A case‐control study of gastric cancer and diet in Italy. III. Risk patterns by histologic type

Abstract

In a case-control study of gastric cancer (GC) in high-risk and low-risk areas of Italy, 923 GCs were systematically categorized by one pathologist according to the Lauren classification distinguishing 2 main histologic types, intestinal (55%) and diffuse (23%). Intestinal types outnumbered diffuse types by a 3 to 1 margin in high-risk regions in the north-central part of the country, while both types occurred at nearly equal rates in low-risk areas. Intestinal types also occurred relatively more frequently at older ages and among males. Relative risks of each type of GC were evaluated in relation to dietary and other data obtained from interviews with the cancer patients and controls. The risk patterns for intestinal and diffuse types were remarkably similar. Increased risks of both types were associated with high intake of meat, salted/dried fish, seasoned cheeses and traditional soups, while decreased risks of both types were found among heavy consumers of fresh vegetables and fruits. Correspondingly similar patterns were seen with indices of nutrients, with risks of both intestinal and diffuse GC rising with animal protein intake and declining with consumption of vitamins C and E. Both types were inversely related to socio-economic status, and neither was associated with cigarette smoking. A familial history of GC was reported more frequently by patients with each type than by controls, although the highest risk was for unclassified GC, a group of poorly differentiated and medullary carcinomas accounting for 15% of all GCs in this study. The findings suggest that, despite differences in geographic and demographic patterns, the intestinal and diffuse types of GC have etiologic factors in common.

Plasma and dietary carotenoid, retinol and tocopherol levels and the risk of gastric adenocarcinomas in the European prospective investigation into cancer and nutrition

“…Of the previous studies, all of them case -control, that have considered GC pathology in relation to dietary carotenoids, some have failed to detect any associations or differences by subtype (Boeing et al, 1991;Buiatti et al, 1991), whereas others have shown mixed results (Gonzalez et al, 1994;Harrison et al, 1997;Ekstrom et al, 2000), suggesting that the effects of carotenoids might be similar in both histological subtypes. In the present study, none of the analytes, with the possible exception of a-tocopherol, showed any significant effects by anatomical subsite or histological subtype.…”

“…Several case -control studies have shown strong inverse associations between GC risk and higher consumption of some of these nutrients (Buiatti et al, 1990(Buiatti et al, , 1991Gonzalez et al, 1994;Hansson et al, 1994;Ekstrom et al, 2000). Results from prospective dietary studies are conflicting and show either a strong protection (Zheng et al, 1995) or no clear inverse associations between the dietary intake of carotenoids and GC risk (Ocke et al, 1995;Botterweck et al, 2000b).…”

Dietary factors and gastric cancer in Korea: A case‐control study

“…In many studies, consumption of food rich in nitrate and nitrite, smoked food, a high salt diet and a 4 A kind of kimchi prepared with salted radish and the same subingredients as Baiechu kimchi.- 5 A kind of kimchi prepared with radish and a large quantity of salt water.-*p Ͻ 0.05; **p Ͻ 0.01. high starch diet have seemed to be risk factors for GC, whereas high consumption of fresh fruits and vegetables, milk and milk products have seemed to be protective. [5][6][7][8][9][10][11][12][13][14][15] Although controversial, it has been reported that dietary fat, meats, fish, seasonings and beverages such as coffee and tea are also associated with increased risk of GC. 6,10,11,15,24 Intake of charcoal grilled beef significantly increased the risk of GC in our study.…”

“…Most studies on the relationship between diet and GC have suggested that foods rich in nitrate or nitrite, a high salt diet, smoked meat or fish and a high carbohydrate diet increase the risk of GC, whereas high consumption of fresh vegetables, fruits and dairy products decreases the risk of GC, although the findings are not always consistent. [5][6][7][8][9][10][11][12][13][14][15] Dietary habits of Korean people can be characterized as a high intake of salty foods and carbohydrates and a higher intake of cooked rather than fresh vegetables. For this reason, it is necessary to investigate the effect of dietary factors on GC in Korea.…”

Meat, cancer and dietary advice to the public

“…The large Italian case-control study (Buiatti et al, 1991) is one of the few studies to find this. In contrast the population studies and the majority of casecontrol studies of gastric cancer show meat intake to be inversely related to cancer risk (Table 5).…”