Diet, H pylori infection and gastric cancer: Evidence and controversies

Table 1 Epidemiological studies (population-based case-control) on dietary factors and gastric cancer

Author	Yr	Geographic area	Case/Control n	Increased risk	Decreased risk
Risch HA5	1985	Canada	246/146	Nitrite, chocolate, carbohydrates	Fiber, Vit. C
Buiatti E6	1990	Italy	1016/1159	Nitrites, protein	Vit. C, β-carotene, α-tocopherol, vegetable fat
Graham S7	1990	USA	293/293	Sodium, fat, retinol	β-Carotene, raw vegetables, onions, cucumbers
Ramon JM8	1993	Spain	117/234	--	Vit. A, Vit. C
Kaaks R9	1998	Belgium	301/2851	Vit. A, Vit. B12, mono, disaccharides	Polyunsaturated fat, Vit. C/B1-B2-B6, C/A
Lopez-Carrillo L10	1999	Mexico	220/752	Protein, saturated fat, cholesterol	Polyunsaturated fat, fiber, Vit. E
Mathew A11	2000	India	194/305	Rice, spicy foods, chili, high-temperature food	--
Palli D12	2001	Italy	382/561	Protein, nitrite, sodium	Vit. C/B6, β-carotene, α-tocopherol, nitrates
Mayne ST13	2001	USA	352/687	Animal protein, cholesterol, Vit. B12, nitrite	Fiber, β-carotene, folate, Vit. C
Jedrychowski W14	2001	Poland	80/--	Carbohydrates	Vit. E, β-carotene
Hamada GS15	2002	Brazil	97/192	Beef	Fruits
Chen H16	2002	Nebraska	124/449	Saturated fat	Fiber, Vit. C
Hara M17	2003	Japan	149/287	--	Cruciferous vegatables, mushrooms
Nomura AM18	2003	Hawaii	300/446	Processed meat, bacon	β-carotene, Vit. C, Vit. E, folate
Lagiou P19	2004	Greece	110/100	--	Flavanone
De Stefani E20	2004	Uruguay	240/960	Salted-stewed meat, rice, tuber	Vegetables, legumes, fruit, black tea

Table 2 Epidemiological prospective cohort studies on association between dietary factors and GC (1990-2004)

Author	Yr	Geographic area	Subjects n	FU yr	Increased risk	Decreased risk	No effect
Chyou PH21	1990	USA (Hawaii)	8006	18	--	Green/ cruciferous vegetables, fruit	--
Kneller RW22	1991	USA	17633	20	Carbohydrates, salted-fish, bacon, cooked cereals, milk	--	--
Kato I23	1992	Japan	9753	6	Alcohol, broiling meat	Fruit	--
Nomura A24	1995	USA (Hawaii)	8006	25	--	Fruit, vegetables	Alcohol
Dorant E25	1996	The Netherlands	120852	3.3	--	Onions	Leek, garlic
Goldbohm RA26	1996	The Netherlands	120852	4.3	--	--	Black tea
Ocke MC27	1998	The Netherlands	12763	25	--	Vegetables, fruit, fiber-rich cereals	--
Terry P28	1998	Sweden	11946	25	--	Fruit, vegetables	--
Galanis DJ29	1998	USA (Hawai)	11907	14.8	Coffee	Fruit, raw vegetables	Pickled vegetables, dried/salted fish
Knekt P30	1999	Finland	9985	24	--	--	Nitrates, nitrites, NDMA
Jansen MC31	1999	Netherlands	12000	25	Refined grains	Fruit	Vegetables
							Whole grain
Botterweck AA32	2000	The Netherlands	120852	6.3	Retinol, carotene	Vit. C	Folate, Vit. E, carotene, lycopene, fibers, Vit. A, BHA, BHT
Tsubono Y33	2001	Japan	26311	8	--	--	Green tea
McCullough ML34	2001	USA	1200000	14	Vegetables1	Vegetables, citrus fruit, whole grain2	--
Nagata C35	2002	Japan	33304	7	--	Soy products	--
Ngoan LT36	2002	Japan	13000	10	Processed meat, cooking oil, pickled food, soup	Green/yellow vegetables, fruit, cuttle-fish, tofu, potatoes	--
Kobayashi M37	2002	Japan	39993	10	--	Fruit, vegetables	--
Masaki M38	2003	Japan	5765	10	Meat pattern	Vegetable and fruit pattern	--
					Rice/snack pattern	Western breakfast pattern
Khan MM39	2004	Japan	3158	18	Carbonated drink/juice1	Miso soup2	--
Kim MK40	2004	Japan	42 112	10	Traditional dietary pattern	Healthy dietary pattern1	--
Sasazuki S41	2004	Japan	72 743	11	--	Green tea1	--
1EPIC42-44	2006	Europe	521 457	6.6	Red and processed meat, ENOC	Plasma vitamin C Total vegetable intake Onion, garlic	Dietary Vitamin C

¹Effect limited to women;

²Effect limited to men; FU: follow-up; NDMA: N-nitrosodimethylamine. EPIC: European prospective investigation into cancer and nutrition study; BHA: butylated hydroxyanisole; BHT: butylated hydroxytoluene (cooking fats, oils, mayonnaise, creamy salad dressing, dried soup); ENOC: endogenous nitroso compounds.

Table 3 Randomised controlled dietary intervention trials for prevention of stomach cancer

Author	Yr	Geographic area	Subjects n	Dietary intervention	Intervention (yr)	FU (yr)	Results
Wang GQ67	1994	China	29584	retinol/zinc; riboflavin/niacin; Vit. C/molybdenum; carotene/Vit.E/selenium	5.25	5.25	↓ gastric cancer mortality
Varis K68	1998	Finland	29133	α-tocopherol 50 mg/d; β-carotene 20 mg/d;	5	5	= gastric cancer incidence
Malila N69	2002	Finland	29133	α-tocopherol 50 mg/d; β-carotene 20 mg/d	5-8	8	= gastric cancer incidence
Zhu S70	2003	China	216	Folate 20 mg/d + Vit. B12 1 mg/mo Natural β-carotene 30 mg/d Synthetic β-carotene 30 mg/d	2	8	No change cancer incidence ↓ precancerous lesions
Li H71	2004	China	2526	Synthetic allitridum 200 mg + selenium 100 mg	2	5	No change cancer incidence

FU: follow-up.

Table 4 Epidemiological studies (case/control) on association between H. pylori infection and GC risk (1990-2005)

Author	Yr	Geographic area	Case/Control n	OR (95% CI)	Detection of infection
Loffeld RJ74	1990	The Netherland	91/401	2.04 (1.07-3.91)	Serology
Caruso ML75	1990	Italy	44/22	4.72 (1.32-19.04)	Histology
Talley NJ76	1991	USA	69/252	1.63 (0.79-3.37)	Serology
Sipponen P77	1992	Finland	54/84	2.21 (1.01-4.91)	Serology, histology
Kuipers EJ78	1993	The Netherlands	116/116	0.86 (0.44-1.68)	Serology
Estevens J79	1993	Portugal	80/80	0.54 (0.24-1.19)	Serology
Blaser MJ80	1993	Japan	29/58	2.14(0.72-6.40)	Serology
Tatsuta M81	1993	Japan	41/19	2.42 (0.69-8.66)	Biopsy culture
Buruk F82	1993	Turkey	46/40	1.89 (0.69-5.21)	Serology
Hansson LE83	1993	Sweden	112/103	2.60 (1.35-5.02)	Serology
Archimandritis A84	1993	Greece	47/50	1.23 (0.51-2.95)	Serology
Lin JT85	1993	China, Taiwan	143/823	1.42 (0.97-2.08)	Serology
Hu PJ86	1994	China	51/102	5.10 (1.70-15.5)	Serology, histology
Sipponen P87	1994	Finland	243/1408	1.31 (0.99-1.74)	Histology
Asaka M88	1994	Japan	213/213	2.55 (1.48-4.44)	Serology
Kikuchi S89	1995	Japan	105/102	13.3 (5.3-35.6)	Serology
Rudi J90	1995	Germany	111/111	1.39 (0.82-2.36)	Serology
Fukuda H91	1995	Japan	282/767	1.13 (0.81-1.58)	Serology
Menegatti M92	1995	Italy	307/162	3.66 (2.33-5.74)	Serology, histology
Asaka M93	1995	Japan	109/109	2.40 (1.20-4.80)	Serology
Hatz RA94	1996	Germany	95/93	2.03 (1.05-3.92)	Serology
Shibata T95	1996	Japan	50/50	1.10 (0.43-2.86)	Histology
Kato S96	1996	Japan	82/151	1.12 (0.60-2.07)	Serology
Kokkola A97	1996	Finland	50/22	3.27 (1.42-7.52)	Histology
Menegatti M98	1996	Italy	148/54	4.02 (1.99-8.17)	Serology, histology
Sivaprakash R99	1996	India	75/75	1.91 (1.00-3.67)	Serology, biopsy culture
Kim HY100	1997	Korea	160/160	1.39 (0.89-2.17)	Histology
Miehlke S101	1997	Germany	215/215	16.7 (CI 9.6-29.1)	Histology, 13C-UBT
Shi Y102	1997	China	110/125	3.30 (1.90-5.9)	Serology
Barreto-Zuniga R103	1997	Japan	55/75	3.00 (1.69-5.33)	Serology
Martin-de-Argila C104	1997	Spain	48/50	3.01 (1.02-8.86)	Serology
Azuma T105	1998	Japan	82/167	0.97 (0.54-1.75)	Serology
Komoto K106	1998	Japan	105/105	5.60 (2.33-13.4)	Serology, histology
Wu MS107	1998	Taiwan	135/135	2.43 (1.29-4.65)	Serology
Whiting JL108	1998	UK	154/154	1.67 (1.01-2.75)	Serology
Lee BM109	1998	Korea	175/113	5.20 (3.10-8.70)	CLO test
Kikuchi S110	1999	Japan	103/101	15.0 (6.4, 35.2)	Serology
Zhang ZF111	1999	USA	134/65	11.2 (2.5-50.3)	Histology
Cai L112	2000	China	101/101	3.45 (0.90-13.2)	Serology
Enroth H113	2000	Sweden	72/324	2.1 (1.1-3.9)	Serology, histology
Chang WK114	2001	Korea	136/136	1.82 (1.10-3.00)	Serology
Ekstrom AM115	2001	Sweden	298/244	5.0 (1.10-23.6)	Serology
Fujioka N116	2001	Brazil	93/1861 228/2262	0.80 (0.47-1.36) 0.84 (0.54-1.30)	Serology
Konturek SJ117	2002	Poland	337/337	2.59 (1.61-4.22)	Serology
Sriamporn S118	2002	Thailand	111/232	0.60 (0.40-1.0)	Serology
Wu AH119	2003	USA	127/356	1.85 (1.03-3.32)	Serology
Brenner H120	2004	Germany	68/360	18.3 (2.4-136.7)	Serology
Machida-Montani A121	2004	Japan	122/235	8.20 (3.70-18.2)	Serology
Kato M122	2004	Japan	2503/6578	2.47 (2.19-2.79)	Serology
Nomura AM123	2005	Hawaii	299/336	4.86 (5.90-8.13)	Serology

¹Japanese Brazilian;

²non-Japanese Brazilian.

Table 5 Epidemiological studies (cohort nested case-control study) on association between H pylori infection and GC risk

Author	Yr	Geographic area	Case/Control n	OR (95% CI)	Mean follow-up (yr)
Nomura AM124	1991	USA	109/109	6.0 (2.1-17.3)	12
Parsonnet J125	1991	USA	109/109	3.6 (1.8-7.3)	14.2
Forman D126	1991	England	116/484	2.7 (1.0-7.9)	15
Parsonnet J127	1993	USA	136/136	2.62 (1.47-4.69)	21
Blaser MJ128	1995	USA	102/102	1.45 (0.76-2.80)	3
Lin JT129	1995	China, Taiwan	29/220	1.13 (0.81-1.58)	13
Aromaa A130	1996	Finland	80/146	1.50 (0.70-3.22)	6
Webb PM131	1996	China	87/261	0.93 (0.57-1.54)	40
Siman JH132	1997	Sweden	56/224	5.00 (2.20-11.5)	5.7
Watanabe Y133	1997	Japan	45/225	1.84 (1.54-5.72)	8
1Yuan JM°134	1999	China	188/548	1.84 (1.08-3.11)	12
Hansen S135	1999	Norvay	208/208	5.15 (2.83-9.37)	13
You WC136	2000	China	34/2594	1.8 (1.20-2.60)	4.5
Tulinius H137	2001	Iceland	23/128	1.16 (1.05-1.28)	20
Siman JH138	2001	Sweden	56/224	5.0 (2.2-11.2)	5.7
Limburg P139	2001	China	92/192	2.29 (1.26-4.14)	15
Nomura AM140	2002	Hawaii	261/261	2.70 (1.30-5.6)	25
Kosunen TU141	2005	Finland	363/4854	2.49 (1.86-3.34)	24
Shin A142	2005	Korea	86/344	1.06 (0.80-1.40)	2.6
Knekt P143	2006	Finland	225/435	3.12 (1.97-4.95)	15

¹Re-evaluation of the Webb study with ELISA developed and validated among Shanghai residents.

Table 6 Epidemiological studies (hospital-based case-control) on association between dietary factors and H pylori infection and gastric cancer risk

Author	Yr	Geographic area	Case/Control n	Increased risk	Decreased risk	H pylori risk
Sriamporn S118	2002	Thailand	131/262	Salt, fermented foods	Vegetables, fruit	Independent
Lee SA156	2003	Korea	69/199	Salt, kimchi, salt-fermented fish	Vegetables, fruit, soybean curds, broth	Increased
Lopez-Carrillo L157	2003	Mexico	234/468	Capsaicin	--	Independent
Machida-Montani A121	2004	Japan	122/235	Fermented soy bean, rice	--	Independent