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April 14, 1999

Low-Fat Dairy Foods and Colonic Epithelial Cell Proliferation

Author Affiliations
 

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(14):1274. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-14-jac90002

To the Editor: Dr Holt and colleagues1 concluded that increasing the daily intake of calcium by up to 1200 mg via low-fat dairy food in subjects at risk for colonic neoplasia reduces proliferative activity of colonic epithelial cells and restores markers of normal cell differentiation.

The epidemiologic situation among sub-Saharan Africans is the converse of that indicated by the study of Holt et al.1 First, judging by admissions of patients to hospitals, colon cancer is nearly absent in rural populations, and its incidence is low in urban dwellers. For example, in Zimbabwe, according to the Cancer Registry in Harare, the age-adjusted incidence rates for men and women are 6.6 and 3.0 per 100,000.2 In South Africa, colon cancer is uncommon and adenomatous polyps are rare. As to level of calcium intake, it is relatively low in almost all African populations, about 300 to 450 mg/d3; moreover, African women experience large losses of calcium from high parity and long lactations. Clearly, a risk factor in one context may have limited applicability in another. Even among white populations, most studies that have observed a protective effect of calcium were conducted in Nordic or Anglo-Saxon communities, but no study has demonstrated a protective effect of calcium or dairy products in Hispanic communities.4

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