and 1988. Over up to 19.4 years of follow-up, 318 cases of pancreatic cancer were diagnosed.

For participants whose serum alpha-tocopherol levels at the beginning of the study were among the top 20 percent of participants, the risk of developing pancreatic cancer was 48 percent lower than those whose levels were in the lowest fifth. Among the 27,111 subjects for whom dietary questionnaire responses were available, for those who had the highest polyunsaturated fat intake at over 9.9 grams per day there was an even greater reduction in pancreatic cancer risk observed in participants with the highest vitamin E levels, a finding that could be explained by vitamin E's ability to counteract polyunsaturated fats' pro-oxidant effect.

While no protective association was observed between dietary intake of vitamin E and pancreatic cancer risk in this study, the authors note that dietary intake as estimated by questionnaire responses is not precise, and that serum vitamin concentrates may be more biologically meaningful due to their reflection of the combined effects of intake, absorption and utilization as well as depletion caused by oxidative stress. "Our results support the hypothesis that higher concentrations of serum alpha-tocopherol may protect against pancreatic carcinogenesis in smokers," they conclude. "Further research is needed to evaluate our findings in other populations, particularly relative to exposure factors that influence endogenous oxidative stress."

Related Health Concern: Pancreatic cancer

While the exact cause of pancreatic cancer is not known with certainty, several factors—including smoking, nutrition, glucose levels, hormones, and genetics—are thought to be involved in its initiation and development.

Smoking. Smoking is a major risk factor, accounting for 25-30 percent of all cases. Heavy smokers are two to three times more at risk for cancer than are nonsmokers (Lowenfels AB et al 2002). Several studies have observed a reduction in pancreatic cancer risk within a decade after smoking cessation (Michaud DS 2004).

Nutritional influences on pancreatic cancer. DNA damage caused by exposure to free radicals has been found in human pancreatic tissues (Uden S et al 1992). In pancreatic cancer cells, antioxidant levels are much lower compared to those in non-cancerous pancreatic cells. Nutritional supplements such as alpha-tocopherol (Ferreira PR et al 2004; Hernaandez J et al 2005; Rautalahti MT et al 1999), ascorbic acid (Zullo A et al 2000), zinc (Ertekin MV et al 2004; Prasad AS et al 2004; Uden S et al 1992), and selenium may be beneficial in elevating antioxidant levels (Zhan CD et al 2004).

Glucose levels and pancreatic cancer. Abnormal sugar metabolism, diabetes (DeMeo MT 2001 Gapstur SM et al 2000), and foods that elevate after-meal blood sugar levels are associated with increased pancreatic cancer risk in individuals with insulin resistance (Michaud DS et al 2002). Increasing soluble fiber intake has been shown to improve after-meal glucose levels and insulin response in healthy subjects (Aller R et al 2004; Lu ZX et al 2000). Thus, supplemental fiber may help to stabilize glucose levels (Rayes N et al 2002; Tsai AC et al 1987).

Folate. Maintaining adequate blood folate levels or increasing folate intake from dietary or vitamin sources may reduce pancreatic cancer risk significantly (Kim YI 1999). In a study of 27,101 healthy male smokers, 157 developed pancreatic cancer during 13 years of follow-up. Those with the lowest folate intake showed a 48 percent increased risk of pancreatic cancer (Stolzenberg-Solomon RZ et al 2001).

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