Skip to main content

Advertisement

SpringerLink
Log in

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P (2015) Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc 13(3):132–140

    Article  PubMed  Google Scholar 

  • Bae JM, Kim EH (2016) Dietary intakes of citrus fruit and risk of gastric cancer incidence: an adaptive meta-analysis of cohort studies. Epidemiol Health 38:e2016034

    Article  PubMed  PubMed Central  Google Scholar 

  • Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424

    Article  PubMed  Google Scholar 

  • Cao X, Wan J, Du M, Wang Y, Hou L (2021) Effect of vitamin E succinate-induced endoplasmic reticulum stress to activate JNK expression on autophagy in human gastric cancer SGC-7901 cells. Chin J Cancer Biother 28(02):109–114

    Google Scholar 

  • Carman S, Kamangar F, Freedman ND et al (2009) Vitamin E intake and risk of esophageal and gastric cancers in the NIH-AARP Diet and Health Study. Int J Cancer 125(1):165–170

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Clinton SK, Giovannucci EL, Hursting SD (2019) The World Cancer Research Fund/American Institute for Cancer Research Third Expert Report on diet, nutrition, physical activity, and cancer: impact and future directions. J Nutr 150(4):663–671

    Article  PubMed Central  Google Scholar 

  • Clinton SK, Giovannucci EL, Hursting SD (2020) The World Cancer Research Fund/American Institute for Cancer Research Third Expert Report on diet, nutrition, physical activity, and cancer: impact and future directions. J Nutr 150(4):663–671

    Article  PubMed  Google Scholar 

  • Cui Y, Lu Z, Bai L, Shi Z, Zhao WE, Zhao B (2007) beta-Carotene induces apoptosis and up-regulates peroxisome proliferator-activated receptor gamma expression and reactive oxygen species production in MCF-7 cancer cells. Eur J Cancer 43(17):2590–2601

    Article  CAS  PubMed  Google Scholar 

  • Cumpston M, Li T, Page MJ et al (2019) Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 10:2

    Google Scholar 

  • Deng W, Yang H, Wang J et al (2016) Coffee consumption and the risk of incident gastric cancer—a meta-analysis of prospective cohort studies. Nutr Cancer 68(1):40–47

    Article  CAS  PubMed  Google Scholar 

  • DerSimonian R, Laird N (2015) Meta-analysis in clinical trials revisited. Contemp Clin Trials 45(Pt A):139–145

    Article  PubMed  PubMed Central  Google Scholar 

  • Du S, Li Y, Su Z et al (2020) Index-based dietary patterns in relation to gastric cancer risk: a systematic review and meta-analysis. Br J Nutr 123(9):964–974

    Article  CAS  PubMed  Google Scholar 

  • Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fang X, Wei J, He X et al (2015) Landscape of dietary factors associated with risk of gastric cancer: a systematic review and dose-response meta-analysis of prospective cohort studies. Eur J Cancer 51(18):2820–2832

    Article  PubMed  Google Scholar 

  • Guyatt GH, Oxman AD, Kunz R et al (2011) GRADE guidelines: 7. Rating the quality of evidence–inconsistency. J Clin Epidemiol 64(12):1294–1302

    Article  PubMed  Google Scholar 

  • Guyatt G, Oxman AD, Akl EA et al (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64(4):383–394

    Article  PubMed  Google Scholar 

  • Harbord RM, Egger M, Sterne JA (2006) A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 25(20):3443–3457

    Article  PubMed  Google Scholar 

  • Hazafa A, Rehman KU, Jahan N, Jabeen Z (2020) The role of polyphenol (flavonoids) compounds in the treatment of cancer cells. Nutr Cancer 72(3):386–397

    Article  CAS  PubMed  Google Scholar 

  • Hua S, Kittler R, White KP (2009) Genomic antagonism between retinoic acid and estrogen signaling in breast cancer. Cell 137(7):1259–1271

    Article  PubMed  PubMed Central  Google Scholar 

  • Jain A, Tiwari A, Verma A, Jain SK (2017) Vitamins for cancer prevention and treatment: an insight. Curr Mol Med 17(5):321–340

    CAS  PubMed  Google Scholar 

  • Kang H, Rha SY, Oh KW, Nam CM (2010) Green tea consumption and stomach cancer risk: a meta-analysis. Epidemiol Health 32:e2010001

    Article  PubMed  PubMed Central  Google Scholar 

  • Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F (2014) Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomark Prev 23(5):700–713

    Article  Google Scholar 

  • Kim SR, Kim K, Lee SA et al (2019) Effect of red, processed, and white meat consumption on the risk of gastric cancer: an overall and dose–response meta-analysis. Nutrients 11(4):826

    Article  PubMed Central  Google Scholar 

  • Kong P, Cai Q, Geng Q et al (2014) Vitamin intake reduce the risk of gastric cancer: meta-analysis and systematic review of randomized and observational studies. PLoS One 9(12):e116060

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Li Y, Hahn T, Garrison K et al (2012) The vitamin E analogue α-TEA stimulates tumor autophagy and enhances antigen cross-presentation. Cancer Res 72(14):3535–3545

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lin SH, Li YH, Leung K, Huang CY, Wang XR (2014) Salt processed food and gastric cancer in a Chinese population. Asian Pac J Cancer Prev 15(13):5293–5298

    Article  PubMed  Google Scholar 

  • Liu BH, Lee YK (2003) Effect of total secondary carotenoids extracts from Chlorococcum sp. on Helicobacter pylori-infected BALB/c mice. Int Immunopharmacol 3(7):979–986

    Article  CAS  PubMed  Google Scholar 

  • Luo G, Zhang Y, Guo P, Wang L, Huang Y, Li K (2017) Global patterns and trends in stomach cancer incidence: age, period and birth cohort analysis. Int J Cancer 141(7):1333–1344

    Article  CAS  PubMed  Google Scholar 

  • Mirvish SS (1995) Role of N-nitroso compounds (NOC) and N-nitrosation in etiology of gastric, esophageal, nasopharyngeal and bladder cancer and contribution to cancer of known exposures to NOC. Cancer Lett 93(1):17–48

    Article  CAS  PubMed  Google Scholar 

  • Orywal K, Szmitkowski M (2017) Alcohol dehydrogenase and aldehyde dehydrogenase in malignant neoplasms. Clin Exp Med 17(2):131–139

    Article  CAS  PubMed  Google Scholar 

  • Persson C, Sasazuki S, Inoue M et al (2008) Plasma levels of carotenoids, retinol and tocopherol and the risk of gastric cancer in Japan: a nested case-control study. Carcinogenesis 29(5):1042–1048

    Article  CAS  PubMed  Google Scholar 

  • Raei N, Behrouz B, Zahri S, Latifi-Navid S (2016) Helicobacter pylori infection and dietary factors act synergistically to promote gastric cancer. Asian Pac J Cancer Prev 17(3):917–921

    Article  PubMed  Google Scholar 

  • Ren JS, Kamangar F, Forman D, Islami F (2012) Pickled food and risk of gastric cancer—a systematic review and meta-analysis of English and Chinese literature. Cancer Epidemiol Biomark Prev 21(6):905–915

    Article  Google Scholar 

  • Riley RD, Higgins JP, Deeks JJ (2011) Interpretation of random effects meta-analyses. BMJ 342:d549

    Article  PubMed  Google Scholar 

  • Salaspuro M (2011) Acetaldehyde and gastric cancer. J Dig Dis 12(2):51–59

    Article  CAS  PubMed  Google Scholar 

  • Shea BJ, Reeves BC, Wells G et al (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358:j4008

    Article  PubMed  PubMed Central  Google Scholar 

  • Song PJ (1978) Diet and the etiology of gastric cancer. J Peking Univ 1(01):52–60

    Google Scholar 

  • Song P, Wu L, Guan W (2015) Dietary nitrates, nitrites, and nitrosamines intake and the risk of gastric cancer: a meta-analysis. Nutrients 7(12):9872–9895

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sterne JA, Sutton AJ, Ioannidis JP et al (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 343:d4002

    Article  PubMed  Google Scholar 

  • Tian SB, Yu JC, Kang WM, Ma ZQ, Ye X, Cao ZJ (2014) Association between dairy intake and gastric cancer: a meta-analysis of observational studies. PLoS One 9(7):e101728

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65(2):87–108

    Article  PubMed  Google Scholar 

  • Velmurugan B, Nagini S (2005) Combination chemoprevention of experimental gastric carcinogenesis by s-allylcysteine and lycopene: modulatory effects on glutathione redox cycle antioxidants. J Med Food 8(4):494–501

    Article  CAS  PubMed  Google Scholar 

  • Wallace JL (2001) Nonsteroidal anti-inflammatory drugs and the gastrointestinal tract. Mechanisms of protection and healing: current knowledge and future research. Am J Med 110(1A):19S-23S

    Article  CAS  PubMed  Google Scholar 

  • Wang JB, Fan JH, Dawsey SM et al (2016) Dietary components and risk of total, cancer and cardiovascular disease mortality in the Linxian Nutrition Intervention Trials cohort in China. Sci Rep 6:22619

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wang PL, Xiao FT, Gong BC, Liu FN (2017a) Alcohol drinking and gastric cancer risk: a meta-analysis of observational studies. Oncotarget 8(58):99013–99023

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang T, Cai H, Sasazuki S et al (2017b) Fruit and vegetable consumption, Helicobacter pylori antibodies, and gastric cancer risk: a pooled analysis of prospective studies in China, Japan, and Korea. Int J Cancer 140(3):591–599

    Article  CAS  PubMed  Google Scholar 

  • Weng KG, Yuan YL (2017) Soy food intake and risk of gastric cancer: a dose-response meta-analysis of prospective studies. Medicine (baltimore) 96(33):e7802

    Article  Google Scholar 

  • Yang D, Wang X, Yuan W, Chen Z (2019) Intake of anthocyanins and gastric cancer risk: a comprehensive meta-analysis on cohort and case-control studies. J Nutr Sci Vitaminol (tokyo) 65(1):72–81

    Article  CAS  Google Scholar 

  • Ye Y, Wu Y, Xu J, Ding K, Shan X, Xia D (2017) Association between dietary carbohydrate intake, glycemic index and glycemic load, and risk of gastric cancer. Eur J Nutr 56(3):1169–1177

    Article  CAS  PubMed  Google Scholar 

  • You J, Sun Y, Bo Y et al (2018) The association between dietary isoflavones intake and gastric cancer risk: a meta-analysis of epidemiological studies. BMC Public Health 18(1):510

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Yu Y, Hou L, Song H, Xu P, Sun Y, Wu K (2017) Akt/AMPK/mTOR pathway was involved in the autophagy induced by vitamin E succinate in human gastric cancer SGC-7901 cells. Mol Cell Biochem 424(1–2):173–183

    Article  CAS  PubMed  Google Scholar 

  • Zhang Y (2018) Molecular mechanisms of alcohol-related gastric cancer. Chin Pharmacol Bull 34:906–909

    Google Scholar 

  • Zheng W, Sellers TA, Doyle TJ, Kushi LH, Potter JD, Folsom AR (1995) Retinol, antioxidant vitamins, and cancers of the upper digestive tract in a prospective cohort study of postmenopausal women. Am J Epidemiol 142(9):955–960

    Article  CAS  PubMed  Google Scholar 

  • Zhou Y, Wang T, Meng Q, Zhai S (2016) Association of carotenoids with risk of gastric cancer: a meta-analysis. Clin Nutr 35(1):109–116

    Article  CAS  PubMed  Google Scholar 

Download references

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).

Author information

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

Authors
  1. Shu-Jun Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pi-Di Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jia-Min Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qian Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jian-Hui Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wen-Zhen Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chen-Tong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiao-Bo Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Xiao-Bo Yang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 35 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-022-04005-1

Keywords

Search

Navigation