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Diet and gastric cancer risk: an umbrella review of systematic reviews and meta-analyses of prospective cohort studies

  • Review – Cancer Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

Several systematic reviews and meta-analyses evaluated the associations between dietary factors and the incidence of gastric cancer (GC).

Objectives

To evaluate the strength and validity of existing evidence, we conducted an umbrella review of published systematic reviews and meta-analyses that investigated the association between diets and GC incidence.

Methods

We searched the PubMed, Embase, and Cochrane databases for systematic reviews and meta-analyses of prospective cohort studies investigating the association between dietary factors and GC risk. For each association, we recalculated the adjusted summary estimates with their 95% confidence interval (CI) and 95% prediction interval (PI) using a random-effects model. We used the I2 statistic and Egger’s test to assess heterogeneity and small-study effects, respectively. We also assessed the methodological quality of each study and the quality of evidence.

Results

Finally, we identified 16 meta-analyses that described 57 associations in this umbrella review. Of the 57 associations, eight were statistically significant using random-effects, thirteen demonstrated substantial heterogeneity between studies (I2 > 50%), and three found small-study effects. The methodological quality of meta-analyses was classified as critically low for two (13%), low for thirteen (81%), and only one (6%) was rated as high confidence. Quality of evidence was rated high for a positive association for GC incidence with a higher intake of total alcohol (RR = 1.19, 95% CI 1.06–1.34) and moderate-quality evidence to support that increased processed meat consumption can increase GC incidence. Three associations (total fruit, vitamin E, and carotenoids) were determined to be supported by low-quality evidence, and two (pickled vegetables/foods and citrus fruit) were supported by very low-quality.

Conclusions

Our findings support the dietary recommendations for preventative GC, emphasizing lower intake of alcohol and foods preserved by salting. New evidence suggests a possible role for total fruit, citrus fruit, carotenoids, and vitamin E. More research is needed on diets with lower quality evidence.

Registration number

CRD42021255115.

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Acknowledgements

We thank the members of the research for their efforts in collecting materials and writing manuscripts. The authors’ responsibilities were as follows—Yang XB: study design; Liu SJ and Xu JM: literature search and literature screening; data extraction; Liu SJ and Wang CT: data synthesis and statistical analysis; Liu SJ and Wu WZ: drafting of manuscript; Liu SJ and Huang PD: revision of manuscript; Li Q and Xie JH: review of the manuscript. All authors approved the final draft.

Funding

This work was supported by Science and Technology Research Project of Guangdong Provincial Hospital of Chinese Medicine (YN2018ZD02), Science and Technology Planning Project of Guangdong Province (No. 2016A020226036), Science and Technology Planning Project of Guangdong Province (No. 2017B030314166), National Natural Science Foundation of China (No. 81673845), Provincial Natural Science Foundation of Guangdong (No. 2019A1515010638), Special Project of State Key Laboratory of Dampness Syndrome of Chinese Medicine (No. SZ2020ZZ03), and Key-Area Research and Development Program of Guangdong Province (No. 2020B1111100010).

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Authors and Affiliations

  1. School of Second Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China

    Shu-Jun Liu, Pi-Di Huang & Jia-Min Xu

  2. State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 36, Yuexiu District, Guangzhou, 510000, Guangdong, People’s Republic of China

    Qian Li, Jian-Hui Xie, Wen-Zhen Wu & Xiao-Bo Yang

  3. Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China

    Qian Li, Jian-Hui Xie, Wen-Zhen Wu & Xiao-Bo Yang

  4. The First Clinical Medical College, Heilongjiang University of Traditional Chinese Medicine, Harbin, China

    Chen-Tong Wang

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  1. Shu-Jun Liu
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Contributions

XBY: study design; SJL and JMX: literature search and literature screening; data extraction; SJL and CTW: data synthesis and statistical analysis; SJL and WZW: drafting of manuscript; SJL and PDH: revision of manuscript; QL and JHX: review of the manuscript. All authors approved the final draft.

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Correspondence to Xiao-Bo Yang.

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Liu, SJ., Huang, PD., Xu, JM. et al. Diet and gastric cancer risk: an umbrella review of systematic reviews and meta-analyses of prospective cohort studies. J Cancer Res Clin Oncol 148, 1855–1868 (2022). https://doi.org/10.1007/s00432-022-04005-1

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