An update of the WCRF/AICR systematic literature review on esophageal and gastric cancers and citrus fruits intake

Abstract

PurposeThe 2007 World Cancer Research Fund/American Institute for Cancer Research expert report concluded that foods containing vitamin C probably protect against esophageal cancer and fruits probably protect against gastric cancer. Most of the previous evidence was from case–control studies, which may be affected by recall and selection biases. More recently, several cohort studies have examined these associations. We conducted a systematic literature review of prospective studies on citrus fruits intake and risk of esophageal and gastric cancers.MethodsPubMed was searched for studies published until 1 March 2016. We calculated summary relative risks and 95 % confidence intervals (95 % CI) using random-effects models.ResultsWith each 100 g/day increase of citrus fruits intake, a marginally significant decreased risk of esophageal cancer was observed (summary RR 0.86, 95 % CI 0.74–1.00, 1,057 cases, six studies). The associations were similar for squamous cell carcinoma (RR 0.87, 95 % CI 0.69–1.08, three studies) and esophageal adenocarcinoma (RR 0.93, 95 % CI 0.78–1.11, three studies). For gastric cancer, the nonsignificant inverse association was observed for gastric cardia cancer (RR 0.75, 95 % CI 0.55–1.01, three studies), but not for gastric non-cardia cancer (RR 1.02, 95 % CI 0.90–1.16, four studies). Consistent summary inverse associations were observed when comparing the highest with lowest intake, with statistically significant associations for esophageal (RR 0.77, 95 % CI 0.64–0.91, seven studies) and gastric cardia cancers (RR 0.62, 95 % CI 0.39–0.99, three studies).ConclusionsCitrus fruits may decrease the risk of esophageal and gastric cardia cancers, but further studies are needed.Electronic supplementary materialThe online version of this article (doi:10.1007/s10552-016-0755-0) contains supplementary material, which is available to authorized users.

Risk of gastric cancer among patients with gastric intestinal metaplasia

“…For example, H. pylori infection has been well recognized to be a significant risk factor of GNCC, while the association between H. pylori and cardia gastric cancer incidence remains unclear . Moreover, smoking, intake of salty, preserved meat and smoked food are risk factors of GNCC, while low citrus fruit intake, gastroesophageal reflux disease (GERD) and obesity have been suggested to be associated with higher GCC risk . In the current meta‐analysis, the pooled OR for the association between IM and GNCC was 4.98, which is higher compared with GCC (pooled OR = 1.93).…”

“…Gastric cancer remains one of the most common malignancies in both sexes, and is the third leading cause of cancer mortality worldwide . Helicobacter pylori ( H. pylori ) has been well recognized as the most important risk factor for gastric cancer, moreover, smoking and dietary factors such as high intake of salty food, preserved meat and alcohol, and low citrus fruit consumption are also associated with higher gastric cancer risk . The survival rate for patients with gastric cancer remains poor, which is associated with the late stage of diagnosis.…”

Epidemiology, etiology, and prevention of esophageal squamous cell carcinoma in China

“…In several observational studies, non-frequent consumption of fresh fruits and vegetables is closely associated with a higher risk of ESCC 17-21 . However, in that report, no distinction was made between ESCC and esophageal adenocarcinoma.…”

Chemopreventive Agents and Inhibitors of Cancer Hallmarks: May Citrus Offer New Perspectives?

“…More recently, different meta-analyses have highlighted an inverse association between CF intake and the risk of various types of cancers, such as breast cancer [274], bladder cancers [275,276,277], and esophageal cancer [278]. A very recent systematic literature review of prospective studies on CF intake and risk of esophageal and gastric cancers revealed only a marginally significant decreased risk of esophageal cancer and reported no significant inverse association for gastric cardia cancer, but data are still limited [279]. …”