Cancer Causes & Control

, Volume 22, Issue 5, pp 725–736

Dietary habits and gastric cancer risk in north-west Iran

  • Mohammadreza Pakseresht
  • David Forman
  • Reza Malekzadeh
  • Abbas Yazdanbod
  • Robert M. West
  • Darren C. Greenwood
  • Jean E. Crabtree
  • Janet E. Cade
Original paper



North-west Iran is a high-risk area for gastric cancer (GC). Dietary practices may increase risk of GC. For the first time, the diet–GC association in this area was assessed using a validated food frequency questionnaire.


Cases and controls were recruited in a population-based study. In addition to collecting dietary data using a food frequency questionnaire, Helicobacter pylori antibody level was measured. Multiple logistic regression models were used to estimate odds ratios for associations between dietary factors and GC among 286 cases and 304 controls.


A positive association was estimated for total fat intake (OR = 1.33/20 g, 95% CI: 1.12–1.57) and risk of GC. Inverse associations were observed for vitamin C, iron, and zinc intake and risk of GC and its subgroups (cardia, non-cardia). Fruits and vegetables consumption and refrigerator use showed inverse associations (OR = 0.72/100 g, 95% CI: 0.65–0.80 and OR = 0.75/10 years, 95% CI: 0.60–0.95, respectively). Positive association was observed among those who preferred fried food (OR = 2.21, 95% CI: 1.45–3.37) or consumed highly salted/roasted seeds (OR = 1.97, 95% CI: 1.13–3.43).


GC in north-west Iran is associated with dietary practices: foods, nutrients and food preparation habits.


Diet Gastric cancer Case–control study H. pylori Iran 


  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108PubMedCrossRefGoogle Scholar
  2. 2.
    Parkin DM, Pisani P, Ferlay J (1993) Estimates of the worldwide incidence of eighteen major cancers in 1985. Int J Cancer 54:594–606PubMedCrossRefGoogle Scholar
  3. 3.
    World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity and the prevention of cancer: a global perspective. AICR, WashingtonGoogle Scholar
  4. 4.
    Babaei M, Jaafarzadeh H, Sadjadi AR et al (2009) Cancer incidence and mortality in Ardabil: report of an ongoing population-based cancer registry in Iran, 2004–2006. Iranian J Publ Health 38:35–45Google Scholar
  5. 5.
    Malekzadeh R, Merat S, Derakhshan MH et al (2003) Low Helicobacter pylori eradication rates with 4- and 7-day regimens in an Iranian population. J Gastroenterol Hepatol 18:13–17PubMedCrossRefGoogle Scholar
  6. 6.
    Nouraie M, Pourshams A, Kamangar F et al (2004) Ecologic study of serum selenium and upper gastrointestinal cancers in Iran. World J Gastroenterol 10:2544–2546Google Scholar
  7. 7.
    Pourfarzi F, Whelan A, Kaldor J, Malekzadeh R (2009) The role of diet and other environmental factors in the causation of gastric cancer in Iran—a population based study. Int J Cancer 125:1953–1960PubMedCrossRefGoogle Scholar
  8. 8.
    Hamilton SR, Aaltonen LA (2000) WHO classification of tumors, pathology and genetics of tumors of the digestive system: tumours of the oesophagogastric junction. IARC Press, LyonGoogle Scholar
  9. 9.
    Laurén P (1965) The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma: an attempt at a histo-clinical classification. Acta Pathol Microbiol Scand 64:31–49PubMedGoogle Scholar
  10. 10.
    Pakseresht M (2008) The impact of food and nutrition on the risk of gastric cancer in northwest Iran. University of Leeds, LeedsGoogle Scholar
  11. 11.
    Malekshah AF, Kimiagar M, Saadatian-Elahi M et al (2006) Validity and reliability of a new food frequency questionnaire compared to 24 h recalls and biochemical measurements: pilot phase of Golestan cohort study of esophageal cancer. Eur J Clin Nutr 60:971–977PubMedCrossRefGoogle Scholar
  12. 12.
    Food Standards Agency (2002) McCance and Widdowson’s the composition of foods, 6th edn. Royal Society of Chemistry, CambridgeGoogle Scholar
  13. 13.
    Buiatti E, Palli D, Decarli A et al (1990) A case-control study of gastric cancer and diet in Italy: II. Association with nutrients. Int J Cancer 45:896–901PubMedCrossRefGoogle Scholar
  14. 14.
    Hansson LE, Nyren O, Bergstrom R et al (1994) Nutrients and gastric cancer risk. A population-based case-control study in Sweden. Int J Cancer 57:638–644PubMedCrossRefGoogle Scholar
  15. 15.
    Cave WT (1994) Dietary fat effects on animal models of breast cancer. Adv Exp Med Biol 364:47–58PubMedGoogle Scholar
  16. 16.
    Karmali RA (1983) Prostaglandins and cancer. CA Cancer J Clin 33:322–332PubMedCrossRefGoogle Scholar
  17. 17.
    National Nutrition Institute (2004) Comprehensive national survey of food and nutrition status in Iran, 1999–2002. TehranGoogle Scholar
  18. 18.
    Cornee J, Pobel D, Riboli E, Guyader M, Hemon B (1995) A case-control study of gastric cancer and nutritional factors in Marseille, France. Eur J Epidemiol 11:55–65PubMedCrossRefGoogle Scholar
  19. 19.
    Harrison LE, Zhang ZF, Karpeh MS, Sun M, Kurtz RC (1997) The role of dietary factors in the intestinal and diffuse histologic subtypes of gastric adenocarcinoma: a case-control study in the US. Cancer 80:1021–1028PubMedCrossRefGoogle Scholar
  20. 20.
    Ji BT, Chow WH, Yang G et al (1998) Dietary habits and stomach cancer in Shanghai, China. Int J Cancer 76:659–664PubMedCrossRefGoogle Scholar
  21. 21.
    Lopez-Carrillo L, Lopez-Cervantes M, Ward MH, Bravo-Alvarado J, Ramirez-Espitia A (1999) Nutrient intake and gastric cancer in Mexico. Int J Cancer 83:601–605PubMedCrossRefGoogle Scholar
  22. 22.
    Suh S, Koo B, Choi Y, Lee H (2003) The nutritional intakes of the stomach cancer patients in the Daegu and Gyeongbuk areas, Korea. Korean J Commun Nutr 8:202–219Google Scholar
  23. 23.
    Emerit J, Beaumont C, Trivin F (2001) Iron metabolism, free radicals, and oxidative injury. Biomed Pharmacother 55:333–339PubMedCrossRefGoogle Scholar
  24. 24.
    Mayne ST, Risch HA, Dubrow R et al (2001) Nutrient intake and risk of subtypes of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev 10:1055–1062PubMedGoogle Scholar
  25. 25.
    Chen H, Tucker KL, Graubard BI et al (2002) Nutrient intakes and adenocarcinoma of the esophagus and distal stomach. Nutr Cancer 42:33–40PubMedCrossRefGoogle Scholar
  26. 26.
    Hong L, Han Y, Shi R et al (2005) ZNRD1 gene suppresses cell proliferation through cell cycle arrest in G1 phase. Cancer Biol Ther 4:60–64PubMedCrossRefGoogle Scholar
  27. 27.
    Lee DH, Anderson KE, Folsom AR, Jacobs DR Jr (2005) Heme iron, zinc and upper digestive tract cancer: the Iowa Women’s Health Study. Int J Cancer 117:643–647PubMedCrossRefGoogle Scholar
  28. 28.
    Jacob RA (1996) Introduction: three eras of vitamin C discovery. In: Harris JR (ed) Subcellular biochemistry, vol 25, Ascorbic acid: biochemistry and biomedical cell biology. Plenum Press, New YorkGoogle Scholar
  29. 29.
    Ekstrom AM, Serafini M, Nyren O, Hansson LE, Ye W, Wolk A (2000) Dietary antioxidant intake and the risk of cardia cancer and noncardia cancer of the intestinal and diffuse types: a population-based case-control study in Sweden. Int J Cancer 87:133–140PubMedCrossRefGoogle Scholar
  30. 30.
    Heber D, Blackburn GL, Go VLW, Milner J (2006) Nutritional oncology, 2nd edn. Academic press, LondonGoogle Scholar
  31. 31.
    Dorant E, van den Brandt PA, Goldbohm RA, Sturmans F (1996) Consumption of onions and a reduced risk of stomach carcinoma. Gastroenterology 110:12–20PubMedCrossRefGoogle Scholar
  32. 32.
    Guyonnet D, Belloir C, Suschetet M, Siess MH, Le Bon AM (2000) Liver subcellular fractions from rats treated by organosulfur compounds from Allium modulate mutagene activation. Mutat Res 466:17–26PubMedGoogle Scholar
  33. 33.
    World Cancer Research Fund/American Institute for Cancer Research (1997) Food, nutrition and the prevention of cancer: a global perspective. American Institute for Cancer Research, WashingtonGoogle Scholar
  34. 34.
    Sivam GP, Lampe JW, Ulness B, Swanzy SR, Potter JD (1997) Helicobacter pylori–in vitro susceptibility to garlic (Allium sativum) extract. Nutr Cancer 27:118–121PubMedCrossRefGoogle Scholar
  35. 35.
    Kato I, Tominaga S, Ito Y (1990) A comparative case-control analysis of stomach cancer and atrophic gastritis. Cancer Res 50:6559–6564PubMedGoogle Scholar
  36. 36.
    Botterweck AA, van den Brandt PA, Goldbohm RA (1998) A prospective cohort study on vegetable and fruit consumption and stomach cancer risk in the Netherlands. Am J Epidemiol 148:842–853PubMedGoogle Scholar
  37. 37.
    Ngoan LT, Mizoue T, Fujino Y, Tokui N, Yoshimura T (2002) Dietary factors and stomach cancer mortality. Br J Cancer 87:37–42PubMedCrossRefGoogle Scholar
  38. 38.
    Takenaka S, Sera N, Tokiwa H, Hirohata I, Hirohata T (1989) Identification of mutagens in Japanese pickles. Mutat Res 223:35–40PubMedCrossRefGoogle Scholar
  39. 39.
    Sorbye H, Kvinnsland S, Svanes K (1994) Effect of salt-induced mucosal damage and healing on penetration of N-methyl-N′-nitro-N-nitrosoguanidine to proliferative cells in the gastric mucosa of rats. Carcinogenesis 15:673–679PubMedCrossRefGoogle Scholar
  40. 40.
    International Agency for Research on Cancer (1994) IARC monographs on the evaluation of the carcinogenic risks to humans, Vol 60. Some industrial chemicals. International Agency for Research on Cancer, LyonGoogle Scholar
  41. 41.
    Jagerstad M, Skog K (2005) Genotoxicity of heat-processed foods. Mutat Res 574:156–172PubMedGoogle Scholar
  42. 42.
    van den Brandt PA, Botterweck AA, Goldbohm RA (2003) Salt intake, cured meat consumption, refrigerator use and stomach cancer incidence: a prospective cohort study (Netherlands). Cancer Causes Control 14:427–438PubMedCrossRefGoogle Scholar
  43. 43.
    Crabtree JE, Wyatt JI, Sobala GM, Miller G, Tompkins DS, Primrose JN, Morgan AG (1993) Systemic and mucosal humoral responses to Helicobacter pylori in gastric cancer. Gut 34:1339–1343PubMedCrossRefGoogle Scholar
  44. 44.
    Massarrat S, Saberi-Firoozi M, Soleimani A, Himmelmann GW, Hitzges M, Keshavarz H (1995) Peptic ulcer disease, irritable bowel syndrome and constipation in two populations in Iran. Eur J Gastroenterol Hepatol 7:427–433PubMedGoogle Scholar
  45. 45.
    Kamali-Sarvestani E, Bazargani A, Masoudian M, Lankarani K, Taghavi AR, Saberifiroozi M (2006) Association of H. pylori cagA and vacA genotypes and IL-8 gene polymorphisms with clinical outcome of infection in Iranian patients with gastrointestinal diseases. World J Gastroenterol 12:5205–5210PubMedGoogle Scholar
  46. 46.
    Talebkhan Y, Mohammadi M, Mohagheghi MA et al (2008) cagA gene and protein status among Iranian Helicobacter pylori strains. Dig Dis Sci 53:925–932PubMedCrossRefGoogle Scholar
  47. 47.
    Helicobacter and Cancer Collaborative Group (2001) Gastric cancer and Helicobacter pylori: a combined analysis of 12 case control studies nested within prospective cohorts. Gut 49:347–353CrossRefGoogle Scholar
  48. 48.
    Peek RM, Crabtree JE (2006) Helicobacter infection and gastric neoplasia. J Pathol 208:233–248PubMedCrossRefGoogle Scholar
  49. 49.
    Aromaa A, Kosunen TU, Knekt P et al (1996) Circulating anti-Helicobacter pylori immunoglobulin A antibodies and low serum pepsinogen I level are associated with increased risk of gastric cancer. Am J Epidemiol 144:142–149PubMedGoogle Scholar
  50. 50.
    Kamangar F, Qiao YL, Blaser MJ et al (2007) Helicobacter pylori and oesophageal and gastric cancers in a prospective study in China. Br J Cancer 96:172–176PubMedCrossRefGoogle Scholar
  51. 51.
    Siman JH, Forsgren A, Berglund G, Floren CH (2001) Helicobacter pylori infection is associated with a decreased risk of developing oesophageal neoplasms. Helicobacter 6:310–316CrossRefGoogle Scholar
  52. 52.
    Wu DC, Wu IC, Lee JM et al (2005) Helicobacter pylori infection: a protective factor for esophageal squamous cell carcinoma in a Taiwanese population. Am J Gastroenterol 100:588–593PubMedCrossRefGoogle Scholar
  53. 53.
    Dosemeci M, Wacholder S, Lubin JH (1990) Does non-differential misclassification of exposure always bias a true effect toward the null value? Am J Epidemiol 132:746–748PubMedGoogle Scholar
  54. 54.
    Godwin SL, Chambers IV E, Cleveland L (2004) Accuracy of reporting dietary intake using various portion-size aids in-person and via telephone. J Am Diet Assoc 104:585–594PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Mohammadreza Pakseresht
    • 1
    • 2
  • David Forman
    • 3
    • 4
  • Reza Malekzadeh
    • 5
  • Abbas Yazdanbod
    • 6
  • Robert M. West
    • 7
  • Darren C. Greenwood
    • 7
  • Jean E. Crabtree
    • 8
  • Janet E. Cade
    • 2
  1. 1.Department of Epidemiology and BiostatisticsSchool of Health, Yazd Shahid Sadoughi University of Medical SciencesYazdIran
  2. 2.Nutritional Epidemiology Group, Centre for Epidemiology and BiostatisticsLeeds Institute of Genetics, Health and Therapeutics, University of LeedsLeedsUK
  3. 3.Section of Cancer InformationInternational Agency for Research on CancerLyonFrance
  4. 4.Cancer Epidemiology Group, Centre for Epidemiology and BiostatisticsLeeds Institute of Genetics, Health and Therapeutics, University of LeedsLeedsUK
  5. 5.Digestive Diseases Research CenterTehran University of Medical SciencesTehranIran
  6. 6.Ardabil University of Medical SciencesArdabilIran
  7. 7.Division of Biostatistics, Centre for Epidemiology and BiostatisticsLeeds Institute of Genetics, Health and Therapeutics, University of LeedsLeedsUK
  8. 8.Section of Molecular GastroenterologyLeeds Institute of Molecular Medicine, University of LeedsLeedsUK

Personalised recommendations