Abstract
PurposeThis meta-analysis aimed to extensively investigate the association between various measures of vitamin D status and non-Hodgkin lymphoma (NHL) and its subtypes.MethodsWe searched MEDLINE (PubMed), Embase, and the Cochrane Library in February 2018. Two authors independently reviewed and selected articles based on predetermined criteria.ResultsA total of 30 studies with 56,458 NHL cases were finally selected, with 24, 9, and 3 studies on sunlight/ultraviolet radiation (UVR) exposure, dietary intake, and serum/plasma 25-hydroxyvitamin D levels, respectively. Significant protective effects of overall sunlight/UVR exposure on NHL and subtypes were observed, with summary relative risks (RRs) ranging from 0.67–0.80 (RR for NHL = 0.80; 95% confidence interval [CI]: 0.71–0.90) among subjects with high exposure compared to those with low exposure. The results were consistent with various classifications of sunlight/UVR exposure. In contrast, when exposure measures of dietary vitamin D intake (RR for NHL = 1.03; 95% CI: 0.90–1.19) and serum/plasma 25-hydroxyvitamin D levels (RR for NHL = 0.97; 95% CI: 0.82–1.15) were used, risk estimates were inconsistent or non-significant for NHL and the subtypes.ConclusionWhile risk estimates varied by different measures of vitamin D status, a protective effect of sunlight/UVR exposure on NHL incidence was verified, across most of the tested subtypes as well as exposure categories.
Highlights
Non-Hodgkin lymphoma (NHL) is one of the most common hematologic malignancies, accounting for 3% of all incident cancer cases according to GLOBOCAN reports [1]
While risk estimates varied by different measures of vitamin D status, a protective effect of sunlight/ultraviolet radiation (UVR) exposure on NHL incidence was verified, across most of the tested subtypes as well as exposure categories
Using PubMed, Embase, and the Cochrane Library, literature published until February 2018 were searched using the following terms: “vitamin D”, “25-hydroxyvitamin D”, “sun exposure”, “ultraviolet radiation”, “UV-B radiation”, “solar radiation”, and “non-Hodgkin lymphoma”, “diffuse large B-cell lymphoma”, “follicular lymphoma”, “chronic lymphocytic leukemia”, “small lymphocytic lymphoma”, “mantle cell lymphoma”, “marginal zone lymphoma”, “T-cell lymphoma”, and “peripheral T-cell lymphoma”
Summary
Non-Hodgkin lymphoma (NHL) is one of the most common hematologic malignancies, accounting for 3% of all incident cancer cases according to GLOBOCAN reports [1]. Previous studies have investigated the influence of vitamin D status on NHL with exposure measures using sunlight or ambient ultraviolet radiation (UVR) exposure, dietary vitamin D intake, and 25-hydroxyvitamin D (25(OH)D) levels. Pooled analysis results from the International Lymphoma Epidemiology Consortium (InterLymph; https://epi.grants.cancer.gov/InterLymph/) have shown the protective effect of recreational/total sunlight exposure, or in composite measures, on the incidence of NHL [6] and its B- or T-cell subtypes, including diffuse large B-cell lymphoma (DLBL) [7], follicular lymphoma (FL) [8], chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) [9], marginal zone lymphoma (MZL) [10], mantle cell lymphoma [11], and peripheral T-cell lymphomas (PTCL) [12]. A separate meta-analysis found an insignificant association of NHL incidence with dietary vitamin D and 25(OH)D levels [13]
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