Abstract
Objective:This study investigated the association between fruit and vegetable intake and stomach cancer, with considering the impacts of Helicobacter pylori (H. pylori) infection and tobacco smoking. Methods:A case-control study featuring 80 male incident stomach-cancer cases and 146 male controls was conducted in a general hospital in Viet Nam. A semi-quantitative food frequency and demographic lifestyle questionnaire were used; and venous blood samples were collected to determine H. pylori status by IgG ELISA. The respective associations between fruit and vegetable intake and stomach cancer were examined using unconditional logistic regression analysis with adjustments for possible cofactors. Results:Fruit intake and stomach cancer showed a weak inverse association when this became non-significant after adjusting for H. pylori infection (OR = 0.50, 95%CI: 0.22–1.12, p trend = 0.094). Stratifying by H. pylori status returned a negative trend for fruit intake and stomach cancer among H. pylori-negative participants (OR = 0.21, 95%CI: 0.06–0.69, p trend = 0.010), but no significant interaction for H. pylori-positive participants (OR = 0.76, 95%CI: 0.21–2.68, p trend = 0.670). Vegetable intake and stomach cancer showed no association, regardless of H. pylori status. Compared to ever-smokers with low intake, never-smokers with high vegetable (OR = 0.25, 95% CI: 0.06–0.95) and fruit intake (OR = 0.20, 95%CI: 0.06–0.65) showed the lowest odds of stomach cancer. Conclusions:Fruit, but not vegetable, intake showed a weak inverse association with stomach cancer. H. pylori infection and tobacco-smoking status may influence the protective effects of fruit and vegetable intake on stomach cancer.
Highlights
Stomach cancer is the sixth most-diagnosed cancer, and the third most common cause of cancer death (Bray et al, 2018)
In Model 2, which adjusted for H. pylori status, the negative relationship between fruit intake and stomach cancer was no longer statistically associated; this was despite the fact that a decreasing trend was still observed across the three tertiles of fruit intake
The present study findings suggest that there is a weak inverse association between fruit intake and stomach cancer, and that H. pylori infection potentially has a modifying effect on this association
Summary
Stomach cancer is the sixth most-diagnosed cancer, and the third most common cause of cancer death (Bray et al, 2018). To date there has been no clear finding regarding the benefits of fruits and vegetables for stomach cancer (Lunet et al, 2005; Tsugane and Sasazuki, 2007; World Cancer Research Fund/American Institute for Cancer Research, 2018). Chronic infection with H. pylori has been found to be a carcinogen causing stomach cancer, and studies have suggested that fruit and vegetable intake modifies the effect of H. pylori infection on stomach cancer. The differing effects of fruits and vegetables on H. pylori-associated stomach cancer have been explored in some previous studies, but inconsistent results have been reported (Machida-Montani et al, 2004; Epplein et al, 2008; Wang et al, 2012; Wang et al, 2017).
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