Dietary Factors and the Risk of Gastric Cancer in Mexico City

American Journal of Epidemiology, May 1999

Dietary factors play an important role in gastric cancer risk but have not been investigated extensively in Mexico. The authors conducted a population-based case-control study of gastric cancer in the Mexico City, Mexico, metropolitan area in 1989–1990. A total of 220 patients with histologically confirmed gastric adenocarcinomas were interviewed. Controls were an age-stratified random sample of residents of the Mexico City metropolitan area. The dietary questionnaire was a 70-item semiquantitative food frequency adapted for the Mexican diet. Odds ratios were calculated for quartiles of consumption of food groups and were adjusted for age, gender, calories, chili pepper intake, cigarette smoking, socioeconomic status, added salt, and history of peptic ulcer disease. There was approximately a threefold increased risk of gastric cancer for frequent consumption (highest quartile) of both fresh meat (odds ratio (OR) = 3.1) and processed meat (OR = 3.2). Odds ratios were also significantly elevated for frequent consumption of dairy products (OR = 2.7) and fish (OR = 2.2). The authors observed a decreasing gradient of risk with increasing frequency of vegetable consumption due to a significant inverse trend for the yellow and orange vegetables. High intake of citrus fruits showed a slight inverse association. Consumption of salty snacks more than twice per month was associated with an 80 percent increased risk, and there was a significant positive trend. These findings are consistent with many studies around the world that indicate important roles for salt, processed meats, and vegetable consumption in gastric cancer risk. Am J Epidemiol 1999; 149:925–32.

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Dietary Factors and the Risk of Gastric Cancer in Mexico City

Mary H. Ward 1 2 Lizbeth Lopez-Carrillo 0 2 0 Institute Nacional de Salud Publico , Col. Sta. Maria Ahuacatitlan, C.P., Cuernavaca, Morelos, Mexico. Reprint requests to Dr. Lizbeth L6pez-Carrillo , Instituto Nacional de Salud Publico, Av. Universidad no. 655, Col. Sta. Maria Ahuacatitlan , C.P. 62508 Cuernavaca, Morelos , Mexico 1 0ccupational Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, MD 2 Received for publication February 18 , 1998, and accepted for publication September 25, 1999. Abbreviations: Cl, confidence interval; OR, odds ratio; SES, socioeconomic status Dietary factors play an important role in gastric cancer risk but have not been investigated extensively in Mexico. The authors conducted a population-based case-control study of gastric cancer in the Mexico City, Mexico, metropolitan area in 1989-1990. A total of 220 patients with historically confirmed gastric adenocarcinomas were interviewed. Controls were an age-stratified random sample of residents of the Mexico City metropolitan area. The dietary questionnaire was a 70-item semiquantitative food frequency adapted for the Mexican diet. Odds ratios were calculated for quartiles of consumption of food groups and were adjusted for age, gender, calories, chili pepper intake, cigarette smoking, socioeconomic status, added salt, and history of peptic ulcer disease. There was approximately a threefold increased risk of gastric cancer for frequent consumption (highest quartile) of both fresh meat (odds ratio (OR) = 3.1) and processed meat (OR = 3.2). Odds ratios were also significantly elevated for frequent consumption of dairy products (OR = 2.7) and fish (OR = 2.2). The authors observed a decreasing gradient of risk with increasing frequency of vegetable consumption due to a significant inverse trend for the yellow and orange vegetables. High intake of citrus fruits showed a slight inverse association. Consumption of salty snacks more than twice per month was associated with an 80 percent increased risk, and there was a significant positive trend. These findings are consistent with many studies around the world that indicate important roles for salt, processed meats, and vegetable consumption in gastric cancer risk. Am J Epidemiol 1999;149:925-32. case-control studies; diet; stomach neoplasms - Gastric cancer is the second most frequent cause of cancer death in Mexico (1). Mortality from gastric cancer has decreased dramatically in developed countries over the past 40 years. In contrast, over the same time in Mexico and among some Hispanic groups living in the United States, mortality rates of this cancer have remained relatively unchanged (2). Gastric cancer incidence rates vary by more than 20-fold around the world; differences in dietary patterns may explain much of the variation in rates across countries. Infection with the bacterium Helicobacter pylori, which causes inflammation of the gastric mucosa, is a risk factor for gastric cancer (3). However, H. pylori infection may not be sufficient to cause this cancer because only a small percentage of those infected develop this disease. Dietary factors are thought to play a role as cofactors in the progression from gastritis to gastric cancer (3,4). Consistently increased risks have been found for diets low in vegetables and fruit (5-8) and high in salt or salt-preserved foods (5, 6). Other studies found increased risks for diets high in meats processed with salt or nitrite and for overall meat intake (4, 6, 9-12). Lack of refrigeration has been established as a risk factor (4). Other dietary factors possibly associated with an increased risk include a high caloric intake, hightemperature cooking methods for meats, and consumption of smoked foods (4). We conducted a population-based case-control study of gastric cancer in the Mexico City metropolitan area and reported previously that chili pepper consumption was a strong risk factor for gastric cancer (13). Here we report on the association of the intake of meat and other foods and gastric cancer risk. MATERIALS AND METHODS The methods were previously described in detail (13). Briefly, 267 newly diagnosed cases of gastric cancer in patients aged 20 years and older were identified between September 17, 1989, and June 30, 1990, in 15 metropolitan area hospitals in Mexico City. These cases represented approximately 80 percent of those reported to the Mexican National Cancer Registry in the same period. Twenty-two (8.2 percent) of the identified cases were unavailable for interview. A further 20 cases (7.5 percent) were excluded because the pathology material could not be obtained, and five cases (1.9 percent) were excluded because their tumors were not adenocarcinomas of the stomach, leaving 220 cases confirmed as gastric adenocarcinomas. The confirmed adenocarcinomas were further classified according to Lauren (14) into the intestinal type (98 cases), the diffuse type (95 cases), an (...truncated)


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Mary H. Ward, Lizbeth López-Carrillo. Dietary Factors and the Risk of Gastric Cancer in Mexico City, American Journal of Epidemiology, 1999, pp. 925-932, 149/10,