Abstract
We aimed to assess the effect of a high-quality diet on the risk of upper gastrointestinal cancer and to evaluate the overall quality of our findings by searching PubMed, EMBASE, Web of Science, Cochrane, and the references of related articles to February 2020. Two reviewers independently retrieved the data and performed the quality assessments. We defined the highest-quality diet as that with the lowest Diet Inflammatory Index category and the highest Mediterranean Diet Score category. Overall odds ratios and 95% confidence intervals were estimated for upper gastrointestinal cancer risk comparing the highest- versus lowest-diet quality. A random-effects meta-analysis was then applied with Review Manager, and the quality of the overall findings was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation approach. The highest-quality diets were significantly associated with reduced risk of upper gastrointestinal cancers, achieving odds ratios of 0.59 (95% confidence interval: 0.48–0.72) for the Diet Inflammatory Index, pooling the findings from nine studies, and 0.72 (95% confidence interval: 0.61–0.88) for the Mediterranean Diet Score, pooling the findings from 11 studies. We observed a minimum of 69% heterogeneity in the pooled results. The pooled results were graded as low quality of evidence. Although it may be possible to offer evidence-based general dietary advice for the prevention of upper gastrointestinal cancers, the evidence is currently of insufficient quality to develop dietary recommendations.
Highlights
Upper gastrointestinal (UGI) cancers, including those of the stomach, esophagus, and nasopharynx, are a leading cause of morbidity and mortality worldwide, accounting for some 1.6 million new cases and 1.3 million deaths each year [1]
To evaluate whether the existing evidence is of sufficient quality in developing evidence-based dietary recommendations for the prevention of UGI cancers, we evaluated the quality of the pooled results on the risk of UGI cancer for both the Diet Inflammatory Index (DII) and Mediterranean Diet Score (MDS), using the Grading of Recommendations
Thethe quality of evidence was a score of −3 to the findings being(Figure restricted to Table specific cancersregions, were identified self-reported physician-reviewed geographic such asby
Summary
Upper gastrointestinal (UGI) cancers, including those of the stomach, esophagus, and nasopharynx, are a leading cause of morbidity and mortality worldwide, accounting for some 1.6 million new cases and 1.3 million deaths each year [1] Both unmodifiable and modifiable factors are associated with their development, and dietary components have received particular attention as a potentially modifiable factor. Given the proven effect of distinct nutritional components in various chronic diseases, several dietary indices have been developed to estimate diet quality in different populations. These indices differ in terms of the basis on which they are scored and the dietary components that they cover. Several observational studies have reported no effect on the incidence of gastric cancer when
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