J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 16, Number 10, October 2024, pages 483-490

Assessing the Impact of Serum Calcium, 25-Hydroxy Vitamin D, Ferritin, and Uric Acid Levels on Colorectal Cancer Risk

**Table 1.** Sociodemographic and Lifestyle Habits by CRC and Control (N = 1,300)
Variables	CRC (n = 650), n (%)	Control (n = 650), n (%)	OR (95% CI)	P value
CRC: colorectal cancer; BMI: body mass index; PET/CT: positron emission tomography/computed tomography; OR: odds ratio; CI: confidence interval.
Age groups (in years)
< 55	258 (39.7)	105 (16.2)	1.41 (2.63 - 4.43)	0.001
> 55	392 (62.3)	545 (63.8)	1.0
Gender
Male	341 (52.5)	340 (52.3)	1.06 (0.81 - 1.23)	0.956
Female	309 (47.5)	310 (47.7)	1
BMI (kg/m²)
Normal (< 25 kg/m²)	158 (25.8)	192 (29.5)	1
Overweight (29 - 30 kg/m²)	266 (40.9)	288 (44.3)	1.06 (0.81 - 1.38)	0.690
Obese (> 30 kg/m²)	216 (33.2)	170 (26.2)	1.45 (1.09 - 1.94)	0.011
Tomography (last 6 months)
Yes	524 (89.6)	168 (26)	5.13 (4.36 - 6.02)	0.001
No	126 (9.4)	472 (74)	1.0
PET/CT (last 6 months)
Yes	190 (29.2)	50 (7.7)	1.82 (1.66 - 2.00)	0.001
No	460 (70.8)	600 (92.3)	1.0
Colonoscopy (last 6 months)
Yes	623 (95.8)	113 (17.4)	17.68 (12.22 - 25.58)	0.001
No	27 (4.2)	537 (82.6)	1.0
CRC awareness
Yes	537 (82.6)	163 (25.1)	4.07 (3.43 - 4.83)	0.001
No	113 (17.4)	487 (74.9)	1.0
Risk factor of colon cancer
Genetic factors
Yes	137 (21.1)	54 (8.3)	1.55 (1.39 - 1.73)	0.001
No	513 (78.9)	590 (91.7)	1.0
Exposure to chemicals
Yes	62 (9.5)	27 (4.2)	1.43 (1.23 - 1.66)	0.001
No	588 (90.5)	623 (95.8)	1.0
Malnutrition
Yes	125 (19.2)	78 (12.0)	1.74 (1.28 - 2.37)	0.001
No	525 (80.8)	572 (88.0)	1.0
Smoking
Yes	120 (18.5)	60 (9.2)	2.22 (1.59 - 3.10)	0.001
No	530 (81.5)	590 (90.8)	1.0
Hookah/nargileh use
Yes	75 (11.5)	40 (6.2)	1.98 (1.35 - 2.96)	0.001
No	575 (88.5)	610 (93.8)	1.0
Alcohol use
Yes	85 (13.1)	60 (9.2)	1.42 (1.10 - 2.01)	0.001
No	565 (86.9)	590 (90.8)	1.0
Intestinal inflammations
Yes	207 (31.8)	82 (12.6)	3.23 (2.43 - 4.30)	0.001
No	443 (68.2)	568 (87.4)	1.0
Obesity
Yes	109 (16.8)	64 (9.8)	1.84 (1.32 - 2.56)	0.001
No	541 (83.2)	586 (90.2)	1.0
Processed foods
Yes	145 (22.3)	84 (12.9)	1.93 (1.44 - 2.59)	0.001
No	505 (77.7)	566 (887.1)	1.0

Table 1. Sociodemographic and Lifestyle Habits by CRC and Control (N = 1,300)

Variables

CRC (n = 650), n (%)

Control (n = 650), n (%)

OR (95% CI)

P value

CRC: colorectal cancer; BMI: body mass index; PET/CT: positron emission tomography/computed tomography; OR: odds ratio; CI: confidence interval.

Age groups (in years)

< 55

258 (39.7)

105 (16.2)

1.41 (2.63 - 4.43)

0.001

> 55

392 (62.3)

545 (63.8)

1.0

Gender

Male

341 (52.5)

340 (52.3)

1.06 (0.81 - 1.23)

0.956

Female

309 (47.5)

310 (47.7)

BMI (kg/m²)

Normal (< 25 kg/m²)

158 (25.8)

192 (29.5)

Overweight (29 - 30 kg/m²)

266 (40.9)

288 (44.3)

1.06 (0.81 - 1.38)

0.690

Obese (> 30 kg/m²)

216 (33.2)

170 (26.2)

1.45 (1.09 - 1.94)

0.011

Tomography (last 6 months)

Yes

524 (89.6)

168 (26)

5.13 (4.36 - 6.02)

0.001

126 (9.4)

472 (74)

1.0

PET/CT (last 6 months)

Yes

190 (29.2)

50 (7.7)

1.82 (1.66 - 2.00)

0.001

460 (70.8)

600 (92.3)

1.0

Colonoscopy (last 6 months)

Yes

623 (95.8)

113 (17.4)

17.68 (12.22 - 25.58)

0.001

27 (4.2)

537 (82.6)

1.0

CRC awareness

Yes

537 (82.6)

163 (25.1)

4.07 (3.43 - 4.83)

0.001

113 (17.4)

487 (74.9)

1.0

Risk factor of colon cancer

Genetic factors

Yes

137 (21.1)

54 (8.3)

1.55 (1.39 - 1.73)

0.001

513 (78.9)

590 (91.7)

1.0

Exposure to chemicals

Yes

62 (9.5)

27 (4.2)

1.43 (1.23 - 1.66)

0.001

588 (90.5)

623 (95.8)

1.0

Malnutrition

Yes

125 (19.2)

78 (12.0)

1.74 (1.28 - 2.37)

0.001

525 (80.8)

572 (88.0)

1.0

Smoking

Yes

120 (18.5)

60 (9.2)

2.22 (1.59 - 3.10)

0.001

530 (81.5)

590 (90.8)

1.0

Hookah/nargileh use

Yes

75 (11.5)

40 (6.2)

1.98 (1.35 - 2.96)

0.001

575 (88.5)

610 (93.8)

1.0

Alcohol use

Yes

85 (13.1)

60 (9.2)

1.42 (1.10 - 2.01)

0.001

565 (86.9)

590 (90.8)

1.0

Intestinal inflammations

Yes

207 (31.8)

82 (12.6)

3.23 (2.43 - 4.30)

0.001

443 (68.2)

568 (87.4)

1.0

Obesity

Yes

109 (16.8)

64 (9.8)

1.84 (1.32 - 2.56)

0.001

541 (83.2)

586 (90.2)

1.0

Processed foods

Yes

145 (22.3)

84 (12.9)

1.93 (1.44 - 2.59)

0.001

505 (77.7)

566 (887.1)

1.0

**Table 2.** Comparison of CRC Developing Functional Gastrointestinal Symptoms With Controls (N = 1,300)
Variables	CRC (n = 650), n (%)	Control (n = 650), n (%)	OR (95% CI)	P value
CRC: colorectal cancer; OR: odds ratio; CI: confidence interval.
Pain in abdomen
Yes	162 (24.9)	79 (10.3)	2.39 (1.78 - 3.22)	0.001
No	488 (75.1)	571 (87.7)	1.0
Cramp in abdomen
Yes	151 (23.2)	94 (14.5)	1.79 (1.34 - 2.37)	0.001
No	499 (76.8)	556 (84.5)	1.0
Diarrhea
Yes	160 (24.6)	114 (17.5	1.53 (1.17 - 2.10)	0.001
No	490 (75.4)	536 (82.5)	1.0
Constipation
Yes	184 (28.3)	67 (10.3)	3.43 (2.53 - 4.66)	0.001
No	466 (71.7)	583 (89.7)	1.0
Blood in the stool
Yes	128 (19.7)	75 (11.5)	1.88 (1.38 - 2.58)	0.0011
No	522 (80.3)	575 (88.5)	1.0
Bloating (flatulence)
Yes	172 (26.5)	112 (17.2)	1.72 (1.32 - 2.26)	0.001
No	478 77.5)	538 (88.8)	1.0
Irritable bowel
Yes	122 (18.8)	62 (9.5)	2.19 (1.57 - 3.04)	0.001
No	578 (81.2)	587 (90.5)	1.0
Nausea/vomiting
Yes	154 (23.7)	81 (12.5)	12.18 (1.62 - 2.92)	0.001
No	496 (76.3)	569 (87.5)	1.0
Anemia
Yes	146 (22.5)	99 (15.2)	1.61(1.21 - 2.13)	0.001
No	504 (77.5)	5517 (84.8)	1.0
Stress
Yes	148 (22.8)	61 (9.4)	2.84(2.06 - 3.92)	0.001
No	502 (77.2)	589 (90.6)	1.0
Feeling fatigue weakness
Yes	170 (26.2)	110 (16.9)	1.73 (1.32 - 2.27)	0.001
No	488 (73.8)	540 (83.1)	1.0
Weight loss
Yes	125 (19.2)	61 (9.4)	2.29 (1.65 - 3.9)	0.002
No	525 (80.8)	589 (90.6)	1.0
Physical exercise
Yes	143 (22.0)	189 (29.1)	1.20 (1.07 - 1.34)	0.003
No	507 (78.0)	461 (70.9)	1.0

Table 2. Comparison of CRC Developing Functional Gastrointestinal Symptoms With Controls (N = 1,300)

Variables

CRC (n = 650), n (%)

Control (n = 650), n (%)

OR (95% CI)

P value

CRC: colorectal cancer; OR: odds ratio; CI: confidence interval.

Pain in abdomen

Yes

162 (24.9)

79 (10.3)

2.39 (1.78 - 3.22)

0.001

488 (75.1)

571 (87.7)

1.0

Cramp in abdomen

Yes

151 (23.2)

94 (14.5)

1.79 (1.34 - 2.37)

0.001

499 (76.8)

556 (84.5)

1.0

Diarrhea

Yes

160 (24.6)

114 (17.5

1.53 (1.17 - 2.10)

0.001

490 (75.4)

536 (82.5)

1.0

Constipation

Yes

184 (28.3)

67 (10.3)

3.43 (2.53 - 4.66)

0.001

466 (71.7)

583 (89.7)

1.0

Blood in the stool

Yes

128 (19.7)

75 (11.5)

1.88 (1.38 - 2.58)

0.0011

522 (80.3)

575 (88.5)

1.0

Bloating (flatulence)

Yes

172 (26.5)

112 (17.2)

1.72 (1.32 - 2.26)

0.001

478 77.5)

538 (88.8)

1.0

Irritable bowel

Yes

122 (18.8)

62 (9.5)

2.19 (1.57 - 3.04)

0.001

578 (81.2)

587 (90.5)

1.0

Nausea/vomiting

Yes

154 (23.7)

81 (12.5)

12.18 (1.62 - 2.92)

0.001

496 (76.3)

569 (87.5)

1.0

Anemia

Yes

146 (22.5)

99 (15.2)

1.61(1.21 - 2.13)

0.001

504 (77.5)

5517 (84.8)

1.0

Stress

Yes

148 (22.8)

61 (9.4)

2.84(2.06 - 3.92)

0.001

502 (77.2)

589 (90.6)

1.0

Feeling fatigue weakness

Yes

170 (26.2)

110 (16.9)

1.73 (1.32 - 2.27)

0.001

488 (73.8)

540 (83.1)

1.0

Weight loss

Yes

125 (19.2)

61 (9.4)

2.29 (1.65 - 3.9)

0.002

525 (80.8)

589 (90.6)

1.0

Physical exercise

Yes

143 (22.0)

189 (29.1)

1.20 (1.07 - 1.34)

0.003

507 (78.0)

461 (70.9)

1.0

**Table 3.** Clinical Biochemistry Baseline Value Among CRC and Control Subjects (N = 1,300)
Variables	CRC (n = 650), mean ± SD	Control (n = 650), mean ± SD	P value
CRC: colorectal cancer; HbA1c: glycated hemoglobin; HDL: high-density lipoprotein; LDL: low-density lipoprotein.
Hemoglobin (g/dL)	12.76 ± 0.78	13.00 ± 1.06	0.001
HbA1c (%)	6.37 ± 0.64	6.14 ± 0.46	0.001
Fasting blood glucose (mmol/L)	6.53 ± 0.78	6.32 ± 0.54	0.001
Vitamin D (mmol/L)	16.03 ± 7.21	21.35 ± 8.07	0.009
Neutrophil level (× 10⁹/L)	6.33 ± 0.24	5.66 ± 0.18	0.001
Red blood cell (RBC) (× 10¹²/L)	4.18 ± 0.49	4.386 ± 0.46	0.001
White blood cell (WBC) (× 10⁹/L)	7,723.7 ± 1,502	8,344.9 ± 2,049	0.001
Lymphocyte (× 10³/µL)	1.62 ± 0.93	2.06 ± 0.83	0.038
Platelet (/mm³)	222.1 ± 93.6	207 ± 102	0.001
Hematocrit (%)	34.70 ± 6.54	37.1 ± 5.61	< 0.001
Aspartate transaminase (U/L)	26.10 ± 13.0	25.8 ± 11.3	0.644
Alanine transaminase (U/L)	21.00 ± 0.93	20.4 ± 7.4	0.470
Potassium (mEq/L)	3.72 ± 0.91	4.46 ± 0.76	0.001
Na (mEq/L)	133.6 ± 4.59	136.1 ± 4.89	0.001
Calcium (mg/dL)	5.19 ± 0.50	3.59 ± 0.45	0.001
Creatinine(mmol/µL)	57.45 ± 16.90	70.4 ± 26.5	0.001
Cholesterol (mmol/L)	3.740 ± 0.43	6.04 ± 0.77	0.011
HDL (mmol/L)	1.39 ± 0.14	3.55 ± 0.58	0.001
LDL (mmol/L)	2.78 ± 0.64	5.02 ± 0.43	0.001
Bilirubin (µmol/L)	6.19 ± 2.09	10.71 ± 3.16	0.001
Triglyceride (mmol/L)	2.59 ± 0.38	1.75 ± 0.49	0.058
Uric acid (mg/L)	4.32 ± 0.49	4.18 ± 0.52	0.001
Fe (µg/L)	66.7 ± 20.51	71.3 ± 24.9	0.001
Ferritin (µg/L)	82.1 ± 15.44	99.2 ± 14.38	0.001
C-reactive protein (CRP) (µg/L)	0.79 ± 0.08	0.92 ± 0.09	0.001
Total protein (µg/L)	6.37 ± 0.89	6.16 ± 0.818	0.027
Systolic blood pressure (mm Hg)	128.82 ± 12.48	125.53 ± 12.00	0.001
Diastolic blood pressure (mm Hg)	79.29 ± 10.82	77.64 ± 9.81	0.002

Table 3. Clinical Biochemistry Baseline Value Among CRC and Control Subjects (N = 1,300)

Variables

CRC (n = 650), mean ± SD

Control (n = 650), mean ± SD

P value

CRC: colorectal cancer; HbA1c: glycated hemoglobin; HDL: high-density lipoprotein; LDL: low-density lipoprotein.

Hemoglobin (g/dL)

12.76 ± 0.78

13.00 ± 1.06

0.001

HbA1c (%)

6.37 ± 0.64

6.14 ± 0.46

0.001

Fasting blood glucose (mmol/L)

6.53 ± 0.78

6.32 ± 0.54

0.001

Vitamin D (mmol/L)

16.03 ± 7.21

21.35 ± 8.07

0.009

Neutrophil level (× 10⁹/L)

6.33 ± 0.24

5.66 ± 0.18

0.001

Red blood cell (RBC) (× 10¹²/L)

4.18 ± 0.49

4.386 ± 0.46

0.001

White blood cell (WBC) (× 10⁹/L)

7,723.7 ± 1,502

8,344.9 ± 2,049

0.001

Lymphocyte (× 10³/µL)

1.62 ± 0.93

2.06 ± 0.83

0.038

Platelet (/mm³)

222.1 ± 93.6

207 ± 102

0.001

Hematocrit (%)

34.70 ± 6.54

37.1 ± 5.61

< 0.001

Aspartate transaminase (U/L)

26.10 ± 13.0

25.8 ± 11.3

0.644

Alanine transaminase (U/L)

21.00 ± 0.93

20.4 ± 7.4

0.470

Potassium (mEq/L)

3.72 ± 0.91

4.46 ± 0.76

0.001

Na (mEq/L)

133.6 ± 4.59

136.1 ± 4.89

0.001

Calcium (mg/dL)

5.19 ± 0.50

3.59 ± 0.45

0.001

Creatinine(mmol/µL)

57.45 ± 16.90

70.4 ± 26.5

0.001

Cholesterol (mmol/L)

3.740 ± 0.43

6.04 ± 0.77

0.011

HDL (mmol/L)

1.39 ± 0.14

3.55 ± 0.58

0.001

LDL (mmol/L)

2.78 ± 0.64

5.02 ± 0.43

0.001

Bilirubin (µmol/L)

6.19 ± 2.09

10.71 ± 3.16

0.001

Triglyceride (mmol/L)

2.59 ± 0.38

1.75 ± 0.49

0.058

Uric acid (mg/L)

4.32 ± 0.49

4.18 ± 0.52

0.001

Fe (µg/L)

66.7 ± 20.51

71.3 ± 24.9

0.001

Ferritin (µg/L)

82.1 ± 15.44

99.2 ± 14.38

0.001

C-reactive protein (CRP) (µg/L)

0.79 ± 0.08

0.92 ± 0.09

0.001

Total protein (µg/L)

6.37 ± 0.89

6.16 ± 0.818

0.027

Systolic blood pressure (mm Hg)

128.82 ± 12.48

125.53 ± 12.00

0.001

Diastolic blood pressure (mm Hg)

79.29 ± 10.82

77.64 ± 9.81

0.002

**Table 4.** The Predictor Risk of CRC Using Multivariate Stepwise Regression Analysis (N = 1,300)
Independent variables	Regression coefficients	Standard error	Wald value	P value	Exp (B)	95% CI
CRC: colorectal cancer; CI: confidence interval.
Intestinal inflammation	1.064	0.228	21.704	0.001	2.897	1.852 - 4.532
Nausea/vomiting	0.896	0.247	13.210	0.001	2.451	1.511 - 3.974
Stomach pain	0.766	0.256	8.961	0.003	2.151	1.303 - 3.553
Nargileh/hookah use	0.564	0.267	4.478	0.034	1.758	1.042 - 2.964
Uric acids	0.556	0.112	24.387	0.001	1.740	1.397 - 2.168
Bilirubin	0.530	0.035	234.430	0.001	1.699	1.587 - 1,818
Cigarette smoke	0.487	0.228	4.571	0.033	1.628	1.041 - 2.545
Processed foods	0.420	0.139	9,148	0.002	1.521	1.159 - 1.997
Calcium	0.404	0.185	4.746	0.029	1.497	1.041 - 2.153
Vitamin D deficiency	0.080	0.012	45.177	0.001	1.083	1.058 - 1,109
Ferritin	0.150	0.050	10.423	0.001	1.015	1.006 - 1.024

Table 4. The Predictor Risk of CRC Using Multivariate Stepwise Regression Analysis (N = 1,300)

Independent variables

Regression coefficients

Standard error

Wald value

P value

Exp (B)

95% CI

CRC: colorectal cancer; CI: confidence interval.

Intestinal inflammation

1.064

0.228

21.704

0.001

2.897

1.852 - 4.532

Nausea/vomiting

0.896

0.247

13.210

0.001

2.451

1.511 - 3.974

Stomach pain

0.766

0.256

8.961

0.003

2.151

1.303 - 3.553

Nargileh/hookah use

0.564

0.267

4.478

0.034

1.758

1.042 - 2.964

Uric acids

0.556

0.112

24.387

0.001

1.740

1.397 - 2.168

Bilirubin

0.530

0.035

234.430

0.001

1.699

1.587 - 1,818

Cigarette smoke

0.487

0.228

4.571

0.033

1.628

1.041 - 2.545

Processed foods

0.420

0.139

9,148

0.002

1.521

1.159 - 1.997

Calcium

0.404

0.185

4.746

0.029

1.497

1.041 - 2.153

Vitamin D deficiency

0.080

0.012

45.177

0.001

1.083

1.058 - 1,109

Ferritin

0.150

0.050

10.423

0.001

1.015

1.006 - 1.024