A case-control study of stomach cancer and its relation to diet,cigarettes, and alcohol consumption in Saitama Prefecture,Japan

A case-control study of stomach cancer in relation to dietary, smoking, and drinking habits was undertaken in Saitama Prefectur, Japan. The study was based on 294 cases of newly diagnosed adenocarcinoma of the stomach at a single institution, 294 general population controls (matched by sex, age, and administrative division), and 202 hospital controls. Dietary habits were investigated based on the intake of 12 separate foods and 12 food groups in a food frequency questionnaire, together with individual food preferences. The consumption of raw vegetables was inversely related to the risk of stomach cancer, with a dose-response relation observed consistently in the comparisons with both sets of controls. Current cigarette smokers (1–29/day) had an increased risk (relative risk = 1.8,95 percent confidence interval = 1.1–3.0) compared with nonsmokers in the general population controls, but no dose-response effect with heavier cigarette smoking. Alcohol use did not affect the risk of stomach cancer. In the multiple logistic regression, the comsumption of raw vegetables showed a protective effect on stomach cancer while cigarette smoking had no significant association, in both sets of controls.Drs Hoshiyama and Sasaba are in the Department of Epidemiology, Saitama Cancer Center Research Institute, Japan. Address correspondence to Dr Hoshiyama, Komuro 818, Ina, Saitama 362, Japan.     

Associations of Japanese food intake with survival of stomach and colorectal cancer: A prospective patient cohort study

Dietary factors may affect the prognosis of digestive tract cancer, but evidence has been sparse. We investigated the association between pretreatment intake of 6 Japanese foods (including soy food, miso [soybean paste] soup and seaweed) and the risk of death among patients with histologically confirmed major digestive tract cancers (stomach, 1931; colon, 793; rectum, 510) diagnosed during 1997‐2013 at a single institution in Japan. Pretreatment dietary intake was assessed using a food frequency questionnaire, and the patients were followed until December 2016. The Cox proportional hazards model was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Among the patients with stomach cancer, frequent intake of soy food was inversely associated with the risk of all‐cause (P_trend for four frequency groups = 0.01; HR = 0.72, 95% CI: 0.50‐1.04 for highest vs lowest group) and stomach cancer (P_trend = 0.03; HR = 0.63, 95% CI: 0.40‐0.99) death. A similar inverse association was also found for intake of miso soup. In contrast, frequent seaweed intake was inversely associated with the risk of all‐cause death among the patients with colon cancer (P_trend = 0.03). Rectal cancer patients who had frequently consumed seaweed tended to have a lower risk of rectal cancer death (P_trend = 0.02). These findings indicate that pretreatment intake of Japanese foods such as soybean products and seaweed may have favorable effects on patient survival of stomach and colorectal cancer, although this needs to be confirmed by further research.     

生活习惯和饮食与胃癌发生的相关性研究

目的:探讨生活习惯和饮食等危险因素与胃癌发生的关系。方法:采用病例对照研究,胃癌患者97例,非胃癌肿瘤患者77例为对照组,调查患者的一般情况、既往史及家族史、饮食摄入情况、生活居住环境以及饮酒和吸烟史等,饮食部分的调查采用频数法。对资料进行单因素和多因素非条件Logistic回归分析。结果:单因素分析结果,饮酒、吸烟年限长、有胃癌家族史和喜吃腌制食物是胃癌的危险因素,OR值分别为2.456、2.333、3.060和1.959;清淡、酸性食物、喝绿茶和喝茶年限超过20年是胃癌的保护性因素,OR值分别为0.402、0.297、0.402和0.331;多因素分析结果,腌制食物、吸烟年限长、胃癌家族史是胃癌的危险因素,而清淡饮食和喝茶年限长是胃癌的保护性因素。结论:腌制食物、吸烟年限长和胃癌家族史可增加胃癌的发病风险,而清淡饮食和喝茶年限长可降低胃癌发生的危险性。     

Protective Effect of Allium Vegetables against Both Esophageal and Stomach Cancer: A Simultaneous Case-referent Study of a High-epidemic Area in Jiangsu Province, China

To study the relation between allium vegetable intake and cancer of the esophagus (EC) and stomach (SC) in Yangzhong city, which is one of the highest-risk areas for these cancers in Jiangsu province, China, a simultaneous case-referent study was conducted using histopathologically confirmed cases (EC: n=81, SC: n=153) and population-based referents (n=234). A questionnaire was used to collect information on the general status of subjects, their dietary habits, frequency intake of allium vegetables and other foods, tea consumption, smoking and alcohol drinking. The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by a multiple logistic regression model. The results showed that frequent intake of allium vegetables (including garlic, onion, Welsh onion and Chinese chives), raw vegetables, tomatoes and snap beans, and tea consumption were inversely associated with the risk for EC and SC. In the highest consumption category (≥1 time/ week) of garlic, onion, Welsh onion and Chinese chives, the adjusted ORs compared with the lowest category (<1 time/month) were 0.30 (CI=0.19−0.47), 0.25 (CI=0.11−0.54), 0.15 (CI=0.08−0.26), and 0.57 (CI=0.23−1.42) for EC, and 0.31 (CI=0.22−0.44), 0.17 (CI=0.08−0.36), 0.22 (CI=0.15−0.31) and 0.40 (CI = 0.17−0.94) for SC, respectively. The main results in the present study suggested that allium vegetables, like raw vegetables, may have an important protecting effect against not only stomach cancer, but also esophageal cancer.     

Diet and cancer of the stomach: a case-control study in China

A case-control study focusing on the role of single food items was undertaken in the Heilongjiang area, 241 patients with histologically verified stomach cancer and an equal number of controls (with non-neoplastic diseases) matched by age, sex and area of residence being interviewed during a 2-year period. Questions asked covered economic status, occupation, histories of smoking and drinking, diet and dietary habits and disease history. Data concerning the average frequency and quantity of consumption of single food items were obtained by the same interviewer. An inverse association between the consumption of vegetables and stomach cancer was observed whereas high intake of potatoes and of salted and fermented soya paste appeared to be high-risk factors. Specifically, Chinese cabbage plays an important role in reducing the risk of developing stomach cancer.     

Salty Food Intake and Risk of Helicobacter pylori Infection

To clarify the risk factors for Helicobacter pylori infection, which is considered to play an etiologic role in atrophic gastritis, duodenal ulcer and gastric cancer, various parameters including diet and socioeconomic characteristics were compared between H. pylori -infected and non-infected men. In a cross-sectional study of 634 men aged 40 to 49 years selected randomly from five areas with different rates of gastric cancer mortality, 474 of 628 men evaluated were positive for IgG antibody against H. pylori . After logistic regression analysis adjusted for area, the results showed a significant association between frequent intake of pickled vegetables and prevalence of H. pylori antibody (odds ratios against men who consume < 1 day/week were 1.19 for 1–2 days/week, 1.92 for 3–4 days/week, 1.90 for 5–7 days/week; P for trend = 0.02). Daily consumption of miso soup was also associated with an increased risk (odds ratio against non-daily consumer = 1.60, 95% confidence interval = 1.03–2.49). Occupation, number of siblings, education, smoking and alcohol drinking, and other dietary habits were not significantly associated with the prevalence of infection in this population. Although there are limitations in a cross-sectional study such as this, consumption of salty foods appears to increase the risk of H. pylori infection, which could be a marker of salty food intake or an intermediate risk factor in the etiologic sequence between salty food intake and gastric cancer.     

Esophageal cancer in Shanxi Province,People's Republic of China: a case-control study in high and moderate risk areas

Dietary, smoking, and drinking habits, as well as sociopsychological factors and familial history, were investigated in a case-control study on the etiology of esophageal cancer (EC) in two areas of Shanxi (Yangcheng and Linfen), north central China. Data were analyzed from 326 cases and 396 controls. We identified several factors associated with high or low risk; some were common across the areas and others were area-specific. Consumption of millet gruel was associated positively with EC, in a dose-response relationship. An increase in EC risk was seen for consumption of millet soup with noodles, and also with certain sociopsychological factors, in both areas. A large increase in risk was found with consumption of boiled vegetables in Linfen, with a dose-response relationship. EC risk tended to become greater with the increasing intake of moldy foods and of pickled vegetable juice. A positive association between EC risk and family history of EC was observed only in Yangcheng. Soybean consumption was found to be associated with reduced risk. Dental hygiene (brushing teeth) was associated with reduced risk in Linfen. There was a suggestion of increased risk associated with heavy tobacco smoking, but it was not significant in either area. Alcohol consumption had a marginally significant association with risk in the high risk area, but not in Linfen.Drs Y-P Wang, Han, Su, Y-L Wang, and Zhu are in the Shanxi Cancer Institute, PR China. Drs Sasaba, Nakachi, and Hoshiyama are with the Division of Epidemiology at Saitama Cancer Center Research Institute, Japan. Dr Tagashira is in the Saitama Cancer Center Research Institute, Japan. Address correspondence to Dr Sasaba, Ina, Saitama 362, Japan.     

Lung cancer risks in relation to vegetable and fruit consumption and smoking

In a case-control study on lung cancer, risk was analysed in relation to smoking habits and frequency of vegetable and fruit consumption. Lung cancer cases in West Sweden and population controls were interviewed using a questionnaire where the frequency of consumption of dietary items and smoking habits were assessed. The material presented comprises 177 female and 359 male confirmed cases of lung cancer and 916 population controls. There was a dose-response relationship in regard to the number of cigarettes smoked and the number of years smoked, the latter factor being more important. After adjustment for number of cigarettes smoked/day and number of years smoked, the risk for those who seldom consumed vegetables was about twice of that among those who consumed vegetables frequently, both among nonsmokers, smokers and former smokers. This risk increase in relation to vegetable consumption also was present for different smoking categories. A similar tendency, although less pronounced, was found for fruit consumption. The results demonstrate that dietary factors are related to the risk for lung cancer, although smoking is the dominant risk factor.     

A Case Control Study on Risk Factors for Stomach Cancer in Urban Shanghai

Objective To examine the possible risk factors for stomach cancer among men and women in Shanghai, China. Methods In urban Shanghai, in-person interviews were completed for 311 cases newly diagnosed with stomach cancer of ages 30 -74. Data were collected from April 1999 to October 1999 and compared to 1579 population-based controls (controls in three cancer studies used together). Information on demographic variables, smoking, diet consumption and others was collected from all subjects. Unconditional logistic regression was used to adjust the possible factors. Results Stomach cancer risk in men rose with smoking, eating hot and fried foods, chronic gastritis and a family history of gastric cancer among men; the risk among women was associated with the consumption of preserved, pickled and fried foods, heavy drinking, chronic gastritis, a history of ulcer disease and a family history of gastric cancer. A dose-response relationship was found (trends test,P<0.01) among men smokers. In contrast, the consumption of fresh vegetables and fruits, beans (especially soybeans) and soy products, plant oil, and eggs and egg products, was inversely associated with stomach cancer risk. After adjustment of the potential confounding variables, these associations remained significant. Conclusions The present findings provide further evidence that smoking, eating salted foods (especially salted vegetables), oil-fried foods(including fried cereal, eggs, and peanuts), chronic gastritis, a family history of gastric cancer and so on increase the risk of stomach carcinoma in Shanghai. Fresh vegetables and fruits, beans and soybean products (even after adjusted for use of fresh vegetables and fruits), plant oil, and so on may have protective effects.     

Assessment of Risk Factors in Laryngeal Cancer in India : A Case- Control Study

Cancer of the larynx is fourteenth most common cancer in the world. Limited data are available from India on ‍associations with risk factors and hence the present hospital based matched case-control study was conducted. ‍Three hundred and five laryngeal cancer patients and an equal number of healthy controls matched for their age ‍within 2 years, sex and place of residence constituted the study population. A pre-tested, semi-structured questionnaire ‍was administered to each individual to elicit information on their socio-demographic profile, food habits and risk ‍factors and dietary consumption patterns. Univariate logistic regression analysis and multivariate forward stepwise ‍conditional logistic analysis were performed. In the univarite analysis a lower consumption of roots and tubers ‍green leaf vegetable other vegetables and fruits, and higher consumption of milk, eggs, meat, tea, alcohol , smoking, ‍consumption of betel leaf with tobacco as well as a preference for spicy and fried foods emerged as significant ‍positive variables. After adjusting for education, years of use of alcohol, smoking, chewing of betel leaf with tobacco ‍in the model, low green leafy vegetables and preference for spicy foods were found to be positively related to the risk ‍of laryngeal cancer. There was a significant difference in the dietary consumption patterns of laryngeal cancer ‍patients and controls, indicating a role for nutritional factors in the etiology of laryngeal cancer in the Indian ‍population. ‍     

泰安市主要恶性肿瘤病例对照研究

 目的　探讨泰安市主要恶性肿瘤相关危险因素及保护因素。方法　对泰安市主要恶性肿瘤食管癌、肺癌、胃癌、肝癌进行1∶1配对病例对照研究,应用条件Logistic回归对相关因素进行单因素和多因素分析。结果　食管癌和胃癌的共同危险因素为喜食干、硬、烫、油炸、动物性食物,大量饮酒、家族癌症史,主食煎饼与食管癌发病有关;经常吸烟、居住地及其周围有污染源增加肺癌的患病概率;乙肝病毒感染、慢性肝病史、情绪不稳定、暴饮暴食是影响肝癌发病的重要危险因素。经常饮茶对4种恶性肿瘤具有保护作用,生吃大蒜、常吃蔬菜水果、奶类豆类食品对预防食管癌、胃癌的发生均有保护作用。结论　在人群中倡导适当锻炼,戒烟限酒,心理平衡,养成良好的饮食和膳食习惯,能够有效预防主要恶性肿瘤的发生。     

Salt Processed Food and Gastric Cancer in a Chinese Population

To investigate the association between salt processed food and gastric cancer, a hospital based case-control study was conducted in a high risk area of China. One hundred and seven newly diagnosed cases with histological confirmation of gastric cancer and 209 controls were recruited. Information on dietary intake was collected with a validated food frequency questionnaire. Unconditional logistic regression was applied to estimate the odds ratios with adjustment for other potential confounders. Comparing the high intake group with never consumption ofsalt processed foods, salted meat, pickled vegetables and preserved vegetables were significantly associated with increased risk of gastric cancer. Meanwhile, salt taste preference in diet showed a dose-response relationship with gastric cancer. Our results suggest that consumption of salted meat, pickled and preserved vegetables, are positively associated with gastric cancer. Reduction of salt and salt processed food in diets might be one practical measure to preventing gastric cancer.     

Dietary Protective and Risk Factors for Esophageal and Stomach Cancers in a Low-epidemic Area for Stomach Cancer in Jiangsu Province, China: Comparison with Those in a High-epidemic Area

Comparative epidemiological studies with ecological and case-control approaches in high- and low-epidemic areas of China have provided us with much evidence with regard to risk and benefit in the environment. To clarify how dietary factors are involved in esophageal and stomach cancer development, we performed a case-control study in a low-epidemic area, and compared the findings with those obtained earlier for a high-epidemic area for stomach cancer in the same Jiangsu Province, China. We recruited 199 and 187 cases with esophageal and stomach cancers, respectively, and 333 population-based common controls. Odds ratios (ORs) for esophageal and stomach cancers were calculated with adjustment for potential confounding factors, using an unconditional logistic model. Current and former smoking elevated the OR for esophageal cancer, along with high intake of pickled vegetables and broiled meat, while decreased ORs were observed for frequently consumed raw vegetables and garlic. With regard to stomach cancer, ORs were increased with frequent consumption of salty fish, leftover gruel, and broiled meat, and lowered by snap bean consumption. The present risk factors were common to the previously obtained results in the high-epidemic area, and similarly distributed in each general population. While more protective factors were observed in the high-epidemic area, their penetrance was much greater in the low-epidemic area. The present study thus suggests that frequent vegetable and garlic consumption contributes to low mortality rates for esophageal and stomach cancers in a low-epidemic area, counteracting similar exposure levels for risk factors as in the high-epidemic area
.     

Relationship of hepatocellular carcinoma to soya food consumption: a cohort-based, case-control study in Japan

To determine if the risk of hepatocellular carcinoma (HCC) is reduced by consumption of soya foods, we conducted a case-control study within a cohort of Japanese A-bomb survivors. We compared the prediagnosis consumption of isoflavone-rich miso soup and tofu to HCC risk, adjusting for hepatitis B (HBV) and C (HCV) viral infections, the major HCC risk factors in this population. The study included 176 pathologist-confirmed cases of HCC diagnosed in 1964-1988 and 560 controls who died of diseases other than liver cancer. We examined dietary information collected at least 2 years before diagnosis or death and tissue-based measures of viral hepatitis. Using logistic regression, crude ORs were 0.5 (95% CI 0.29-0.95) and 0.5 (95% CI 0.20-0.99) for high vs. low miso soup and tofu intake, respectively. Adjusting for year of birth, sex, HBV, HCV and other factors, the OR for miso soup was unchanged at 0.5 (95% CI 0.14-1.55), and miso results were similar when ORs were recalculated separately for earlier and later birth cohorts to assess consistency of results. The adjusted OR for tofu was 0.9 (95% CI 0.20-3.51). We also found a statistically significant (p < 0.0001) interaction between sex and HCV, with risk of HCC being substantially higher for women. We conclude that consumption of miso soup and other soya foods may reduce HCC risk.     

Evaluation of dietary and life-style habits of patients with gastric cancer: a case-control study in Turkey

Objective: Gastric cancer is an important public health problem in the world and Turkey. In addition toHelicobacter pylori (H. pylori), smoking, alcohol consumption and family history, certain dietary factors havebeen associated with its occurrence. The impact of dietary habits and life-style factors on the risk of gastriccancer in Turkey were evaluated in this study. Design: A questionnaire was applied to 106 patients with gastricadenocarcinoma and 106 controls without cancer matched for age (range 28-85 years) and gender selected froma hospital based population. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated withlogistic regression analysis. Results: The incidence of H. pylori was 81.3% in patients. Frequent consumption ofsalty dishes, very salty foods like pickles, soup mixes, sausages, foods at hot temperature (ORs = 3.686, 7.784,5.264, 3.148 and 3.273 respectively) and adding salt without tasting (OR = 4.198) were associated with increasedgastric risk. Also heavy smoking and high amount of alcohol consumption (p = 0.000) were risk factors. Frequentconsumption of green vegetables, onion, garlic and dried fruits (ORs = 0.569, 0.092, 0.795 and 0.041) was nonsignificantlyassociated with decreased risk. Conclusion: Improved dietary habits, reducing salt consumptionand eradication of H. pylori infection may provide protection against gastric cancer in Turkey.     

Factors Related to Late Menopause and Early Menarche as Risk Factors for Breast Cancer

To investigate underlying factors of late menopause and early menarche which are regarded as risk factors for breast cancer, we analyzed the relationships between ages at menarche and menopause, and other environmental and physical factors using the data of a population-based survey conducted in Aichi Prefecture, Japan. The analysis on menopause was based on 3,148 women aged 55 or more and the analysis on menarche was based on 16,392 women aged 40 or more. These subjects were grouped into three groups (early, average and late groups) according to their ages at menopause and menarche. Women with late menopause had larger height, weight and body mass index and included more professional, administrative and office workers, more daily fish & shellfish consumers and more women with colorectal cancer history of the mother and less current smokers. Women with early menarche also had larger height, weight and body mass index and more residence in a metropolitan area and consumed more bread, meats, fish & shellfish, vegetables, fruits, milk and black tea and less rice, miso soup and pickles. In a multiple regression analysis, occupation, weight, daily or occasional drinking and daily intake of fish & shellfish were positively and smoking was inversely associated with late menopause, while residence in a metropolitan area, weight and daily intakes of bread, milk and green-yellow vegetables were positively associated with early menarche. These results suggest the importance of underlying factors of early menarche and late menopause in the etiology and prevention of breast cancer.     

Dietary soy and isoflavone intake and risk of colorectal cancer in the Japan public health center-based prospective study

Several experimental studies have reported that the anticarcinogenic properties of dietary soy play an important role in preventing colorectal cancer. However, few epidemiologic studies have examined this association in general populations and their findings have been inconsistent. We investigated the association between dietary soy and isoflavone intake and incidence of colorectal cancer in a prospective cohort study of 83,063 Japanese men and women, ages 45 to 74 years. Dietary soy and isoflavone intake was measured through a validated food frequency questionnaire in 1995 and 1998. Throughout 2004, a total of 886 cases of colorectal cancer were newly identified (291 proximal colon, 286 distal colon, and 277 rectum). The hazard ratios and 95% confidence intervals (95% CIs) were estimated by fitting a Cox proportional hazards model. The intake of isoflavones, miso soup, and soy food was not associated with colorectal cancer in either men or women. By colorectal cancer subsite, the risk of proximal colon cancer in men decreased with increasing consumption of isoflavones, miso soup, and soy food. Compared with men in the lowest quartiles of isoflavones, miso soup, and soy food intake, the hazard ratios in the highest quartiles were 0.55 (95% CI, 0.33-0.92), 0.72 (95% CI, 0.43-1.21), and 0.51 (95% CI, 0.30-0.87), respectively. The results showed no association for distal colon and rectal cancer in men or for subsites of colorectal cancer in women. These findings suggest that the intake of isoflavones, miso soup, and soy food has no substantial effect on the risk of colorectal cancer in Japanese men and women.     

A prospective study of stomach cancer and its relation to diet, cigarettes, and alcohol consumption

From 1965 to 1968 in Hawaii, 7990 American men of Japanese ancestry were interviewed and examined in a cohort study. The intake of 20 separate foods in a food frequency questionnaire and the intake of carbohydrate and other nutrients, based on a 24-h diet recall history, were recorded. Since then, 150 incident cases of stomach cancer have been identified. Although men with stomach cancer (cases) consumed pickles and ham/bacon/sausages more often and fruits and fried vegetables less often than men without cancer (noncases), none of the differences was statistically significant. Current cigarette smokers had an increased risk (relative risk = 2.7; 95% confidence interval = 1.8 to 4.1) compared with nonsmokers, but there was no dose-response effect with heavier cigarette smoking. The consumption of alcohol, either from beer, spirits, or wine, did not affect the incidence of stomach cancer. The failure to detect an association with dietary foods in this study may be due to the omission of many oriental foods in the questionnaire and the limitations of the 24-h diet recall history.     

Dietary factors and stomach cancer mortality

The present study examined the relationship between stomach cancer and the low intake of fresh fruit and vegetables and/or a high intake of pickled, preserved or salted foods and frequent use of cooking oil. During 139,390 person-year of follow-up of over 13,000 subjects, 116 died from stomach cancer. Using a Cox proportional hazards-regression analysis of relative risk (RR, 95% CI) controlling for age, sex, smoking and other dietary factors, a significant decline was found with a high consumption of green and yellow vegetables (RR=0.4, 95% CI=0.2-0.9). Reductions of between 40 and 50% were also observed with a high consumption of fresh foods (fruit, cuttle fish, tofu, and potatoes), but these associations were not statistically significant. The risk was significantly increased by the high consumption of processed meat (RR=2.7, 95% CI=1.0-7.4) and by the frequent use of cooking oil (RR=4.0, 95% CI=1.3-11.8). The high consumption of pickled food and traditional soups also increased risk, but not significantly. The findings suggest that a diet high in salt and low in vitamins may be associated with an increase in stomach cancer.     

Per capita foods/nutrients intake and mortality from gastrointestinal cancers in Japan

Analytical epidemiologic studies are less effective when dietary habits are homogenous within a population. For that reason, we performed chronological and spatial correlation analyses between mortality from stomach and large intestinal cancers and various foods/nutrients intakes. The age-adjusted death rates (AADRs) for male colon cancer were strongly associated with the population size and those for female colon cancer and male rectal cancer were weakly associated with the population size, but the AADRs for stomach cancer in both sexes and those for female rectal cancer were not associated. From 1969-71 to 1981-83, the AADRs for stomach and female rectal cancers decreased and the AADRs for colon and male rectal cancers increased. With an increasing population size and from the earlier period to the recent period, the intakes of western-style fat-rich foods such as butter & margarine, cheese and ham & sausage increased and those of rice, fish and some traditional Japanese foods decreased. The results of geographical correlation analyses were generally consistent with the results from the urban-rural variations. The chronological correlation analyses suggested that stomach cancer might be associated with Japanese-style dietary habits after almost no lag time and colon cancer might be associated with westernized dietary habits after a lag time of about 10 years.