Association of Vitamin A Intake With Cutaneous Squamous Cell Carcinoma Risk in the United States

Jongwoo Kim, MD, MSc^1,2; Min Kyung Park, PhD¹; Wen-Qing Li, PhD^1,3; Abrar A. Qureshi, MD, PhD^1,3,4; Eunyoung Cho, ScD^1,3,4

Author Affiliations

JAMA Dermatol. Published online July 31, 2019. doi:10.1001/jamadermatol.2019.1937

Key Points

Question Is vitamin A intake associated with reduced cutaneous squamous cell carcinoma risk?

Findings In this cohort study of 48 400 US men and 75 170 US women, during a follow-up period of more than 26 years, higher total vitamin A intake was associated with a reduction in cutaneous squamous cell carcinoma risk.

Meaning This study found an inverse association between intake of vitamin A and carotenoids and risk of cutaneous squamous cell carcinoma, supporting the protective role of vitamin A against squamous cell carcinoma development.

Abstract

Importance Retinoids are bioactive forms of vitamin A that are essential in the maintenance of epithelial maturation and differentiation. Synthetic retinoids are used in chemoprevention of skin cancer among high-risk populations with potential adverse effects. Epidemiologic data on vitamin A intake and risk of cutaneous squamous cell carcinoma (SCC) are limited.

Objective To examine whether vitamin A intake is associated with a reduction in SCC risk.

Design, Settings, and Participants This cohort study prospectively examined intake of vitamin A and carotenoids and SCC risk in the Nurses' Health Study (1984-2012) and the Health Professionals Follow-up Study (1986-2012). Diet was assessed repeatedly. Incident SCC was confirmed by pathologic reports. Data analysis was performed from June 21, 2017, to December 4, 2018.

Exposures Intakes of vitamin A, retinol, and carotenoids.

Main Outcomes and Measures Incident SCC. Cox proportional hazards regression models were used to compute cohort-specific hazard ratios (HRs) and 95% CIs. Pooled HRs of the cohort-specific results were calculated.

Results A total of 3978 SCC cases in 75 170 women in the Nurses' Health Study (mean [SD] age, 50.4 [7.2] years) and 48 400 men in the Health Professionals Follow-up Study (mean [SD] age, 54.3 [9.9] years) were documented. Higher total vitamin A was associated with a reduction in SCC risk; with quintile 1 as the reference, the pooled multivariate HRs for the increasing quintiles of vitamin A intake were 0.97 (95% CI, 0.87-1.07) for quintile 2, 0.97 (95% CI, 0.80-1.17) for quintile 3, 0.93 (95% CI, 0.84-1.03) for quintile 4, and 0.83 (95% CI, 0.75-0.93) for quintile 5 (P < .001 for trend). Higher intakes of retinol and some carotenoids were also associated with a reduction in SCC risk; the pooled HRs for the highest quintiles of intake compared with the lowest quintiles were 0.88 (95% CI, 0.79-0.97; P = .001 for trend) for total retinol, 0.86 (95% CI, 0.76-0.96; P = .001 for trend) for beta cryptoxanthin, 0.87 (95% CI, 0.78-0.96; P < .001 for trend) for lycopene, and 0.89 (95% CI, 0.81-0.99; P = .02 for trend) for lutein and zeaxanthin. The results were generally consistent by sex and other SCC risk factors.

Conclusions and Relevance This study suggests that increased intake of dietary vitamin A is associated with decreased risk of incident SCC. Future studies are needed to determine whether vitamin A supplementation has a role in chemoprevention of SCC.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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