The Mini-Gastric Bypass Surgery

Cereal fiber intake may reduce risk of gastric adenocarcinomas: the EPIC-EURGAST study.

Department of Epidemiology, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain.

Numerous case-control studies suggest dietary fiber may reduce risk of gastric cancer, but this has not been confirmed prospectively. A previous case-control study reported reduced risk of gastric cardia adenocarcinomas associated with cereal fiber, but not with fruit or vegetable fiber. To date, different food sources of fiber have not been examined with respect to noncardia tumors or diverse histologic sub-types. This study prospectively examines associations between fiber from different food sources and incident gastric adenocarcinomas (GC) among more than 435,000 subjects from 10 countries participating in the European Prospective Investigation into Cancer and Nutrition study. Subjects aged 25-70 years completed dietary questionnaires in 1992-98, and were followed up for a median of 6.7 years. About 312 incident GCs were observed. The relative risk of GC was estimated based on cohort-wide sex-specific fiber intake quartiles using proportional hazards models to estimate hazards ratios (HRs) and 95% confidence intervals (CIs). Intakes of cereal fiber, but not total, fruit or vegetable fiber, were associated with reduced GC risk [adjusted HR for the highest vs. lowest quartile of cereal fiber 0.69, 0.48-0.99]. There was a strong inverse association for diffuse [HR 0.43, 0.22-0.86], but not intestinal type [HR 0.98, 0.54-1.80] tumors. Associations for cardia vs. noncardia tumors were similar to those for overall GC, although cardia associations did not reach significance. Cereal fiber consumption may help to reduce risk of GC, particularly diffuse type tumors. Further study on different food sources of fiber in relation to GC risk is warranted to confirm these relationships.

PMID: 17582605 [PubMed - indexed for MEDLINE]

Fiber intake and risk of adenocarcinomas of the esophagus and stomach.

Department of Preventive Medicine, University of Southern California, Keck School of Medicine, 1441 Eastlake Avenue, MS#44, Los Angeles, CA 90089-9175, USA. annawu@hsc.usc.edu

BACKGROUND: Since the 1970s, incidence rates for esophageal and gastric cardia adenocarcinomas have risen substantially for reasons that are not well understood. We sought to determine the role of dietary factors in these tumor types. METHODS: This analysis on dietary factors included 206 esophageal adenocarcinoma, 257 gastric cardia, 366 distal gastric adenocarcinoma patients and, 1,308 control subjects from a population-based, case-control study conducted in Los Angeles County. Polytomous logistic regression was used to calculate odds ratios (ORs), as an estimate of the relative risk, and corresponding 95% confidence intervals (CIs) for the three tumor types. RESULTS: Intake of fiber had a significant impact on risk of esophageal and gastric cardia adenocarcinoma after adjustment for age, gender, race, birthplace, education, cigarette smoking, body size, history of reflux, and vitamin use. Compared to subjects in the lowest quartile of fiber intake, subjects in the highest quartile of intake showed odd ratios of 0.44 (95% CI = 0.26-0.76) for esophageal adenocarcinoma (P trend = 0.004) and 0.58 (95% CI = 0.38-0.88) for gastric cardia adenocarcinoma (P trend = 0.016); these inverse associations remained after further adjustment for intake of fat. Positive associations between dietary fat and the three tumor types weakened after adjustment for fiber intake and were no longer statistically significant. For distal gastric cancer, a significant inverse association with fiber was observed only after adjustment for fat intake. The significant inverse associations with fiber remained after further adjustment for H. pylori infection for all three tumor types. CONCLUSIONS: High intake of fiber was associated with significant reduced risks of esophageal and gastric cardia adenocarcinoma even after adjustment for dietary fat, H. pylori infection and other covariates.

PMID: 17562192 [PubMed - indexed for MEDLINE

Case-control study of diet and other risk factors for gastric cancer in Hawaii (United States).

Cancer Research Center of Hawaii, University of Hawaii, Honolulu, Hawaii 96822, USA. abe@crch.hawaii.edu

OBJECTIVE: To investigate the association of diet and other factors with gastric adenocarcinoma of the distal stomach. METHODS: Three hundred cases and 446 population-based controls were interviewed with a quantitative, food frequency questionnaire, which listed over 250 foods. The questionnaire also included information on smoking history, alcohol intake, education, medical history, medication use, and a family history of cancer. RESULTS: Cigarette smoking, family history of gastric cancer and personal history of gastric ulcer were positively associated with gastric cancer, while education and past use of non-steroidal anti-inflammatory drugs were inversely related to risk. The consumption of all vegetables, mainly dark green, light green, and yellow vegetables, reduced risk. Many of these vegetables contain beta-carotene, vitamin C, vitamin E or folate, which were also inversely related to gastric cancer risk. When these nutrients were analyzed simultaneously, the inverse association was mainly with beta-carotene. The intake of processed meats and bacon was positively associated with gastric cancer risk, but primarily in men. When we simultaneously adjusted these meats for the intake of the different vegetables, the association was no longer significant. CONCLUSIONS: These findings provide additional support that the consumption of dark green and yellow vegetables are protective against adenocarcinoma of the distal stomach.

PMID: 12948286 [PubMed - indexed for MEDLINE

Nutrition and diet in the development of gastrointestinal cancer.

Arizona Cancer Center, University of Arizona, 1515 N Campbell Avenue, PO Box 245024, Tucson, AZ 85724-5024, USA. cthomson@u.arizona.edu

Diet plays a role in the prevention and development of gastrointestinal cancers. The majority of available research consists of case-control studies, but the number of clinical trials is growing. The dietary recommendations to reduce gastrointestinal cancer risk include lowering total energy, fat, and saturated fat intake; avoidance of grilled and smoked foods; avoidance of alcohol; and increasing intake of fruits, vegetables, and fiber. Studies of esophageal cancer support these dietary approaches, with the exception of dietary fat reduction and increased green tea intake. For gastric cancer, consuming additional fruits and vegetables, including those high in ascorbic acid, may reduce risk, and the capacity for diet to alter Helicobacter pylori infection should be explored.

PMID: 12667416 [PubMed - indexed for MEDLINE

Nutrient intake and risk of subtypes of esophageal and gastric cancer.

Yale University School of Medicine, Department of Epidemiology and Public Health, New Haven, Connecticut 06520-8034, USA. Susan.Mayne@Yale.Edu

Incidence rates for adenocarcinoma of the esophagus and gastric cardia have been rising rapidly. We examined nutrient intake as a risk factor for esophageal and gastric cancers in a population-based case-control study in Connecticut, New Jersey, and western Washington state. Interviews were completed for cases with histologically confirmed esophageal adenocarcinoma (n = 282), adenocarcinoma of the gastric cardia (n = 255), esophageal squamous cell carcinoma (n = 206), and noncardia gastric adenocarcinoma (n = 352), along with population controls (n = 687). Associations between nutrient intake and risk of cancer were estimated by adjusted odds ratios (ORs), comparing the 75th versus the 25th percentile of intake. The following nutrients were significantly inversely associated with risk of all four tumor types: fiber, beta-carotene, folate, and vitamins C and B6. In contrast, dietary cholesterol, animal protein, and vitamin B12 were significantly positively associated with risk of all four tumor types. Dietary fat [OR, 2.18; 95% confidence interval (CI), 1.27-3.76] was significantly associated with risk of esophageal adenocarcinoma only. Dietary nitrite (OR, 1.65; 95% CI, 1.26-2.16) was associated with noncardia gastric cancer only. Vitamin C supplement use was associated with a significantly lower risk for noncardia gastric cancer (OR, 0.60; 95% CI, 0.41-0.88). Higher intake of nutrients found primarily in plant-based foods was associated with a reduced risk of adenocarcinomas of the esophagus and gastric cardia, whereas higher intake of nutrients found primarily in foods of animal origin was associated with an increased risk.

PMID: 11588131 [PubMed - indexed for MEDLINE

Meat intake and risk of stomach and esophageal adenocarcinoma within the European Prospective Investigation Into Cancer and Nutrition (EPIC).

Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain. cagonzalez@ico.scs.es

BACKGROUND: Dietary factors are thought to have an important role in gastric and esophageal carcinogenesis, but evidence from cohort studies for such a role is lacking. We examined the risks of gastric cancer and esophageal adenocarcinoma associated with meat consumption within the European Prospective Investigation Into Cancer and Nutrition (EPIC) cohort.

METHODS: A total of 521,457 men and women aged 35-70 years in 10 European countries participated in the EPIC cohort. Dietary and lifestyle information was collected at recruitment. Cox proportional hazard models were used to examine associations between meat intake and risks of cardia and gastric non-cardia cancers and esophageal adenocarcinoma. Data from a calibration substudy were used to correct hazard ratios (HRs) and 95% confidence intervals (CIs) for diet measurement errors. In a nested case-control study, we examined interactions between Helicobacter pylori infection status (i.e., plasma H. pylori antibodies) and meat intakes. All statistical tests were two-sided.

RESULTS: During a mean follow-up of 6.5 years, 330 gastric adenocarcinoma and 65 esophageal adenocarcinomas were diagnosed.

Gastric non-cardia cancer risk was statistically significantly associated with intakes of total meat (calibrated HR per 100-g/day increase = 3.52; 95% CI = 1.96 to 6.34), red meat (calibrated HR per 50-g/day increase = 1.73; 95% CI = 1.03 to 2.88), and processed meat (calibrated HR per 50-g/day increase = 2.45; 95% CI = 1.43 to 4.21).

The association between the risk of gastric non-cardia cancer and total meat intake was especially large in H. pylori-infected subjects (odds ratio per 100-g/day increase = 5.32; 95% CI = 2.10 to 13.4).

Intakes of total, red, or processed meat were not associated with the risk of gastric cardia cancer. A positive but non-statistically significant association was observed between esophageal adenocarcinoma cancer risk and total and processed meat intake in the calibrated model.

In this study population, the absolute risk of development of gastric adenocarcinoma within 10 years for a study subject aged 60 years was 0.26% for the lowest quartile of total meat intake and 0.33% for the highest quartile of total meat intake.

CONCLUSION: Total, red, and processed meat intakes were associated with an increased risk of gastric non-cardia cancer, especially in H. pylori antibody-positive subjects, but not with cardia gastric cancer.

PMID: 16507831 [PubMed - indexed for MEDLINE

Comment in:

Int J Cancer. 2006 Dec 15;119(12):2991; author reply 2992.