Marine ω-3 Polyunsaturated Fatty Acid Intake and Risk of Colorectal Cancer Characterized by Tumor-Infiltrating T Cells

IMPORTANCE Marine omega-3 polyunsaturated fatty acids (PUFAs), including eicosapentaenoic acid, docosahexaenoic acid, and docosapentaenoic acid, possess potent immunomodulatory activity and may protect against cancer development. However, evidence relating marine.-3 PUFAs to colorectal cancer (CRC) risk remains inconclusive. OBJECTIVE To test the hypothesis that marine omega-3 PUFA intakemay be associated with lower risk of CRC subsets characterized by immune infiltrate. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort studywas conducted among participants in the Nurses' Health Study (1984-2010) and Health Professionals Follow-up Study (1986-2010). EXPOSURES Intake of marine omega-3 PUFAs. MAIN OUTCOMES AND MEASURES Incidence of CRC characterized by CD3(+), CD8(+), CD45RO (PTPRC)(+), or FOXP3(+) T-cell densities in tumor tissue, measured by immunohistochemical and computer-assisted image analysis. RESULTS Among 173 229 predominantly white participants, 125 172 with 2 895 704 person-years of follow-up provided data about marine omega-3 PUFA intake every 4 years through a validated food frequency questionnaire and followed up for incident CRC evaluation. Of 2504 CRC cases, we documented 614 (252 men, 362 women) from which we could assess T-cell infiltration in the tumor microenvironment. The inverse association of marine omega-3 PUFAs intake with CRC risk differed according to FOXP3(+) T-cell infiltration: compared with intake of less than 0.15 g/d of marine omega-3 PUFAs, intake of at least 0.35 g/d was associated with a multivariable hazard ratio (HR) of 0.57 (95% CI, 0.40-0.81; P <.001 for trend) for FOXP3(+) T-cell-high tumors. In contrast, the HR for FOXP3(+) T-cell-low tumors was 1.14 (95% CI, 0.8-1.60) (P =.77 for trend; P =.01 for heterogeneity). No statistically significant differential association was found for high-density tumors (compared with low-density tumors) according to CD3(+), CD8(+), or CD45RO(+) cell density (P >=.34 for heterogeneity for all comparisons). In functional assays, the suppressive activity of regulatory T cells was approximately 2-fold lower (T-effector-cell proliferation, >= 64% vs 38%) when preincubated with docosahexaenoic acid at 50 mu M, 100 mu M, and 200 mu M concentrations than without docosahexaenoic acid (P <.001 for all comparisons). CONCLUSIONS AND RELEVANCE High marine omega-3 PUFA intake was associated with lower risk of CRC with high-level, but not low-level, FOXP3(+) T-cell density, suggesting a potential role of omega-3 PUFAs in cancer immunoprevention through modulation of regulatory T cells.