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Can Moderate Doses of Vitamin E Protect against Lung Cancer?

We appreciate Dr. Dembe's comments on our article regarding a possible U-shaped association between 10-year use of supplemental vitamin E and lung cancer when this relationship was examined categorically according to low, medium, and high doses (1). As there was little information about a dose–response relationship between supplemental vitamin E and lung cancer risk, we a priori elected to divide dose levels according to the distribution of use in the cohort. Post hoc analyses performed to enhance any association would have been inappropriate. In addition, the most commonly sold dose of vitamin E is 400 mg (dl -tocopheryl acetate). Therefore, study participants in the medium category may have been more likely to have consumed vitamin E supplements for shorter durations (e.g., 400 mg/d for 5 yr) than to have taken lower dose pills (e.g., 200 mg/d for 10 yr).

We agree with Dr. Dembe that our findings suggest a possible U-shaped association between long-term supplemental vitamin E and lung cancer risk and that additional research needs to be done to confirm this association. We hope that our work, along with that of Miller and colleagues (2), may prove useful to future researchers in exploring the dose- and duration-specific association between supplemental vitamin E and lung cancer risk and mortality.

Christopher G. Slatore

University of Washington
Seattle, Washington

David H. Au

VA Puget Sound Health Care System
and
University of Washington
Seattle, Washington

Emily White

University of Washington
and
Fred Hutchinson Cancer Research Center
Seattle, Washington

FOOTNOTES

Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Slatore CG, Littman AJ, Au DH, Satia JA, White E. Long-term use of supplemental multivitamins, vitamin C, vitamin E, and folate does not reduce the risk of lung cancer. Am J Respir Crit Care Med 2008;177:524–530.[Abstract/Free Full Text]
2. Miller ER III, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 2005;142:37–46.[Abstract/Free Full Text]

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