Composite Protective Lifestyle Factors and Risk of Developing Gastric Adenocarcinoma: the Singapore Chinese Health Study

Overview

Journal Br J Cancer

Specialty Oncology

Date 2017 Jan 27

PMID 28125822

Citations 17

Authors

Zhensheng Wang

Woon-Puay Koh

Aizhen Jin

Renwei Wang

Jian-Min Yuan

Affiliations

Soon will be listed here.

Abstract

Background: Incidence of gastric cancer is the highest in Eastern Asia. Multiple modifiable lifestyle factors have been identified as risk factors for gastric cancer. However, their aggregated effect on the risk of gastric cancer has not been examined among populations with high prevalence of Helicobacter pylori.

Methods: A study was conducted to examine the association between multiple lifestyle factors together and the risk of developing gastric adenocarcinoma in the Singapore Chinese Health Study, a prospective cohort of 63 257 men and women between 45 and 74 years enroled during 1993-1998. Composite score of cigarette smoking, alcohol consumption, obesity, dietary pattern, and sodium intake at baseline was assessed with hazard ratio (HR) and 95% confidence interval (CI) of gastric adenocarcinoma using Cox regression method.

Results: Higher healthy composite lifestyle scores were significantly associated with reduced risk of gastric adenocarcinoma in a dose-dependent manner. Hazard ratios (95% CIs) for total, cardia, and non-cardia gastric adenocarcinoma for the highest (score 5) vs lowest composite score (score 0/1/2) were 0.42 (0.31-0.57), 0.22 (0.10-0.47), and 0.55 (0.39-0.78), respectively (all P<0.001). These lifestyles together accounted for 48% of total gastric adenocarcinoma cases in the study population. The inverse association was observed in both genders, and remained after exclusion of first 5 years of follow-up.

Conclusions: The inverse association between the aggregated healthy lifestyle factors and the risk of gastric adenocarcinoma is in dose-dependent manner in this highly H. pylori-exposed population. These lifestyle factors together may account for up to half of disease burden in this study population.

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References

. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403):157-63. DOI: 10.1016/S0140-6736(03)15268-3. View

Zhu H, Yang X, Zhang C, Zhu C, Tao G, Zhao L . Red and processed meat intake is associated with higher gastric cancer risk: a meta-analysis of epidemiological observational studies. PLoS One. 2013; 8(8):e70955. PMC: 3743884. DOI: 10.1371/journal.pone.0070955. View

Tu S, Bhagat G, Cui G, Takaishi S, Kurt-Jones E, Rickman B . Overexpression of interleukin-1beta induces gastric inflammation and cancer and mobilizes myeloid-derived suppressor cells in mice. Cancer Cell. 2008; 14(5):408-19. PMC: 2586894. DOI: 10.1016/j.ccr.2008.10.011. View

Ainslie-Waldman C, Koh W, Jin A, Yeoh K, Zhu F, Wang R . Coffee intake and gastric cancer risk: the Singapore Chinese health study. Cancer Epidemiol Biomarkers Prev. 2014; 23(4):638-47. PMC: 4230822. DOI: 10.1158/1055-9965.EPI-13-0886. View

Bianchini F, Kaaks R, Vainio H . Overweight, obesity, and cancer risk. Lancet Oncol. 2002; 3(9):565-74. DOI: 10.1016/s1470-2045(02)00849-5. View

Shin V, Wu W, Chu K, Koo M, Wong H, Lam E . Functional role of beta-adrenergic receptors in the mitogenic action of nicotine on gastric cancer cells. Toxicol Sci. 2006; 96(1):21-9. DOI: 10.1093/toxsci/kfl118. View

Furihata C, Ohta H, Katsuyama T . Cause and effect between concentration-dependent tissue damage and temporary cell proliferation in rat stomach mucosa by NaCl, a stomach tumor promoter. Carcinogenesis. 1996; 17(3):401-6. DOI: 10.1093/carcin/17.3.401. View

. Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum. 2004; 83:1-1438. PMC: 4781536. View

de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D . Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 2012; 13(6):607-15. DOI: 10.1016/S1470-2045(12)70137-7. View

10.

Yang P, Zhou Y, Chen B, Wan H, Jia G, Bai H . Overweight, obesity and gastric cancer risk: results from a meta-analysis of cohort studies. Eur J Cancer. 2009; 45(16):2867-73. DOI: 10.1016/j.ejca.2009.04.019. View

11.

Tramacere I, Negri E, Pelucchi C, Bagnardi V, Rota M, Scotti L . A meta-analysis on alcohol drinking and gastric cancer risk. Ann Oncol. 2011; 23(1):28-36. DOI: 10.1093/annonc/mdr135. View

12.

Jakszyn P, Bingham S, Pera G, Agudo A, Luben R, Welch A . Endogenous versus exogenous exposure to N-nitroso compounds and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST) study. Carcinogenesis. 2006; 27(7):1497-501. DOI: 10.1093/carcin/bgl019. View

13.

Klyosov A . Kinetics and specificity of human liver aldehyde dehydrogenases toward aliphatic, aromatic, and fused polycyclic aldehydes. Biochemistry. 1996; 35(14):4457-67. DOI: 10.1021/bi9521102. View

14.

Pan W, Flegal K, Chang H, Yeh W, Yeh C, Lee W . Body mass index and obesity-related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians. Am J Clin Nutr. 2003; 79(1):31-9. DOI: 10.1093/ajcn/79.1.31. View

15.

Roberts D, Dive C, Renehan A . Biological mechanisms linking obesity and cancer risk: new perspectives. Annu Rev Med. 2009; 61:301-16. DOI: 10.1146/annurev.med.080708.082713. View

16.

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M . Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2014; 136(5):E359-86. DOI: 10.1002/ijc.29210. View

17.

Shin V, Wu W, Ye Y, So W, Koo M, Liu E . Nicotine promotes gastric tumor growth and neovascularization by activating extracellular signal-regulated kinase and cyclooxygenase-2. Carcinogenesis. 2004; 25(12):2487-95. DOI: 10.1093/carcin/bgh266. View

18.

Lunet N, Valbuena C, Vieira A, Lopes C, Lopes C, David L . Fruit and vegetable consumption and gastric cancer by location and histological type: case-control and meta-analysis. Eur J Cancer Prev. 2007; 16(4):312-27. DOI: 10.1097/01.cej.0000236255.95769.22. View

19.

Butler L, Koh W, Lee H, Tseng M, Yu M, London S . Prospective study of dietary patterns and persistent cough with phlegm among Chinese Singaporeans. Am J Respir Crit Care Med. 2005; 173(3):264-70. PMC: 1447591. DOI: 10.1164/rccm.200506-901OC. View

20.

Spiegelman D, Hertzmark E, Wand H . Point and interval estimates of partial population attributable risks in cohort studies: examples and software. Cancer Causes Control. 2007; 18(5):571-9. DOI: 10.1007/s10552-006-0090-y. View