Vitamin D, magnesium, calcium, and their interaction in relation to colorectal cancer recurrence and all-cause mortality

Evertine Wesselink*, Dieuwertje E. Kok, Martijn J. L. Bours, Johannes H. W. de Wilt, Harm van Baar, Moniek van Zutphen, Anne M. J. R. Geijsen, Eric T. P. Keulen, Bibi M. E. Hansson, Jody van den Ouweland, Renger F. Witkamp, Matty P. Weijenberg, Ellen Kampman, Franzel J. B. van Duijnhoven*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Higher concentrations of 25-hydroxyvitamin D-3[25(OH)D-3] at diagnosis are associated with a lower mortality risk in colorectal cancer (CRC) patients. However, magnesium and calcium are important in vitamin D metabolism.

Objectives: We aimed to investigate 25(OH)D-3, magnesium, or calcium and their interaction among patients with CRC in relation to recurrence and all-cause mortality.

Methods: The study population included 1169 newly diagnosed stage I-III CRC patients from 2 prospective cohorts. Associations between 25(OH)D-3 concentrations, magnesium or calcium intake through diet and/or supplements at diagnosis, and recurrence and all-cause mortality were evaluated using multivariable Cox proportional hazard models. The interaction between 25(OH)D-3 and magnesium or calcium was assessed by investigating 1) joint compared with separate effects, using a single reference category; and 2) the effect estimates of 1 factor across strata of another.

Results: Serum 25(OH)D-3, calcium, and magnesium, alone and their interactions, were not associated with recurrence. Serum 25(OH)D-3 concentrations seemed to be associated with all-cause mortality. An inverse association between magnesium intake (HRQ3 (vs.) (Q1): 0.55; 95% CI: 0.32, 0.95 and HRQ4 vs. (Q1): 0.65; 95% CI: 0.35, 1.21), but not calcium intake, and all-cause mortality was observed. When investigating the interaction between 25(OH)D-3 and magnesium, we observed the lowest risk of all-cause mortality in patients with sufficient vitamin D concentrations (>= 50 nmol/L) and a high magnesium intake (median split) (HR: 0.53; 95% CI: 0.31, 0.89) compared with patients who were vitamin D deficient (

Conclusions: Our findings suggest that the presence of an adequate status of 25(OH)D-3 in combination with an adequate magnesium intake is essential in lowering the risk of mortality in CRC patients, yet the underlying mechanism should be studied. In addition, diet and lifestyle intervention studies are needed to confirm our findings.

Original languageEnglish
Pages (from-to)1007-1017
Number of pages11
JournalAmerican Journal of Clinical Nutrition
Issue number5
Publication statusPublished - May 2020


  • colorectal cancer patients
  • 25(OH)D-3
  • interactions
  • magnesium
  • calcium
  • recurrence
  • all-cause mortality

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