Association of Dietary Cholesterol Intake With Risk of Gastric Cancer: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Background: Many case–control studies have investigated the association between dietary cholesterol and gastric cancer, yielding inconsistent findings. We carried out a systematic review and meta-analysis of observational studies to assess the relationship between dietary cholesterol intake and gastric cancer among adults.Methods: PubMed, Scopus, and Google Scholar were systematically searched to identify articles that evaluated the association of dietary cholesterol with gastric cancer up to May 2021. Pooled odds ratio (ORs) and 95% confidence intervals (CIs) were computed using random-effects models. Dose–response analysis was used to explore the shape and strength of the association.Results: Fourteen case–control studies with 6,490 gastric cancer patients and 17,793 controls met our inclusion criteria. In the meta-analysis of the highest vs. the lowest dietary cholesterol categories, a significantly higher (~35%) risk of gastric cancer was observed in association with high cholesterol consumption (pooled OR: 1.35, 95% CI: 1.29–1.62, I2 = 68%; 95%CI: 45–81%). Subgroup analysis also showed this positive relationship in population-based case–control studies, those conducted on non-US countries, those with a higher number of cases and high-quality studies, those that collected dietary data via interviews, studies not adjusted for Helicobacter pylori infection, and studies where the body mass index was controlled. Besides, a non-linear dose–response association was also identified (P = 0.03).Conclusion: This study demonstrated that dietary cholesterol intake could significantly augment the risk of gastric cancer in case–control studies. Prospective cohort studies with large sample sizes and long durations of follow-up are required to verify our results.

Tumour catabolism independent of malnutrition and inflammation in upper GI cancer patients revealed by longitudinal metabolomics

“…The increased cholesterol levels in sera of upper GI cancer patients compared with PanC patients is a further sign of prolonged starvation because it has been shown that starvation triggers cholesterol release from lysosomes 38 . However, it cannot be excluded that the elevated cholesterol levels are a consequence of long‐term overnutrition because studies have demonstrated a link between serum cholesterol levels and the risk for oesophageal and gastric cancer 39,40 . In line with the obtained ketone signature, the concentration of succinate, which is produced during the utilization of ketones, was increased in sera of upper GI cancer patients compared with healthy controls or PanC patients.…”

Plant-based diets and body composition in Chinese omnivorous children aged 6–9 years old: A cross-sectional study

“…In children, the diet must meet the daily physiological activity needs and maintain body growth and development, particularly in young children. Animal foods contain potentially harmful compositions (i.e., saturated fat, cholesterol) that increase the risk of chronic disease, including: coronary heart disease, and cancer (18)(19)(20). However, animal foods are also an important source of protein for the development of LM (21).…”

Diet and carcinogenesis of gastric cancer

“…However, there were significant inconsistencies between studies included in the meta-analysis. Furthermore, after adjusting for H. pylori , there was no association between dietary cholesterol and gastric cancer [14 ▪ ].…”

“…In a meta-analysis of 14 case–control studies, high cholesterol consumption was associated with a nonlinear dose–response relationship with gastric cancer. Higher intakes of dietary cholesterol were associated with a 35% increased risk of gastric cancer (OR 1.35, CI 1.29–1.62) [14 ▪ ]. However, there were significant inconsistencies between studies included in the meta-analysis.…”