Fruit and vegetable consumption and gastric cancer by location and histological type: case–control and meta-analysis

Abstract

The available information favours a greater impact of environmental exposures on intestinal type gastric cancer, and risk factors for the cardia and distal stomach cancers also appear to be different. We aimed to estimate the association between fruit and vegetable intake and gastric cancer, by location and histological type. We performed a population-based case-control study and a meta-analysis of studies addressing this issue. Incident cases (n=305) were identified in two large teaching hospitals (Porto, Portugal), and controls were randomly sampled among city dwellers (n=1129). Published studies were searched through PubMed, and effects were combined with random effects meta-analysis. In our case-control study, the odds ratio (OR) for the comparison of the highest vs. lowest tertile of fruit consumption was 0.47 [95% confidence interval (CI): 0.21-1.05] for cardia, 0.53 (95% CI: 0.35-0.80) for non-cardia cancer, 0.36 (95% CI: 0.20-0.62) for intestinal, and 1.00 (95% CI: 0.53-1.90) for the diffuse histological type. For vegetables, the corresponding OR was 0.59 (95% CI: 0.26-1.35), 0.85 (95% CI: 0.58-1.26), 0.95 (95% CI: 0.57-1.57), and 0.60 (95% CI: 0.32-1.14). In meta-analysis, considering fruit consumption (highest vs. lowest category), the combined OR was 0.58 (95% CI: 0.38-0.89) for cardia, 0.61 (95% CI: 0.44-0.84) for non-cardia, 0.49 (95% CI: 0.33-0.72) for intestinal type, and 0.82 (95% CI: 0.57-1.20) for diffuse type. Vegetables also decreased the risk of cardia (OR=0.63, 95% CI: 0.50-0.79), non-cardia (OR=0.75, 95% CI: 0.59-0.95), intestinal (OR=0.61, 95% CI: 0.44-0.86), and diffuse type (OR=0.67, 95% CI: 0.44-1.01). Fruit or vegetable intake was associated with a decreased risk of gastric cancer regardless of the anatomical location and the histological type, although dietary intake had a more clear-cut protective effect on intestinal type cancers.

Trends in gastric cancer incidence: a period and birth cohort analysis in a well-defined French population

“…A meta-analysis showed for fruits a relative risk of 0.6 (95 % CI, 0.4-0.8) when comparing the highest to the lowest category of consumption. For vegetables, it was 0.6 (95 % CI, 0.5-0.8) [28]. The protective effect of fruits and vegetables can explain that, in contrast to esophageal adenocarcinoma where obesity and tobacco consumption play a major role, incidence rates did not increase for cardia cancer.…”

“…The protective role of vegetables and fresh fruits reported in case-control studies and not in cohort studies could be attributed to a period effect [27]. In the meta-analysis of case-control studies the relative risk for non-cardia gastric cancer was 0.61 (0.44-0.84) when comparing the highest to the lowest category of fruit consumption and 0.75 (0.59-0.95) when comparing the highest to the lowest category of vegetable consumption [28].…”

Obesity and related risk factors in gastric cardia adenocarcinoma

“…In addition, fruit intake (notably citrus fruits) was associated with a significant reduction in GCA risk, with the exception of the lowest quartile of consumption. Lunet et al [45] reported similar findings in a population-based case-control design and formalized review of the literature through a meta-analysis, concluding that when comparing the highest with the lowest quartile of fruit consumption the relative risk of GCA was 0.53 (95 % CI 0.35-0.80), with similar benefits from vegetable intake (relative risk 0.63, 95 % CI 0.50-0.70). However, other studies have not always confirmed a protective effect from increased vegetable and/or fruit consumption.…”

“…The positive effect of a diet based on fruits and vegetables has been analyzed in several studies [44,45]. In a meta-analysis by Stevens et al [44], several significant trends were noted.…”

Overview of Methodological Quality of Systematic Reviews about Gastric Cancer Risk and Protective Factors

“…Finally, we included 80 papers for this overview of reviews, but in our article we only reviewed 55 etiological SRs/meta-analyses (Fu et al, 1995;Huang et al, 1998;Jacobs et al, 1998;Danesh et al, 1999;Eslick et al, 1999;Jia et al, 2000;Wu et al, 2000;Xue et al, 2001;Huang et al, 2003;Guo et al, 2004;Li et al, 2004;Botelho et al, 2006;Hu et al, 2006;Jakszyn et al, 2006;Liu et al, 2006;MacLean et al, 2006;Nishino et al, 2006;Tian et al, 2006;Xu et al, 2006;An et al, 2007;Kubo et al, 2007;Lunet et al, 2007;Merrill et al, 2007;Bae et al, 2008;Ladeiras-Lopes et al, 2008;Kuoppala et al, 2008;Shimazu et al, 2008;Zhou et al, 2008;Huang et al, 2009;La Torre et al, 2009;Mulholland et al, 2009;Myung et al, 2009;Yang et al, 2009;Zhang et al, 2009;Cavaleiro-Pinto et al, 2010;Gatto et al, 2010;Hussein et al, 2010;Kang et al, 2010;Kim et al, 2010;…”