Fruit and salt consumption are related to the risk of gastric cancer incidence in Asian populations: a comprehensive systematic review and meta-analysis of cohort studies.

Prospective studies examining the association between coffee and tea consumption and gastric cancer risk have shown inconsistent results. We investigated the association between coffee (total, caffeinated and decaffeinated) and tea consumption and the risk of gastric cancer by anatomical site and histological type in the European Prospective Investigation into Cancer and Nutrition study. Coffee and tea consumption were assessed by dietary questionnaires at baseline. Adjusted hazard ratios (HRs) were calculated using Cox regression models. During 11.6 years of follow up, 683 gastric adenocarcinoma cases were identified among 477,312 participants. We found no significant association between overall gastric cancer risk and consumption of total coffee (HR 1.09, 95%-confidence intervals [CI]: 0.84-1.43; quartile 4 vs. non/quartile 1), caffeinated coffee (HR 1.14, 95%-CI: 0.82-1.59; quartile 4 vs. non/quartile 1), decaffeinated coffee (HR 1.07, 95%-CI: 0.75-1.53; tertile 3 vs. non/tertile 1) and tea (HR 0.81, 95%-CI: 0.59-1.09; quartile 4 vs. non/quartile 1). When stratified by anatomical site, we observed a significant positive association between gastric cardia cancer risk and total coffee consumption per increment of 100 mL/day (HR 1.06, 95%-CI: 1.03-1.11). Similarly, a significant positive association was observed between gastric cardia cancer risk and caffeinated coffee consumption (HR 1.98, 95%-CI: 1.16-3.36, p-trend=0.06; quartile 3 vs. non/quartile 1) and per increment of 100 mL/day (HR 1.09, 95%-CI: 1.04-1.14). In conclusion, consumption of total, caffeinated and decaffeinated coffee and tea is not associated with overall gastric cancer risk. However, total and caffeinated coffee consumption may be associated with an increased risk of gastric cardia cancer. Further prospective studies are needed to rule out chance or confounding.

BACKGROUND Gastric cancer is among the deadliest cancers in the world. Gastric cancer incidence is highest among Asian populations. Numerous cell and animal studies have demonstrated chemopreventive effects of coffee, one of the most widely consumed beverages worldwide. Chinese in Singapore are one of the few Asian populations that drink coffee. There are few prospective data among Asians that have explored the effect of coffee drinking on gastric cancer risk. METHODS We examined the association between dietary factors, including coffee and caffeine, and the risk of gastric cancer in the population-based prospective cohort of the Singapore Chinese Health Study. At baseline, dietary information was ascertained with a validated food frequency questionnaire. Incident gastric cancer cases (n=519) were identified from 61,321 men and women after a mean follow-up of 12.4 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for the relationship between coffee and gastric cancer risk using Cox proportional hazards regression after adjustment for potential confounders, including smoking history and alcohol use. Secondary analyses were conducted with stratification by gender and subsite of gastric cancer (cardia, non-cardia, or unspecified). RESULTS In the overall cohort, daily or more frequent coffee consumption was associated with a statistically non-significant decrease in gastric cancer risk (HR=0.83; 95% CI: 0.63, 1.08), compared to monthly or no consumption. When the analysis was confined to women, the inverse association strengthened and became statistically significant with adjustment for caffeine intake (HR=0.56; 95% CI: 0.36, 0.88; P for trend=0.004). In analyses among women, further stratification by duration of follow-up revealed that the inverse association with daily coffee intake was confined to those with longer follow-up (e.g., ≥7 years) (HR=0.40; 95% CI: 0.22, 0.75), compared with never/monthly coffee intake. There was no association with coffee intake and gastric cancer among men. Overall and gender-stratified analyses for coffee and gastric cancer risk did not differ by gastric cancer subsite. CONCLUSIONS We provide results from the first prospective analyses of coffee intake and gastric cancer risk among an Asian population. We report that moderate coffee consumption was associated with a statistically significant 44% reduction in gastric cancer risk among Singapore Chinese women, regardless of caffeine intake. The effect appears strongest among women with a longer period of follow-up, suggesting that coffee may exert its protective effects during the earlier stages of gastric cancer development. Further research is needed to determine why the protective effect of coffee on gastric cancer risk may be isolated to women. Citation Format: Cheryl E. Ainslie-Waldman, Lesley M. Butler, Woon-Puay Koh, Renwei Wang, Jian-Min Yuan. Daily coffee drinking reduces gastric cancer risk among Singapore Chinese women. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4806. doi:10.1158/1538-7445.AM2013-4806

Numerous studies have investigated the associations between dietary components, behavioral patterns, and susceptibility to gastric cancer (GC). Diet and lifestyle cover a spectrum of both protective and harmful factors associated with GC. Additionally, non-modifiable factors such as age, gender, blood type, family history, and genetic predispositions may influence GC development. This review aims to explore the interplay between modifiable and non-modifiable factors, along with dietary habits and lifestyle practices, in relation to GC risk and the potential underlying mechanisms. We have synthesized the primary findings of observational studies (case-control and cohort), systematic reviews, and meta-analyses pertaining to preventive and deleterious factors affecting the incidence of gastric cancer. A literature search was conducted on Google Scholar, MEDLINE (PubMed), ScienceDirect, and Scopus for articles published in English from 2001 to 2024. The main search terms included body weight and body fat; diet; fruits and vegetables; meats and processed meats; fried and fast foods; milk and dairy products; salty foods; food and dietary patterns; fat and sweets intake; alcohol consumption; smoking; physical activity; age; sex; family history; blood type; genetics; and medication, and the risk of gastric cancer. Unhealthy dietary patterns, consumption of fried and fast foods, salty foods, alcohol, and smoking have been associated with an increased risk of GC. Non-modifiable factors such as advanced age, male sex, family history, genetics, and blood type A were linked to an elevated risk of GC. Conversely, physical activity and high consumption of fresh fruits and vegetables may prevent GC occurrence due to the presence of antioxidants, fiber, and polyphenols. While many studies have demonstrated that dietary patterns loaded with red and processed meats were associated with a high risk of GC, others have yielded inconclusive results. Controversial findings regarding the relationship between body weight and body fat, medications, milk and dairy products, and fat and sweets consumption with the risk of GC were also observed. Adequate diet modification and addressing preventable factors may play a pivotal role in reducing the incidence of gastric cancer.

A Summary of the 2020 Gastric Cancer Summit at Stanford University

Introduction Gastric cancer is more common in men than in women, indicating a potential role for sex hormones in its development. The aetiology of gastric cancer differs by anatomical subsite; however, few studies have compared hormonal and reproductive risk factors by subsite in prospective analyses. We investigated the association between reproductive factors and the risk of gastric cancer by subsite in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods EPIC is an on-going multicentre prospective cohort study, which comprises of 5 21 448 men and women, aged 25–70 years, recruited between 1992–2000 from ten European countries. Questionnaires administered at baseline assessed reproductive factors, including age at menarche, menopause, first pregnancy, and first child birth, as well as parity, breast feeding, menopausal hormonal therapy, and oral contraceptive use. The association between reproductive factors and gastric cancer were examined in Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders. Results During an average of 14 years of follow up, 83 gastric cardia cancers and 191 gastric non-cardia cancers were diagnosed among 3 43 985 women. Compared to women who had their first pregnancy at an earlier age ( 26 years) had a decreased risk of gastric non-cardia cancer (HR 0.55, 95% CI: 0.32–0.92). In addition, compared with women who had not undergone ovariectomy, women who had a bilateral ovariectomy had an increased risk of gastric non-cardia cancer (HR 1.83, 95% CI: 1.02–3.28). For gastric cardia cancer, there was also an elevated risk among women who had a bilateral ovariectomy but this did not quite attain statistical significance (HR 2.19, 95% CI: 0.98–4.86). The remaining reproductive factors analysed were not associated with risk of gastric cardia or non-cardia cancer. Conclusion The results of this study suggest that reproductive factors in women may influence risk for gastric cancer, particularly non-cardia gastric cancer.

Genetic risk, incident gastric cancer, and healthy lifestyle: a meta-analysis of genome-wide association studies and prospective cohort study.

Background & Aims: Machine learning can address limitations of principal components analysis by capturing nonlinear relationships, enhancing dietary pattern identification. This study aimed to identify dietary patterns using deep learning and cluster analysis and to assess their association with gastric cancer incidence in a prospective cohort study. Methods: Data were obtained from participants of the large-scale prospective cohort study, Health Examinees-Gem (HEXA-G) study, with baseline surveys conducted between 2004 and 2013. Cancer diagnosis information was retrieved from the Korea Central Cancer Registry up to December 31, 2018. The final analysis included 84, 725 women. Dietary intake was assessed using a validated semiquantitative food frequency questionnaire at baseline. Dimensionality reduction was performed using an autoencoder, followed by k-means clustering. The optimal cluster number was determined using the silhouette coefficient. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for gastric cancer risk associated with the dietary patterns. Results: Ten dietary patterns were identified: ‘Common’, ‘Low calorie’, ‘Rice’, ‘High calorie’, ‘Traditional’, ‘Dairy’, ‘Meat’, ‘Processed’, 'Noodles' and ‘Salty’ patterns. A total of 558 cases of gastric cancer were identified during median 9.4 years of follow-up. Compared to the ‘High calorie’ pattern (reference), the ‘Noodles’ (HR 1.97, 95% CI 1.05-3.70), and ‘Low calorie’ (HR 1.91, 95% CI 1.23-2.97) were associated with higher incidence of gastric cancer after adjusting for potential confounders. When stratified by age, ‘Salty’ pattern was associated with 4.34 times higher risk of gastric cancer (HR 4.34, 95% CI 1.49-12.60) among participants aged 40-49. Conclusion: Our results suggest that relative to the ‘High calorie’ pattern, the ‘Noodles’, ‘Low calorie’, and ‘Salty’ patterns are associated with increased risk of gastric cancer among Korean women. While Helicobacter pylori infection—a major risk factor for gastric cancer—was not accounted for in this study, our findings highlight the importance of dietary interventions to reduce high-risk patterns, such as salty or noodle-based diets, to lower the risk of gastric cancer. Citation Format: Hyobin Lee, Dongseok Heo, Sukhong Min, Sinyoung Cho, Bongwon Suh, Daehee Kang. Deep learning-derived dietary patterns and gastric cancer risk in women: A large-scale prospective cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 1037.

Background: There are controverted whether the long-term use of proton pump inhibitors (PPI) will increase the risk of gastric cancer. We performed a meta-analysis to assess the risk of gastric cancer in PPI users compared with non-PPI users. Methods: The main inclusion criteria were original studies reporting the incidence of gastric cancer in PPI users compared with non-PPI users. Key outcomes were the risk ratios (RR) for gastric cancer in association with PPI users or non-PPI users. Results: We analyzed data from 8 studies, comprising more than 927,684 patients. The risk of gastric cancer in PPI users was significantly higher than in non-PPI users [RR= 2.10, 95% CI (1.17-3.97)]. The risk of gastric cancer was similar between the 2 groups when the duration was ≤1 year [RR= 2.18, 95% CI (0.66-7.11)]. While the risk of gastric cancer for PPI users was higher than in non-PPI users when the duration was between 1-3 years, ≥1 year, ≥3 years and ≥5 years. The risk of non-cardiac gastric cancer for PPI users was higher than for non-PPI users [RR= 2.66, 95% CI (1.66 -4.27)], and the risk of non-cardiac gastric cancer for PPI users was higher than for non-PPI users when the duration ≥1 year [RR= 1.99, 95% CI (1.03-3.83)], but the risk for cardiac gastric cancer was similar between the 2 groups [RR= 1.86, 95% CI (0.71-4.89)]. Conclusions: We found the long-term use of PPI (duration ≥1 year) was significantly associated with a higher risk of non-cardiac gastric cancer.

A systematic review and dose‒response meta-analysis of the association between nitrate & nitrite intake and gastroesophageal cancer risk

Hereditary Diffuse Gastric Cancer: Diagnosis and Management

Epidemiological data concerning the association between diabetes and the subsequent development of gastric cancer are controversial. This population-based retrospective cohort study investigated the subsequent risk of gastric cancer for diabetic patients. From claims data of the universal health insurance of Taiwan, we identified 19,625 persons aged ≥20 years newly diagnosed with diabetes during 2000-2005. A comparison group (n = 78,500), frequency matched by age, sex, and calendar year, was randomly selected from people without diabetes. Incidence and hazard ratios (HR) of gastric cancer were ascertained during the follow-up period until 2008. We also explored associations of antidiabetic medicines with the incidence of gastric cancer. During the follow-up period, 47 subjects in the diabetic group and 216 subjects in the comparison group suffered gastric cancer, with the incidence rates of 4.34 and 4.86 per 10,000 person-years, respectively. During the first 4 years after diabetes diagnosis, the incidence of gastric cancer was relatively low in diabetic patients [adjusted HR = 0.63; 95% confidence interval (CI) = 0.42-0.97]. However, after that time, the diabetic group had a 76% (95% CI = 1.06-2.91) higher risk of developing gastric cancer than the comparison group. In diabetic patients, alpha-glucosidase inhibitors were associated with a significantly decreased risk of gastric cancer (adjusted HR = 0.38; 95% CI = 0.15-0.96). Our findings suggested that the association between diabetes and subsequent risk of gastric cancer may vary over time. Increased risk of gastric cancer was observed in patients with longer duration of diabetes.

Overweight and obesity, indicated as increased body mass index, are associated with the risk of some cancers. We carried out a meta-analysis on published cohort and case-control studies to assess the strength of association between body mass index and gastric cancer. Relevant studies were identified through PubMed, Web of Science and Medline electronic databases. Adjusted relative risks (odds ratios) with 95% confidence interval were used to assess the strength of association between body mass index and gastric cancer. Sixteen eligible studies were included in this meta-analysis. Overall, obesity (body mass index ≥ 30 kg/m(2)) was associated with an increased risk of gastric cancer (odds ratio = 1.13, 95% confidence interval = 1.03-1.24) compared with normal weight (body mass index = 18.5 to <25 kg/m(2)), while overweight (body mass index = 18.5 to <30 kg/m(2)) showed no association (odds ratio = 1.04, 95% confidence interval = 0.96-1.12). Specifically, a stratified analysis showed there were associations between obesity and the increased risk of gastric cancer for males (odds ratio = 1.27, 95% confidence interval = 1.09-1.48), non-Asians (odds ratio = 1.14, 95% confidence interval = 1.02-1.28) and both cohort studies (odds ratio = 1.10, 95% confidence interval = 1.00-1.22) and case-control studies (odds ratio = 1.29, 95% confidence interval = 1.03-1.60). Both overweight (odds ratio = 1.22, 95% confidence interval = 1.05-1.42) and obesity (odds ratio = 1.61, 95% confidence interval = 1.15-2.24) were associated with the increased risk of gastric cardia cancer. The results indicated that obesity was associated with the risk of gastric cancer, especially for males and among non-Asians. Both overweight and obesity were associated with the risk of gastric cardia cancer.

BackgroundThe family history of gastric cancer holds important implications for cancer surveillance and prevention, yet existing evidence predominantly comes from case–control studies. We aimed to investigate the association between family history of gastric cancer and gastric cancer risk overall and by various subtypes in Asians in a prospective study.MethodsWe included 12 prospective cohorts with 550,508 participants in the Asia Cohort Consortium. Cox proportional hazard regression was used to estimate study-specific adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between family history of gastric cancer and gastric cancer incidence and mortality, then pooled using random-effects meta-analyses. Stratified analyses were performed for the anatomical subsites and histological subtypes.ResultsDuring the mean follow-up of 15.6 years, 2258 incident gastric cancers and 5194 gastric cancer deaths occurred. The risk of incident gastric cancer was higher in individuals with a family history of gastric cancer (HR 1.44, 95% CI 1.32–1.58), similarly in males (1.44, 1.31–1.59) and females (1.45, 1.23–1.70). Family history of gastric cancer was associated with both cardia (HR 1.26, 95% CI 1.00–1.60) and non-cardia subsites (1.49, 1.35–1.65), and with intestinal- (1.48, 1.30–1.70) and diffuse-type (1.59, 1.35–1.87) gastric cancer incidence. Positive associations were also found for gastric cancer mortality (HR 1.30, 95% CI 1.19–1.41).ConclusionsIn this largest prospective study to date on family history and gastric cancer, a familial background of gastric cancer increased the risk of gastric cancer in the Asian population. Targeted education, screening, and intervention in these high-risk groups may reduce the burden of gastric cancer.

Background and ObjectivesResults from observational epidemiologic studies on the relationship between coffee consumption and gastric cancer are inconsistent and inconclusive. To assess the association between coffee consumption and the risk of gastric cancer, we summarized evidence from prospective cohort studies.MethodsRelevant studies were retrieved through computer searches (PubMed, EmBase and the Cochrane Library) and a review of references up to December 2014. The quality of the included studies was evaluated by Newcastle-Ottawa quality assessment scale. We used a meta-analytic approach to estimate overall hazard ratios (HRs) and 95% confidence intervals (CIs) for regular coffee drinkers versus individuals who seldom drank coffee. Sensitivity analysis and subgroup analysis were performed to assess the reliability of our results. A dose–response analysis was performed to assess the risk of gastric cancer based on the level of coffee consumption.ResultsNine prospective cohort studies involving 1,250,825 participants and 3027 gastric cancer cases were included in this meta-analysis. The pooled HR of gastric cancer for the study-specific regularly versus seldom coffee drinking categories was 1.05 (95% CI, 0.88 to 1.25) with significant heterogeneity across studies (I2 = 74.0%, P = 0.000). After the sensitivity analysis, three studies were deleted; however the association remained insignificant (HR, 0.99; 95% CI, 0.91 to 1.08). Subgroup analysis by anatomic location showed a risk for coffee consumption associated with cardia cancer (HR, 1.23; 95% CI, 1.04 to 1.45; heterogeneity, I2 = 36.4, P = 0.207). In the dose–response analysis, there was no significant association between coffee intake (in cups) and the risk of gastric cancer (P for linearity trend and non-linearity > 0.05).ConclusionOur meta-analysis demonstrated that coffee consumption was not associated with overall gastric cancer risk; however, coffee consumption may be a risk factor for gastric cardia cancer.

ABSTRACTAs several epidemiological studies on the association of coffee consumption with gastric cancer risk have produced inconsistent results, this meta-analysis was designed to synthesize current evidence of this potential relationship. We searched PubMed, EMBASE, and the Cochrane Library up to September 2014 to retrieve relevant articles. Prospective cohort studies were included if the relative risks (RRs) or hazard ratios and 95% confidence intervals (CIs) for gastric cancer according to coffee consumption were reported. Fixed- or random-effects models were used based on heterogeneity. The search yielded 13 eligible cohort studies of 3484 incident gastric cancer patients from among 1,324,559 participants. A significantly increased risk was found between gastric cardia cancer and coffee consumption (RR = 1.50, 95% CI: 1.09–2.07). Compared with Europeans (RR = 1.12, 95% CI: 0.86–1.46) and Asians (RR = 0.96, 95% CI: 0.72–1.27), Americans (RR = 1.36, 95% CI: 1.06–1.74) demonstrated a significantly positive association. However, the significant differences of the pooled results vanished after adjusting for smoking or body mass index. Our meta-analysis results suggest that a high level of coffee consumption is a risk factor for gastric cancer. However, these results should not be overinterpreted because residual confounding effects of other factors could exist.