Associations between calcium and magnesium intake and the risk of incident oesophageal cancer: an analysis of the NIH-AARP Diet and Health Study prospective cohort



Risk reduction through dietary modifications is an adjunct strategy for prevention of oesophageal cancer, a leading cause of cancer-related mortality and morbidity worldwide. We aimed to estimate the association between calcium and magnesium intakes and incident oesophageal cancer (OC).


We conducted a retrospective analysis of the NIH-AARP Diet and Health Study prospective cohort. We used multivariable Cox proportional hazard modeling to estimate the association between total intakes and incident OC overall and by histology (oesophageal squamous cell carcinoma (OSCC) and adenocarcinoma (OAC)). Sensitivity and stratified analyses were performed.


Among 536,359 included respondents, 1414 incident OCs occurred over 6.5 million person-years follow-up time. Increasing dietary calcium intake was associated with an adjusted 32–41% lower risk of OSCC compared to the lowest quartile (p-trend 0.01). There was a positive association between increasing magnesium intake and OAC risk, but only among participants with low calcium:magnesium intake ratios (p-trend 0.04). There was a significant interaction with smoking status.


Based on a retrospective analysis of the NIH-AARP Diet and Health Study prospective cohort, dietary intakes of calcium and magnesium were significantly associated with risk of OSCC and, among certain participants, OAC, respectively. If validated, these findings could inform dietary modifications among at-risk individuals. Mechanistic investigations would provide additional insight.

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Fig. 1: Analytic Cohort Construction.


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Author information




S.C.S.: study concept, study design, statistical analysis, data interpretation, drafting of paper; Q.D.: data interpretation, critical review of the paper for important intellectual content; R.P., C.R.: critical review of the paper for important intellectual content; M.J.S.: study design, data interpretation, critical review of the paper for important intellectual content.

Corresponding author

Correspondence to Shailja C. Shah.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Special Studies Institutional Review Board of the US National Cancer Institute (NCI). Original consent from participants was obtained from investigators for the NIH-AARP Diet and Health Study at enrolment. No new data collection or participant contact occurred for the purposes of this study.

Consent for publication

Not applicable. No individual-level data are included in this paper.

Data availability

The data that support the findings of this study are available from the NIH-AARP Diet and Health Study. Restrictions apply to the availability of these data, which were used under license for this study. Data are available with the permission of the NIH AARP.

Competing interests

The authors declare no competing interests.

Funding information

Research reported in this publication was supported by the Agency for Healthcare Research (AHRQ) and Quality and Patient-Centered Outcomes Research Institute (PCORI) under Award Number K12 HS026395, awarded to SCS. The content is solely the responsibility of the listed authors and does not necessarily represent the official views of AHRQ or PCORI.

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Shah, S.C., Dai, Q., Zhu, X. et al. Associations between calcium and magnesium intake and the risk of incident oesophageal cancer: an analysis of the NIH-AARP Diet and Health Study prospective cohort. Br J Cancer 122, 1857–1864 (2020). https://doi.org/10.1038/s41416-020-0818-6

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