Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2021; 13(5): 453-461
Published online May 15, 2021. doi: 10.4251/wjgo.v13.i5.453
Sex as an effect modifier in the association between alcohol intake and gastric cancer risk
Jong-Myon Bae
Jong-Myon Bae, Department of Preventive Medicine, Jeju National University College of Medicine, Jeju-si 63243, Jeju, South Korea
Author contributions: Bae JM performed to select related articles, conduct statistical analysis, and write the paper.
Conflict-of-interest statement: The author declares no conflict of interests and no funding sources for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jong-Myon Bae, MD, PhD, Full Professor, Department of Preventive Medicine, Jeju National University College of Medicine, 102 Jejudaehka-ro, Jeju-si 63243, Jeju, South Korea. jmbae@jejunu.ac.kr
Received: November 27, 2020
Peer-review started: November 27, 2020
First decision: February 14, 2021
Revised: February 22, 2021
Accepted: April 13, 2021
Article in press: April 13, 2021
Published online: May 15, 2021
Processing time: 160 Days and 9.9 Hours
Abstract
BACKGROUND

The results of previous meta-analyses evaluating the association between the alcohol intake and gastric cancer risk have reported that a statistical significance only for men.

AIM

To investigate the different association between alcohol intake and gastric cancer risk between men and women.

METHODS

The selection criteria included a prospective cohort study for evaluating alcohol intake and gastric cancer risk, with relative risks adjusted for potential confounders. Adjusted relative risk (RR) for the potential confounders and its 95% confidence interval (CI) in the highest vs lowest level were extracted from each study and a random-effects meta-analysis was conducted. Subgroup analyses by region, level of adjustment for smoking status, adjusting for body mass index, and year of publication were conducted.

RESULTS

A meta-analysis of all 27 cohorts showed that alcohol intake increased the risk of gastric cancer (summary RR = 1.13, 95%CI: 1.04-1.23, I2 = 58.2%). Further, 13 men’s cohorts had higher summary RR while maintaining statistical significance, and only seven women’s cohorts had no statistical significance.

CONCLUSION

The present review suggests that alcohol consumption increases the risk of gastric cancer in men. These findings showed that the sex variable in the association between alcohol intake and gastric cancer risk seemed to be an effect modifier with an interaction term. It is necessary to re-estimate follow-up outcomes after stratifying for sex.

Keywords: Alcohol; Stomach neoplasm; Effect modifier; Cohort studies; Meta-analysis; Risk factors

Core Tip: The present review suggests that alcohol consumption increases the risk of gastric cancer, especially in men. These findings showed that the sex variable in the association between alcohol intake and gastric cancer risk seemed to be an effect modifier with an interaction term. It is necessary to re-estimate follow-up outcomes after stratifying for sex.