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Z Gastroenterol 2003; 41(3): 263-270
DOI: 10.1055/s-2003-37904
Übersicht
© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Kolorektales Karzinom und Folsäure

Colorectal Cancer and FolateC. Bott1 , B. Lembcke1 , J. Stein1
  • 1Medizinische Klinik II, Universitätsklinikum Frankfurt am Main
This work is dedicated to Prof. Dr. med. W. F. Caspary, who was Executive Editor of the Zeitschrift für Gastroenterologie from 1991 to 2003.
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Publication History

Manuscript received: 31. January 2003

Accepted after revision: 11. February 2003

Publication Date:
28 March 2003 (online)

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Zusammenfassung

Ernährungsfaktoren spielen eine Rolle für die Prävention kolorektaler Karzinome. Es finden sich zunehmend Hinweise, dass eine hohe Zufuhr an Folsäure, für die grüne Blattgemüse eine gute Quelle sind, das Risiko für kolorektale Karzinome mindert. Folsäure ist als Überträger von 1-Kohlenstoffresten an der Purin- und Thymidilatsynthese sowie der DNA-Methylierung beteiligt. Veränderungen der Genexpression und DNA-Schäden werden demnach als mögliche Ursachen für das erhöhte Risiko, bei einem niedrigen Folatstatus an einem kolorektalen Karzinom zu erkranken, diskutiert. Diese Hypothese wird durch die Beobachtung unterstützt, dass der weit verbreitete C677T-Polymorphismus des Gens, das für das Enzym Methylentetrahydrofolatreduktase kodiert, das relative Risiko für kolorektale Karzinome bei einem niedrigen Folatstatus erhöht.

Sowohl retrospektiv als auch prospektiv angelegte epidemiologische Studien bestätigen die Vermutung, dass eine hohe Folsäurezufuhr mit einem niedrigeren Risiko für kolorektale Karzinome einhergeht. Es gibt ebenfalls Hinweise aus epidemiologischen Studien, dass eine sog. methylarme Kost, d. h. die Kombination aus einer relativ hohen Alkoholaufnahme und einer geringen Folsäure- und/oder Methioninzufuhr das Risiko für die Entstehung kolorektaler Karzinome noch verstärkt. Einige wenige Studien zur Intervention mit Folsäure geben erste Hinweise darauf, dass eine Supplementierung, die die allgemeinen Zufuhrempfehlungen weit übersteigt, mögliche Biomarker für kolorektale Neoplasien beeinflusst.

Abstract

Nutritional factors are important contributors to colorectal cancer prevention. There is some evidence to suggest that a high dietary folate intake is associated with a reduced risk of colorectal cancer. Folate, which is found in green leafy vegetables, is involved in C1 group transfer and contributes to purin and thymidilate synthesis as well as to DNA methylation. Alterations in gene expression and DNA damage are discussed to result from low folate levels and might be associated with an elevated risk of colorectal malignancies. This hypothesis can be supported by the finding that a common polymorphism in the methylentetrahydrofolate reductase gene enhances the risk of colorectal cancer when folate status is low.

Both retrospective and prospective epidemiologic studies confirm the observation that a high intake of folate correlates with a lower risk of colorectal cancer. There is also evidence from epidemiological studies that diets which are low in methyl donors, such as low contents of folate and/or methionine combined with relatively high alcohol consumption, even enhance the risk of colorectal cancer. A small number of intervention trials provide first evidence that folate intakes far above recommended dietary allowances might influence possible biomarkers of colorectal tumours.

Schlüsselwörter

Folsäure - kolorektales Karzinom - DNA-Synthese - DNA-Methylierung - epidemiologische Studien

Key words

Folate - colorectal cancer - DNA synthesis - DNA methylation epidemiologic studies

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Prof. Dr. Dr. Jürgen Stein

Medizinische Klinik II, Universitätsklinikum Frankfurt am Main

Theodor-Stern-Kai 7

60590 Frankfurt

Email: Stein@em.uni-frankfurt.de

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